title: Minimally invasive surgical implantation of left ventricular epicardial leads for ventricular resynchronization using video-assisted thoracoscopy.
abstract: OBJECTIVE
  Cardiac resynchronization via left ventricular or biventricular pacing is an option for selected patients with ventricular systolic dysfunction and widened QRS complex. Stimulation through a coronary vein is the technique of choice for left ventricular pacing, but this approach results in a failure rate of approximately 8%. We describe our initial experience with minimally invasive surgical implantation of left ventricular epicardial leads using video-assisted thoracoscopy.
  
  
  METHODS
  A total of 14 patients with congestive heart failure, NYHA functional class 3.2 (0.6) and mean ejection fraction 22.9 (6.8)% were included in this study. Left bundle branch block, QRS complex >140 ms and abnormal septal motion were observed in all cases. Epicardial leads were implanted on the left ventricular free wall under general anesthesia using video-assisted thoracoscopic surgery.
  
  
  RESULTS
  Lead implantation was successful in 13 patients. Conversion to a small thoracotomy was necessary in one patient. All patients were extubated in the operating room. None of the patients died during their hospital stay. Follow-up showed reversal of ventricular asynchrony and significant improvement in ejection fraction and functional class.
  
  
  CONCLUSIONS
  Minimally invasive surgery for ventricular resynchronization using video-assisted thoracoscopy in selected patients is a safe procedure that makes it possible to choose the best site for lead implantation and provides adequate short- and medium-term stimulation.
authors.affiliation: Servicio de Cirugía Cardíaca. Hospital Clínico Universitario. Santiago de Compostela. A Coruña. Spain.
authors.forename: Angel L
authors.initials: AL
authors.lastname: Fernández
authors.forename: José B
authors.initials: JB
authors.lastname: García-Bengochea
authors.forename: Ramiro
authors.initials: R
authors.lastname: Ledo
authors.forename: Marino
authors.initials: M
authors.lastname: Vega
authors.forename: Antonio
authors.initials: A
authors.lastname: Amaro
authors.forename: Julián
authors.initials: J
authors.lastname: Alvarez
authors.forename: José
authors.initials: J
authors.lastname: Rubio
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra
authors.forename: Daniel
authors.initials: D
authors.lastname: Sánchez
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D020775:Thoracic Surgery, Video-Assisted