Robotically assisted left ventricular epicardial lead implantation for biventricular pacing.
OBJECTIVE
Ventricular resynchronization might be achieved in a minimally invasive fashion using a robotically assisted, direct left ventricular (LV) epicardial approach.


BACKGROUND
Approximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus (CS) cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques.


METHODS
Ten patients with congestive heart failure (New York Heart Association class 3.4 +/- 0.5) and a widened QRS complex (184 +/- 31 ms) underwent robotic LV lead placement after failed CS cannulation. Mean patient age was 71 +/- 12 years, LV ejection fraction (EF) was 12 +/- 6%, and LV end-diastolic diameter was 7.1 +/- 1.3 cm. Three patients had previous cardiac surgery, and five patients had a prior device implanted.


RESULTS
Nineteen epicardial leads were successfully placed on the posterobasal surface of the LV. Intraoperative lead threshold was 1.0 +/- 0.5 V at 0.5 ms, R-wave was 18.6 +/- 8.6 mV, and impedance was 1,143 +/- 261 ohms at 0.5 V. Complications included an intraoperative LV injury and a postoperative pneumonia. Improvements in exercise tolerance (8 of 10 patients), EF (19 +/- 13%, p = 0.04), and QRS duration (152 +/- 21 ms, p = 0.006) have been noted at three to six months follow-up. Lead thresholds have remained unchanged (2.1 +/- 1.4 V at 0.5 ms, p = NS), and a significant drop in impedance (310 +/- 59 ohms, p < 0.001) has been measured.


CONCLUSIONS
Robotic LV lead placement is an effective and novel technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular pacing.
DeRose
Joseph J
JJ
Division of Cardiothoracic Surgery, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA. jjd11@columbia.edu
Ashton
Robert C
RC
Belsley
Scott
S
Swistel
Daniel G
DG
Vloka
Margot
M
Ehlert
Frederick
F
Shaw
Roxana
R
Sackner-Bernstein
Jonathan
J
Hillel
Zak
Z
Steinberg
Jonathan S
JS
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010496:Pericardium / Q000601:surgery; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome