Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronisation therapy delivery.
OBJECTIVE
Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory.


RESULTS
We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters.


CONCLUSIONS
Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
Puglisi
Andrea
A
Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. puglisandrea@hotmail.com
Lunati
Maurizio
M
Marullo
Antonino G M
AG
Bianchi
Stefano
S
Feccia
Mariano
M
Sgreccia
Fabrizio
F
Vicini
Ilaria
I
Valsecchi
Sergio
S
Musumeci
Francesco
F
Vitali
Ettore
E
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002303:Cardiac Output, Low / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D010138:Pacemaker, Artificial; D013908:Thoracotomy / Q000379:methods*