International Telemetering Conference Proceedings / October 20-23, 2003 / Riviera Hotel and Convention Center, Las Vegas, Nevada / One of the charters of the Advanced Range Telemetry (ARTM) program was to develop more spectrally efficient waveforms while trying to maintain similar performance to the legacy waveform, Pulse Code Modulation/Frequency Modulation (PCM/FM). The first step toward this goal was the ARTM Tier I family of waveforms which include Feher patented, quadrature phase shift keying, -B version (FQSPKB) and shaped offset quadrature phase shift keying, Telemetry Group version (SOQPSK-TG). The final step was development of Tier II, an even more spectrally efficient waveform, multi-h Continuous Phase Modulation (CPM). This paper characterizes the performance of this waveform when applied in an airborne telemetry environment and, where appropriate, comparisons are made with existing Tier 0 and Tier I waveforms. The benefits, drawbacks, and trade-offs when applying this waveform in an airborne environment will also be discussed.

La resynchronisation biventriculaire est un traitement recommandé chez les patients avec dysfonction ventriculaire gauche (VG) sévère et QRS large. Si les résultats en termes de bénéfice clinique sont globalement positifs, toutes les études retrouvent un pourcentage non négligeable de patients non répondeurs à la thérapeutique. Dans ce travail, en couplant données expérimentales animales et études cliniques, nous avons 1) investigué l’impact de la resynchronisation biventriculaire chez des patients avec Tétralogie de Fallot opérée 2) évalué l’impact hémodynamique associé avec une stimulation VG multipoints et avec une stimulation VG endocardique 3) analysé l’intérêt de l’optimisation des paramètres de stimulation à l’effort. Nous avons mis en évidence que 1) la resynchronisation permet un bénéfice hémodynamique significatif sur un modèle animal de dysfonction ventriculaire droite et chez des patients avec Tétralogie de Fallot opérée 2) la stimulation multipoints et la stimulation endocardique VG permettent un bénéfice hémodynamique significatif sur des modèles animaux d’insuffisance cardiaque et chez des patients avec insuffisance cardiaque sévère 3) l’optimisation à l’effort des paramètres de programmation permet un bénéfice hémodynamique. Un capteur intégré dans la prothèse de stimulation pourrait permettre une optimisation automatique.L’ensemble de ces données permet d’espérer une optimisation de la réponse clinique et d’envisager de nouveaux champs d’application pour cette thérapeutique. / Cardiac resynchronization therapy is recommanded in patients with severe left ventricular (LV) dysfunction and wide QRS. Despite positive clinical results, a significant proportion of implanted patients do not demonstrate positive response to the therapy. Coupling experimental data and clinical studies, we have 1) investigated the impact of cardiac resynchronization in patients with repaired Tetralogy of Fallot 2) assessed the hemodynamic impact associated with multisite LV pacing and endocardial LV pacing 3) analyzed the impact of an exercise-optimization of the programmed parameters.We have demonstrated that 1) biventricular pacing is associated with a significant hemodynamic improvement in an animal model of right ventricular dysfunction and in patients with repaired Tetralogy of Fallot 2) multisite LV pacing and endocadial LV pacing are associated with significant hemodynamic improvement in animal models and in humans with severe heart failure 3) optimization during exercise of AV and VV delays induce acute hemodynamic improvement and could be automatically performed by an integrated hemodynimc sensor. Our data suggest a posible improvement in clinical response after cardiac resynchronization and a posible extension of the indications.

