Title: Video-Assisted Thoracoscopic Implantation of the Left Ventricular Pacing Lead for Cardiac Resynchronization Therapy
Background: To study the
feasibility and efficacy of video-assisted thoracoscopic (VAT) placement of
the left ventricular pacing lead for cardiac resynchronization therapy (CRT)
where the conventional transvenous
coronary sinus approach has failed.
Methods: Seventeen
patients underwent the VAT procedure. Indications for CRT were ischemic
cardiomyopathy in six patients and nonischemic cardiomyopathy in 11. The procedure was performed under general anesthesia with single-lung ventilation.
Three 2-cm incisions were used on the left chest wall to place the screw-in
lead near the obtuse marginal arteries high on the lateral wall of the left
ventricle (LV).
Results: The VATS approach
was successful in 13/17 (76%) patients. Median procedure time was 75 minutes
(range 55-135). A learning curve was observed that appeared to plateau at 75
minutes procedure time
after four cases. Median length of hospital stay was 2 days (range 2-8) with
one patient requiring intensive
care. Satisfactory thresholds and impedances of 2.3 ｱ 0.9
V/0.5 ms and 560 ohms, respectively,were
achieved at mean follow-up of 226 days. All patients reported symptomatic
benefit with reduction in
New York
Heart Association score from III preoperatively to II postoperatively.
Conclusions: VAT placement of
the epicardial pacing lead is feasible, safe, and efficacious. It should be considered
in cases where the transvenous route has failed or as an alternative in
prolonged or hazardous transvenous
procedures. (PACE 2008; 31:812-818)
