Minimally invasive surgical alternatives for left ventricle epicardial lead implantation in heart failure patients.

Biventricular pacing is a proven advantageous adjuvant therapy for patients with ventricular dyssynchrony associated with congestive heart failure. Endocardial left ventricular lead placement does have several limitations: anatomic variations of the coronary venous system and late lead dislodgement. Epicardial lead placement is often a rescue procedure but offers some advantages related to safety and a shorter implant time. Moreover, it allows visual selection of the best pacing site and multiplicity of pacing sites. Three minimally invasive surgical methods of left ventricular lead placement are outlined in this article, including specific indications and limitations. Biventricular pacing has been proposed as an adjuvant treatment for patients with heart failure and intraventricular conduction delay.