AIMS: Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory. METHODS AND RESULTS: We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters. CONCLUSION: Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
AIMS: Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory. METHODS AND RESULTS: We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters. CONCLUSION: Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
Authors: Amy L Miller; Daniel B Kramer; Eldrin F Lewis; Bruce Koplan; Laurence M Epstein; Usha Tedrow Journal: Pacing Clin Electrophysiol Date: 2011-04 Impact factor: 1.976
Authors: Gorav Ailawadi; Damien J Lapar; Brian R Swenson; Cory D Maxwell; Micah E Girotti; James D Bergin; John A Kern; John P Dimarco; Srijoy Mahapatra Journal: Heart Rhythm Date: 2010-01-20 Impact factor: 6.343
Authors: Arn Migowski; Antonio Luiz Ribeiro; Marilia Sá Carvalho; Vitor Manuel Pereira Azevedo; Rogério Brant Martins Chaves; Lucas de Aquino Hashimoto; Carolina de Aquino Xavier; Regina Maria de Aquino Xavier Journal: BMC Cardiovasc Disord Date: 2015-03-13 Impact factor: 2.298