BACKGROUND: Epicardial lead placement for biventricular pacing is often a rescue procedure after failed coronary sinus cannulation. This study aims to determine perioperative and early postoperative outcome of minimally invasive left ventricular lead placement as a management strategy for heart failure, comparing minithoracotomy and endoscopic approaches. METHODS: From October 2002 through October 2003, 41 patients underwent minimally invasive left ventricular lead placement, 23 (56%) by minithoracotomy and 18 (44%) endoscopically. Thirty-one (76%) were males, 19 (46%) had previous cardiac surgery, 21 (51%) had ischemic cardiomyopathy, 17 (41%) were in New York Heart Association class III or IV, and 28 (65%) had implantable cardioverter-defibrillators. RESULTS: There were no in-hospital deaths, intraoperative complications, or failures to implant the left ventricular lead. Median operative time was longer for the endoscopic approach (188 minutes) than for minithoracotomy (151 minutes; p = 0.006). Preoperatively, the endoscopic group had more mitral regurgitation (median, 2.5 versus 1.0, respectively; p = 0.009). QRS duration was shorter postoperatively (mean change from preoperative, -32 +/- 24 ms; p < 0.0001); this change was unrelated to surgical approach. Impedance also was less postoperatively (mean change, -490 +/- 300 ohms; p < 0.0001), and the change was unrelated to surgical approach. Changes were greater the larger their preoperative values (p < 0.0001). Threshold increased with follow-up time (adjusted p < 0.0001), but impedance decreased (adjusted p = 0.0009); these trends were similar for both approaches. No changes were evident in left ventricular dimensions. CONCLUSIONS: Minimally invasive left ventricular epicardial lead placement is safe and effective, offering selection of the best pacing site with minimal morbidity; it can be considered a primary option for resynchronization therapy.
BACKGROUND: Epicardial lead placement for biventricular pacing is often a rescue procedure after failed coronary sinus cannulation. This study aims to determine perioperative and early postoperative outcome of minimally invasive left ventricular lead placement as a management strategy for heart failure, comparing minithoracotomy and endoscopic approaches. METHODS: From October 2002 through October 2003, 41 patients underwent minimally invasive left ventricular lead placement, 23 (56%) by minithoracotomy and 18 (44%) endoscopically. Thirty-one (76%) were males, 19 (46%) had previous cardiac surgery, 21 (51%) had ischemic cardiomyopathy, 17 (41%) were in New York Heart Association class III or IV, and 28 (65%) had implantable cardioverter-defibrillators. RESULTS: There were no in-hospital deaths, intraoperative complications, or failures to implant the left ventricular lead. Median operative time was longer for the endoscopic approach (188 minutes) than for minithoracotomy (151 minutes; p = 0.006). Preoperatively, the endoscopic group had more mitral regurgitation (median, 2.5 versus 1.0, respectively; p = 0.009). QRS duration was shorter postoperatively (mean change from preoperative, -32 +/- 24 ms; p < 0.0001); this change was unrelated to surgical approach. Impedance also was less postoperatively (mean change, -490 +/- 300 ohms; p < 0.0001), and the change was unrelated to surgical approach. Changes were greater the larger their preoperative values (p < 0.0001). Threshold increased with follow-up time (adjusted p < 0.0001), but impedance decreased (adjusted p = 0.0009); these trends were similar for both approaches. No changes were evident in left ventricular dimensions. CONCLUSIONS: Minimally invasive left ventricular epicardial lead placement is safe and effective, offering selection of the best pacing site with minimal morbidity; it can be considered a primary option for resynchronization therapy.
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: Michael C Giudici; Nicholas V Augelli; Charles A Longo; Cynthia J Meierbachtol Journal: J Interv Card Electrophysiol Date: 2009-06-20 Impact factor: 1.900
Authors: Rostislav Polasek; Ivo Skalsky; Dan Wichterle; Tomas Martinca; Jana Hanuliakova; Tomas Roubicek; Jan Bahnik; Helena Jansova; Jan Pirk; Josef Kautzner Journal: J Cardiovasc Electrophysiol Date: 2014-05-12