Left ventricular pacing via limited thoracotomy was feasible and safe after failed transvenous implantation, achieving optimal lead position in 100% of patients with no surgical complications.
Observational (n=33)
Does left ventricular pacing via limited thoracotomy provide a feasible and safe alternative in patients with failed transvenous implantation for cardiac resynchronisation therapy?
Limited thoracotomy for epicardial lead implantation is a safe and feasible second-line option for CRT delivery when transvenous approaches fail.
AIMS: Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory. METHODS AND RESULTS: We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters. CONCLUSION: Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
Andrea Puglisi (Tue,) conducted a observational in Heart failure requiring cardiac resynchronisation therapy (n=33). Limited thoracotomy for epicardial lead implantation was evaluated on Feasibility and safety (surgical/post-operative complications and optimal lead position). Left ventricular pacing via limited thoracotomy was feasible and safe after failed transvenous implantation, achieving optimal lead position in 100% of patients with no surgical complications.
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