Thoracoscopic epicardial left ventricular bipolar lead implantation with the use of automated titanium fasteners (Cor-Knot®)

BACKGROUND: Pacemaker implantation techniques using thoracoscopy have been described since about 25 years. However, the published reports concerning types of electrodes refer mostly to monopolar screw-in leads. We report our experience of thoracoscopic implantation of a bipolar suture-on epicardial electrode with monofilamentous sutures tightened by automated fasteners to avoid hand-tied knots. CASE PRESENTATION: A 69-year-old Caucasian female patient with a cardiac resynchronization therapy - defibrillator (CRT-D) due to dilated cardiomyopathy required the implantation of a supplementary left ventricluar resynchronization electrode. Because of unfavorable venous access, we chose a thoracoscopic approach. A bipolar suture-on epicardial electrode, was implanted by means of polypropylene monofilament 2-0 threads and automated titanium fasteners (Cor-Knot®). The intervention was uneventful. The correct function of the device was confirmed postoperatively and the patient was dismissed within 3 days from hospital. Six months after implantation the cardiologic control asserted regular device function and restitution of normal ejection fraction (EF 60%). CONCLUSION: This case demonstrates the feasibility, safety and effectiveness of automated fasteners in the setting of thoracoscopic implantation of epicardial bipolar suture-on leads.