A identificação do momento mais apropriado para realizar a inseminação artificial em tempo fixo (IATF) utilizando sêmen sexado pode aumentar a prenhez por inseminação (P/IA) e aumentar a utilização do sêmen sexado em fazendas de corte. Este trabalho teve por objetivo avaliar o melhor intervalo entre a inseminação e a ovulação na P/IA de vacas Nelore lactantes submetidas ao protocolo de IATF utilizando sêmen sexado. Um total de 339 vacas Nelore apresentando 30 a 60 dias pós-parto da fazenda experimental da APTA, em Colina-SP foram utilizadas. No início do tratamento as fêmeas receberam um dispositivo intravaginal contendo 1g de progesterona (Sincrogest®,Ourofino Saúde Animal) e a aplicação i.m de 2mg de BE (Sincrodiol®, Ourofino). Após oito dias, o dispositivo foi removido e aplicados via i.m 0,25 mg de cloprostenol sódico (Sincrocio® , Ourofino) e 300UI de eCG (Folligon® , Intervet-Schering Plough). As vacas foram homogeneamente distribuídas para receberem IATF com sêmen sexado de um único touro da raça Angus (2.1milhões de espermatozóides por dose) às 36, 48 e 60 horas após a retirada dos dispositivos. O intervalo entre as inseminações e ovulações foi determinado e as análises realizadas comparando a taxa de prenhez entre os intervalos. Exames ultrassonográficos (7.5MHz, CTS-3300V, SIUI, China) foram realizados duas vezes ao dia, a partir da retirada do implante até 96 horas após e aos 30 pós IA para realização do diagnóstico de gestação. A P/IA foi definida como o número de fêmeas prenhes divididas pelo número de fêmeas inseminadas em cada intervalo. Os dados encontrados foram analisados usando o programa estatístico SAS. A taxa de ovulação após o protocolo foi de 92.0 % (312/339), o diâmetro do folículo ovulatório de 14,7 ± 2,3 mm e o intervalo entre retirada do dispositivo e ovulação de 71.8 ± 7.7 horas [48 horas (6.73%; 21/312), 60 horas (0.64%; 2/312), 72 horas (80.77%; 252/312), 84 horas (11.22%; 35/312), e 96 horas (0.64%; 2/312)]. A P/IA aumentou conforme se atrasou o momento da inseminação: 36 horas (5,8%; 5/86)c, 48 horas (20.8%; 27/130)b e 60 horas (30.9%; 38/123)a. A P/IA foi maior quando as inseminações foram realizadas próximas ao momento da ovulação (0 a 12 horas antes da ovulação = 37,9 %; 35/95) do que as realizadas entre 12,1 a 24 horas (19,4%; 21/108; P = 0,05) ou com mais de 24 horas (5,8%; 5/87; P = 0,0001) antes da ovulação sincronizada. Vacas recentemente ovuladas tiveram P/IA semelhante às realizadas próximo ao momento da ovulação (36,4%; 8/22; P = 0,95). Concluiu-se que a P/IA utilizando sêmen sexado é aumentada quando as inseminações são realizadas próximas a ovulação sincronizada. No experimento 2, de ressincronização, foram avaliadas, as taxas de serviço, concepção e prenhez em vacas previamente sincronizadas e inseminadas em tempo fixo. Foram formados dois grupos: observação de estro e IATF, utilizando na IA sêmen sexado e convencional. Os resultados para os grupos observação de estro e IATF foram, respectivamente: taxa de serviço [(63,5% (61/96); 100% (88/88)], taxa de concepção [(41% (25/61); 11,4% (10/88)], taxa de prenhez [(26% (25/96); 11,4% (10/88)]. Os resultados para os grupos observação de estro e IATF de acordo com o tipo de sêmen utilizado foram, respectivamente: sêmen convencional taxa de concepção [(43,3% (13/30); 14,9% (7/47))]; taxa de prenhez [(27,49% (13/61); 14,9% (7/47))]; sêmen sexado taxa de concepção [(38,7% (12/31); 7,3% (3/41))]; taxa de prenhez [(24,57% (12/61); 7,3% (3/41))]. / The identification of most appropriate