Ultrasound-guided thoracotomy for implantation of an epicardial left ventricular lead after left pneumonectomy.

Surgical placement of a left ventricular epicardial pacing lead is a valuable alternative to the standard approach of endovascular placement of a pacing lead in the coronary sinus for cardiac resynchronization therapy. Despite higher perioperative morbidity, surgically placed leads perform well with lower revision and dislocation rates. Moreover, surgery is the only option when an endovascular approach proves to be unsuccessful. We report a successful implantation of an epicardial left ventricular lead through an ultrasound-guided lateral left mini-thoracotomy in a patient with a severely disturbed thoracic anatomy due to left pneumonectomy.