Epicardial Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy Midterm Results

Levent Mavioglu

Department of Cardiovascular Surgery, Evliya Celebi Hospital, Kutahya, Turkey

^*Correspondance to: Levent Mavioglu 

 PDF  Full Text DOI: 10.25107/2474-1647.2324

Abstract

Introduction: Cardiac Resynchronisation Therapy (CRT) grows as an effective treatment modality due to its serious symptomatic recovery and improved survival rates in patients with left ventricle systolic dysfunction refractory to medical treatment and serious intra-interventricular dyssynchronisation. The purpose of our report is to discuss the midterm results of the epicardial LV pacing lead implantation via mini left lateral thoracotomy when conventional transvenous implantation failed.Materials and
Methods: From March 2014 to April 2015, 14 epicardial leads were implanted surgically at two different centers with the same surgical team. All patients who had cardiac heart failure functional class III or IV according to New York Heart Association (NHYA), dilated ischemic or non-ischemic cardiomyopathy dysfunction defined as LVEF <35% and a left bundle branch block (LBBB) ( QRS duration >120 ms) were preselected by the cardiologists.Results: Fourteen patients (71% male) with a mean age of 73.1 ± 6.6 years underwent epicardial LV lead placement. Mean follow-up time was 16.5 ± 3.3 (12 to 23) months, mean intensive care unit stay was 24.7 ± 23.9 (8 to 102) hours and mean hospitalization time was 82.7 ± 46.4 (52 to 240) hours. All patients had left bundle-branch block (LBBB) with mean (SD) QRS duration of 178.7 ± 18.1 ms (range 156 ms to 210 ms). NYHA, QRS interval and LVEF values of patients before implantation and during follow-up showed statistically significant difference (preprocedural vs. postprocedural 2nd month mean NYHA values 3.14 ± 0.3 vs. 1.7 ± 0.4, p<0.001, preprocedural vs. postprocedural mean QRS duration (ms) 178.7 ± 18.1 vs. 133.7 ± 4.7, p<0.001, preprocedural vs. postprocedural 2nd month mean LVEF (%) 22.9 ± 2.2 vs. 34 ± 2.8, p<0.001) whereas pacing threshold, left ventricle impedance and LVEDd values showed no statistically significant difference. There were no operative deaths but one patient (7.1%) died at postoperative 18th month because of non-cardiac reason. One patient had pneumonia (7.1 %) and one patient had bleeding (7.1 %) (Not required re-exploration).Conclusion: Transvenous lead implantation approach is the first line treatment choice for patients who need CRT implantation. If there is a presence of non suitable conditions for that approach, epicardial lead implantation should come to mind without enforcing transvenous approach.

Keywords

Cardiac resynchronization therapy; Left ventricular lead implantation; Arrhythmia

Cite the article

Mavioglu L. Epicardial Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy Midterm Results. Clin Surg. 2019; 4: 2324.