moment to perform the timed artificial insemination (TAI) using sex-sorted semen following synchronization protocol can be important to improve the fertility of sex-sorted semen and increase the use sexed semen technology in commercial beef farms. The aim of this study was evaluated the better interval to perform the TAI relative to synchronized ovulation in suckled cows. A total of 339 suckled multiparous Nelore cows from an experimental farm (APTA), in Colina-SP, were evaluated in this study. The protocol started between 30 and 60 days post-partum. Cows received one synchronization protocol using an intravaginal device containing 1.0g of progesterone (Sincrogest®, Ouro Fino) plus an i.m. injection of 2.0mg of EB (Sincrodiol®, Ouro Fino). Eight days later, the device was removed and 0.25mg i.m. injection of cloprostenol sodium (Sincrocio®, Ouro Fino) and 300IU of eCG (Folligon®, Intervet-Shering Plough) were administered. Cows were homogenously assigned to receive TAI using sex-sorted semen from a single sire (2.1 millions of sperm cell per straw) at 36, 48 or 60 hours after device removal. The TAI to ovulation interval of synchronized cows was determined and the analysis was performed to compare the pregnancy for TAI performed at various intervals before ovulation using 12 hours time intervals. Ovarian ultrasonographic examinations (CTS-3300V, SIUI, China) were performed twice daily from day of the device removal to 96 hours afterwards, to evaluate ovarian follicular dynamics and interval from device removal to ovulation. All females were examined for pregnancy 30 days after AI. The data were analyzed using the SAS program.Incidence of ovulation after the estrous synchronization protocol was 92.0 % (312/339). Diameter of ovulatory follicle was 14.7 ± 2.3 mm and the interval between the P4 device removal and synchronized ovulation occurrence was 71.8 ± 7.7 hours. The distribution of the synchronized ovulation relative to the device removal was: 48 hours (6.73%; 21/312), 60 hours (0.64%; 2/312), 72 hours (80.77%; 252/312), 84 hours (11.22%; 35/312), and 96 hours (0.64%; 2/312). The pregnancy per artificial insemination (P/AI) was increased (P <0.001) when the TAI was delayed 36 hours (5.8%; 5/86)c, 48 hours (20.8%; 27/130)b and 60 hours (30.9%; 38/123)a. Higher P/AI was achieved on TAI performed closer to ovulation (0 to 12 hours before ovulation = 37.9 %; 35/95) than TAI performed on 12.1 to 24 hours (19.4%; 21/108; P = 0.05) or > 24 hours (5.8%; 5/87; P = 0.0001) before the synchronized ovulation. Recently ovulated cows had P/AI similar to those performed around the time of ovulation (36,4%; 8/22). In conclusion, P/AI is increased when the TAI using sex-sorted is performed closer to synchronized ovulation in suckled Nelore cows. In experiment 2, resynchronization, were assessed the service rates, conception and pregnancy in cows previously synchronized and timed AI. Two groups were formed: estrous detection and TAI, using in AI, sexed and unsexed semen. The results for groups of estrus detection and TAI were, respectively, service rate [(63.5% (61/96) 100% (88/88)], conception rate [(41% (25/61), 11.4% (10/88))], pregnancy rate [(26% (25/96), 11.4% (10/88))]. The results for groups of estrus detection and TAI according the type of semen used were: conventional semen conception rate [(43.3% (13/30), 14.9% (7 / 47))] ; pregnancy rate [(27.49% (13/61), 14.9% (7 / 47))]; sexed semen conception rate [(38.7% (12/31) 7.3% (3 / 41))]; pregnancy rate [(24.57% (12/ 61), 7.3% (3 / 41))].

