Cardiac resynchronisation therapy using a branch of the coronary sinus is the technique of choice for left ventricular (LV) pacing in patients with poor LV function. An alternative option is the surgical implantation of an epicardial LV lead under direct vision. We describe our initial experience with epicardial LV lead implantation.
The records of 10 patients undergoing epicardial LV lead implantation at our institution were retrospectively reviewed. Epicardial leads were implanted on the LV free wall using video-assisted thoracoscopic surgery techniques.
Ten patients (seven men; three women; mean age 66.9 years) underwent surgery. All 10 patients suffered from congestive heart failure (CHF) and had a mean LV ejection fraction of 25%. All patients failed endocardial LV lead implantation via the coronary sinus because of lack of adequate branches or inability to cannulate the coronary sinus. There were no intraoperative complications, intrahospital or late deaths. The mean hospital stay was 5.2 days. Follow-up showed reversal of ventricular asynchrony and improvement in functional class in all patients.
Thoracoscopic epicardial LV lead implantation is a safe and feasible procedure in a population of high risk patients who need resynchronisation therapy after endocardial LV lead placement has failed.
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- How many people with heart failure are appropriate for biventricular resynchronization?.Eur Heart J. 2000; 21: 1246-1250
- Cardiac resynchronization therapy for heart failure.N Engl J Med. 2002; 346: 1902-1905
- Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay.N Engl J Med. 2001; 344: 873-880
- Cardiac resynchronization in chronic heart failure.N Engl J Med. 2002; 346: 1845-1853
- Biventricular pacing for congestive heart failure: early experience in surgical epicardial versus coronary sinus lead placement.Heart Surg Forum. 2002; 6: E1-6
- Minimally invasive surgical implantation of left ventricular leads for ventricular resynchronization using video-assisted thoracoscopy.Rev Esp Cardiol. 2004; 57: 313-319
- Six year experience of transvenous left ventricular lead implantation for permanent left biventricular pacing in patients with advanced heart failure: technical aspects.Heart. 2001; 86: 405-410
- Robotically enhanced biventricular resynchronization therapy in chronic heart failure.Ann Thorac Surg. 2003; 76: 413-417
- Robotically assisted left ventricular epicardial lead implantation for biventricular pacing.J Am Coll Cardiol. 2003; 41: 1414-1419
- Better pulmonary function and prognosis with video-assisted thoracic surgery than thoracotomy.Ann Thorac Surg. 2000; 70: 1644-1646
- Effects of resynchronization therapy stimulation site on the systolic function of heart failure patients.Circulation. 2001; 104: 3026-3029
- Minimally invasive video-assisted thoracoscopic left ventricular epicardial lead implantation for biventricular pacing in a patient with persistent left superior vena cava.Heart Vessels. 2008; 23: 289-292
Accepted: November 8, 2010
Received in revised form: September 6, 2010
Received: June 6, 2010
© 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.