A Short-Term Follow-Up Study of Left Ventricular Epicardial Lead Placement for Cardiac Resynchronization Therapy

  • Ye Zhang, Beijing Anzhen Hospital, Capital Medical University, China
  • Zhian Li, Beijing Anzhen Hospital, China
  • Yihua He, Echocardiography, China
  • Ya Yang, Beijing Anzhen Hospital, Capital Medical University, China
  • Xiaoyan Gu, China
  • JV Nixon, Virginia Commonwealth University, Richmond, United States

    • Objective: Transvenous insertion of LV pacing leads via the coronary sinus is flawed in multiple areas including unsuccessful rate in 8–10% of patients and site selection bias. This study describes short-term follow up of minimally invasive surgical techniques for CRT as a viable alternative for patients with heart failure.
    Methods: From April 2007 to December 2008, 10 patients (male 6, 59±8.6 year) with New York Heart Association (NYHA) Class III–IV symptoms, LV ejection fraction 26.8 ± 11.9% and LV systolic dyssynchrony underwent LV epicardial lead placements via minimally invasive thoracoscope. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography was used to assess changes in LV function and dyssynchronic parameters. Also, echo was used to select the best site for LV epicardial lead placement.
    Results: All patients reported symptomatic benefit with reduction in New York Heart Association score from III–IV preoperatively to II postoperatively. Comparing with baseline, post CRT for 10 HF patients, LV diastolic diameter(LVD) decreased from 69.4 ±13.6 mm to 60.0 ± 6.9 mm (P< 0.05), and LV ejection fraction ( EF ) increased from 34.5 ±7.3 % to 42.6 ± 6.6 % ( P< 0.05 ) . LV intraventricular dyssynchrony index decreased from 143.0± 30.9 ms to 54.0 ± 17.4ms(P<0.05).
    Conclusion: Video-assisted thoracoscopic placement of the LV epicardial lead is feasible, safe, and efficacious. TDI can guide the epicardial lead placement to the ideal target location.