New method for cardiac resynchronization therapy: transapical endocardial lead implantation for left ventricular free wall pacing.

Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a significant dislocation rate during follow-up. For these patients, epicardial pacing lead implantation is the most frequently used alternative. The aim of this case report is to describe a fundamentally new approach for the endocardial LV lead implantation. An epicardial lead implantation was planned, but after thoracotomy, extensive pericardial adhesions were found. An active fixation lead was placed into the LV cavity using the standard Seldinger technique through the LV apex. After an uneventful post-operative period at the 3- and 6-month follow-up visits, the patient had effective CRT with unchanged pacing parameters. In conclusion, this is the very first report showing feasibility of transapical LV lead implantation.