ITC/USA 2014 Conference Proceedings / The Fiftieth Annual International Telemetering Conference and Technical Exhibition / October 20-23, 2014 / Town and Country Resort & Convention Center, San Diego, CA / Typical airborne test platforms use multiple telemetry transmit antennas in a top and bottom configuration in order to mitigate signal shadowing during maneuvers on high dynamic platforms. While mitigating one problem, this also creates a co-channel interference problem as the same signal, time delayed with differing amplitude, is sent to both antennas. Space-Time Coding (STC) was developed with the intention of mitigating this co-channel interference problem, also known as the "two antenna problem". Lab testing and preliminary flight testing of developmental and pre-production hardware has been completed and documented. This is the first test dedicated to assessing the performance of a production STC system in a real-world test environment. This paper will briefly describe lab testing that preceded the flight testing, describes the airborne and ground station configurations used during the flight test, and provides detailed results of the performance of the space time coded telemetry link as compared against a reference telemetry link.

ITC/USA 2013 Conference Proceedings / The Forty-Ninth Annual International Telemetering Conference and Technical Exhibition / October 21-24, 2013 / Bally's Hotel & Convention Center, Las Vegas, NV / Since the waveform was first developed by the Advanced Range Telemetry Program (ARTM) and adopted by the Range Commanders Council Telemetry Group (RCC/TG), receiver/demodulators for the ARTM Continuous Phase Modulation (CPM) waveform have undergone continued development by several hardware vendors to boost performance in terms of phase noise, detection performance, and resynchronization time. These same results were initially presented at the International Telemetry Conference (ITC) 2003 when hardware first became available supporting this waveform, at the time called ARTM Tier II. This paper reexamines the current state of the art performance of ARTM CPM receiver/demodulators available in the marketplace today.

A identificação do momento mais apropriado para realizar a inseminação artificial em tempo fixo (IATF) utilizando sêmen sexado pode aumentar a prenhez por inseminação (P/IA) e aumentar a utilização do sêmen sexado em fazendas de corte. Este trabalho teve por objetivo avaliar o melhor intervalo entre a inseminação e a ovulação na P/IA de vacas Nelore lactantes submetidas ao protocolo de IATF utilizando sêmen sexado. Um total de 339 vacas Nelore apresentando 30 a 60 dias pós-parto da fazenda experimental da APTA, em Colina-SP foram utilizadas. No início do tratamento as fêmeas receberam um dispositivo intravaginal contendo 1g de progesterona (Sincrogest®,Ourofino Saúde Animal) e a aplicação i.m de 2mg de BE (Sincrodiol®, Ourofino). Após oito dias, o dispositivo foi removido e aplicados via i.m 0,25 mg de cloprostenol sódico (Sincrocio® , Ourofino) e 300UI de eCG (Folligon® , Intervet-Schering Plough). As vacas foram homogeneamente distribuídas para receberem IATF com sêmen sexado de um único touro da raça Angus (2.1milhões de espermatozóides por dose) às 36, 48 e 60 horas após a retirada dos dispositivos. O intervalo entre as inseminações e ovulações foi determinado e as análises realizadas comparando a taxa de prenhez entre os intervalos. Exames ultrassonográficos (7.5MHz, CTS-3300V, SIUI, China) foram realizados duas vezes ao dia, a partir da retirada do implante até 96 horas após e aos 30 pós IA para realização do diagnóstico de gestação. A P/IA foi definida como o número de fêmeas prenhes divididas pelo número de fêmeas inseminadas em cada intervalo. Os dados encontrados foram analisados usando o programa estatístico SAS. A taxa de ovulação após o protocolo foi de 92.0 % (312/339), o diâmetro do folículo ovulatório de 14,7 ± 2,3 mm e o intervalo entre retirada do dispositivo e ovulação de 71.8 ± 7.7 horas [48 horas (6.73%; 21/312), 60 horas (0.64%; 