Surgical Results of Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy

Objectives: Cardiac resynchronisation therapy (CRT) has proven its effectiveness in patients with symptomatic heart failure [1,2]. Although rewarding, the procedure of biventricular pacemaker implantation is challenging and subsequently fails in 8%-11% of patients. In patients whose left ventricular (LV) electrode cannot be placed transvenously, surgical implantation of an epicardial electrode can be achieved. Methods: Seventeen patients (14 male, 3 female), among whom LV electrode was failed to be placed transvenously, were included into our study. The epicardial LV electrodes were implanted through anterior mini thoracotomy. The patients were followed up for approximate six months and complications, ejection fraction (EF), New York Heart Association (NYHA) class, QRS durations as well as pacing parameters were recorded. Results: Mean age of the patients was 64.4 ± 7.01 (54-79) years. Preoperative mean EF of the patients was 26.1% ± 3.7%. The LV electrode was placed at the optimal place on the lateral LV wall through left sided mini thoracotomy. The mean duration of the operation was 26.76 ± 8.12 minutes and the mean hospital stay was 2.05 ± 0.42 days. There were no intraoperative or postoperative complications. Only 1 patient had LV electrode displaced on the 3rd postoperative month and the patient was reoperated successfully. The EF on the 6th postoperative month was 29.4% ± 3.81% and NYHA class was 2.58 ± 0.5. The etiology of heart failure had no influence on outcome. Conclusions: Surgical implantation of LV lead is associated with low complication rates and excellent follow-up results without exposure to radiation. Thus epicardial leads can be proposed as equal alternative to transvenous leads.