2/312), 72 horas (80.77%; 252/312), 84 horas (11.22%; 35/312), e 96 horas (0.64%; 2/312)]. A P/IA aumentou conforme se atrasou o momento da inseminação: 36 horas (5,8%; 5/86)c, 48 horas (20.8%; 27/130)b e 60 horas (30.9%; 38/123)a. A P/IA foi maior quando as inseminações foram realizadas próximas ao momento da ovulação (0 a 12 horas antes da ovulação = 37,9 %; 35/95) do que as realizadas entre 12,1 a 24 horas (19,4%; 21/108; P = 0,05) ou com mais de 24 horas (5,8%; 5/87; P = 0,0001) antes da ovulação sincronizada. Vacas recentemente ovuladas tiveram P/IA semelhante às realizadas próximo ao momento da ovulação (36,4%; 8/22; P = 0,95). Concluiu-se que a P/IA utilizando sêmen sexado é aumentada quando as inseminações são realizadas próximas a ovulação sincronizada. No experimento 2, de ressincronização, foram avaliadas, as taxas de serviço, concepção e prenhez em vacas previamente sincronizadas e inseminadas em tempo fixo. Foram formados dois grupos: observação de estro e IATF, utilizando na IA sêmen sexado e convencional. Os resultados para os grupos observação de estro e IATF foram, respectivamente: taxa de serviço [(63,5% (61/96); 100% (88/88)], taxa de concepção [(41% (25/61); 11,4% (10/88)], taxa de prenhez [(26% (25/96); 11,4% (10/88)]. Os resultados para os grupos observação de estro e IATF de acordo com o tipo de sêmen utilizado foram, respectivamente: sêmen convencional taxa de concepção [(43,3% (13/30); 14,9% (7/47))]; taxa de prenhez [(27,49% (13/61); 14,9% (7/47))]; sêmen sexado taxa de concepção [(38,7% (12/31); 7,3% (3/41))]; taxa de prenhez [(24,57% (12/61); 7,3% (3/41))]. / The identification of most appropriate moment to perform the timed artificial insemination (TAI) using sex-sorted semen following synchronization protocol can be important to improve the fertility of sex-sorted semen and increase the use sexed semen technology in commercial beef farms. The aim of this study was evaluated the better interval to perform the TAI relative to synchronized ovulation in suckled cows. A total of 339 suckled multiparous Nelore cows from an experimental farm (APTA), in Colina-SP, were evaluated in this study. The protocol started between 30 and 60 days post-partum. Cows received one synchronization protocol using an intravaginal device containing 1.0g of progesterone (Sincrogest®, Ouro Fino) plus an i.m. injection of 2.0mg of EB (Sincrodiol®, Ouro Fino). Eight days later, the device was removed and 0.25mg i.m. injection of cloprostenol sodium (Sincrocio®, Ouro Fino) and 300IU of eCG (Folligon®, Intervet-Shering Plough) were administered. Cows were homogenously assigned to receive TAI using sex-sorted semen from a single sire (2.1 millions of sperm cell per straw) at 36, 48 or 60 hours after device removal. The TAI to ovulation interval of synchronized cows was determined and the analysis was performed to compare the pregnancy for TAI performed at various intervals before ovulation using 12 hours time intervals. Ovarian ultrasonographic examinations (CTS-3300V, SIUI, China) were performed twice daily from day of the device removal to 96 hours afterwards, to evaluate ovarian follicular dynamics and interval from device removal to ovulation. All females were examined for pregnancy 30 days after AI. The data were analyzed using the SAS program.Incidence of ovulation after the estrous synchronization protocol was 92.0 % (312/339). Diameter of ovulatory follicle was 14.7 ± 2.3 mm and the interval between the P4 device removal and synchronized ovulation occurrence was 71.8 ± 7.7 hours. The distribution of the synchronized ovulation relative to the device removal was: 48 hours (6.73%; 21/312), 60 hours (0.64%; 2/312), 72 hours (80.77%; 252/312), 84 hours (11.22%; 35/312), and 96 hours (0.64%; 2/312). The pregnancy per artificial insemination (P/AI) was increased (P <0.001) when the TAI was delayed 36 hours (5.8%; 5/86)c, 48 hours (20.8%; 27/130)b and 60 hours (30.9%; 38/123)a. Higher P/AI was achieved on TAI performed closer to ovulation (0 to 12 hours before ovulation = 37.9 %; 35/95) than TAI performed on 12.1 to 24 hours (19.4%; 21/108; P = 0.05) or > 24 hours (5.8%; 5/87; P = 0.0001) before the synchronized ovulation. Recently ovulated cows had P/AI similar to those performed around the time of ovulation (36,4%; 8/22). In conclusion, P/AI is increased when the TAI using sex-sorted is performed closer to synchronized ovulation in suckled Nelore cows. In experiment 2, resynchronization, were assessed the service rates, conception and pregnancy in cows previously synchronized and timed AI. Two groups were formed: estrous detection and TAI, using in AI, sexed and unsexed semen. The results for groups of estrus detection and TAI were, respectively, service rate [(63.5% (61/96) 100% (88/88)], conception rate [(41% (25/61), 11.4% (10/88))], pregnancy rate [(26% (25/96), 11.4% (10/88))]. The results for groups of estrus detection and TAI according the type of semen used were: conventional semen conception rate [(43.3% (13/30), 14.9% (7 / 47))] ; pregnancy rate [(27.49% (13/61), 14.9% (7 / 47))]; sexed semen conception rate [(38.7% (12/31) 7.3% (3 / 41))]; pregnancy rate [(24.57% (12/ 61), 7.3% (3 / 41))].

Made available in DSpace on 2016-05-02T13:55:50Z (GMT). No. of bitstreams: 1 Priscila Cristina Martins MagalhaesDissertacao.pdf: 1478926 bytes, checksum: 6f3da0417b4c9aa46e9fc1ca9cbda08b (MD5) Previous issue date: 2013-12-20 / In search of economically viable biotechniques to improve reproductive efficiency in cattle breeding, this study aimed to evaluate the technical viability of the use of synchronization protocols after the first fixed-time artificial insemination (FTAI) and before the pregnancy diagnosis. In the first experiment, the FTAI followed by estrous detection was compared to conventional AI and to FTAI followed by resynchronization 21 days after FTAI; and to conventional IA. The same protocol was used for te groups that utilized FTAI, with the following chronology: day 0, insertion of progesterone intravaginal device and treatment with 2 mg of estradiol benzoate; day 8, removal of the device and injection of 500 mg of sodium cloprostenol and 1 mg of estradiol cypionate; day 10, FTAI. Twenty one days after FTAI, every cow in the resynchronization group received a intravaginal implant of 1 mg of estradiol benzoate. After pregnancy diagnosis, on day 28, the empty animals received 500 mg of sodium cloprostenol, 1 mg of estradiol cypionate and the implant was removed. FTAI was done on day 30. Conventional AI was performed 12 hours after estrous detection with the use of a teaser. It was observed that the conception rate did not differ with the treatments after the first service, neither did the pregnancy rate at the end of 90 days of breeding period. In the second experiment, the resynchronization protocol was compared to FTAI followed by natural mating in zebu cows, used in the production of F1 Holstein x Zebu females. The effect of the resynchronization on the pregnancy rate over 75 days of BP was not observed. The resynchronization was inefficient to induce cyclicity in cows in anoestrus after the first FTAI. The resynchronization, before the pregnancy diagnosis, must be used carefully, specially in situations where the estrous detection is low. / Na busca de biotécnicas economicamente viáveis para a melhoria da eficiência reprodutiva na pecuária, objetivou-se, com este trabalho, avaliar a viabilidade técnica da utilização de protocolos de ressincronização após a primeira inseminação artificial em tempo fixo (IATF) e antes do diagnóstico de gestação. No primeiro experimento, comparou-se a IATF seguida de observação de cio e à IA convencional e à IATF seguida de ressincronização 21 dias após a IATF; à IA convencional. Foi utilizado um mesmo protocolo para os grupos que utilizaram a IATF, seguindo a seguinte cronologia: dia 0, inserção de dispositivo intravaginal de progesterona e aplicação de 2 mg de benzoato de estradiol; dia 8, retirada do dispositivo e aplicação de 500 mg de cloprostenol sódico e 1 mg de cipionato de estradiol; dia 10, IATF. Aos 21 dias pós-IATF, todas as vacas do grupo ressincronização receberam um implante intravaginal e 1mg de benzoato de estradiol. Após o diagnóstico de gestação, no dia 28, os animais vazios receberam 500mg de cloprostenol sódico, 1 mg de cipionato de estradiol e o implante foi removido. A IATF foi procedida no dia 30. A IA convencional foi realizada 12 horas após observação de cio, com auxílio de rufião. Observou-se que não houve efeito de tratamento na taxa de concepção, após o primeiro serviço, nem na taxa de prenhez ao final de 90 dias de EM. No segundo experimento, comparou-se o protocolo de ressincronização à IATF seguida de monta natural em vacas zebuínas, utilizadas na produção de fêmeas F1 Holandês x Zebu. Também não foi observado efeito da ressincronização sobre a taxa de prenhez acumulada em 75 dias de EM. A ressincronização foi ineficiente para induzir a ciclicidade nas vacas em anestro após a primeira IATF. A ressincronização, antes do diagnóstico de gestação, deve ser adotada de forma criteriosa, principalmente, em situações em que a eficiência na detecção de cio seja baixa.

Randomized trials and cohort studies have shown sex differences in the implantation and response to Cardiac Resynchronization Therapy (CRT). Furthermore, gender roles are associated with precipitants of congestive heart failure. Cohort studies are well-suited to assessing implantation rates, long-term outcomes, and the role of sex and gender. Therefore, we systematically identified cohort studies that reported outcomes of CRT and evaluated the following: 1) prevalence and temporal changes in sex and gender reporting and analysis; and 2) sex differences in the implantation and response to CRT. Sex was increasingly considered but remained inadequately reported and analyzed. Gender was not considered in the studies. In clinical practice, fewer women received devices, despite benefiting from CRT more than men. Of note, the difference in response may be confounded by differences in the clinical profiles of men and women. There is a need for better integration of sex and gender in studies to understand better the reasons leading to the observed differences.

This doctoral thesis describes a clinical, prospective, single-center pilot study, investigating the feasibility and the outcome of a novel optimization concept for heart failure patients who are not responding to a device-based therapy, so called Cardiac Resynchronization Therapy (CRT).

Aims: Non-responder rates for CRT vary from 11 to 46 %. Retrospective data imply a better outcome with stimulation of the latest contracting LV region. Our study analyzed feasibility, safety and clinical outcome of prospectively planned LV lead placement at the site of latest mechanical activation. Methods: Thirty-eight heart failure patients with CRT indication were assessed by 3D TEE and rotation angiography of the coronary sinus. Both images were merged into a single 3D-model to identify CS target veins close to the site of latest mechanical activation. Subsequently LV lead deployment was attempted at the desired target position. Patients were clinically and echocardiographically evaluated at baseline, after 3 and 6 months. Results: The area of latest mechanical activation covered 6 ± 2 segments (38 ± 13 % of LV surface) and was found lateral in 24/37 (65 %), anterior in 11/37 (30 %), inferior in 2/37 (5 %) and septal in 1/37 (3 %) patients. In 36/37 (97 %) patients an appropriate target vein was identified and successful implantation could be performed in 34/37 (92%) patients. Among those patients clinical and echocardiographic response was observed in 91 % and 81 %, respectively. Conclusions: Individualized lead placement at the latest contracting LV site can be performed safely and successfully in the majority of patients. Initial clinical outcome data are encouraging. Identification of target sites requires multimodality integration between LV wall motion data and CS anatomy. Future developments need to improve those technologies and require randomized data on clinical outcome parameters.