title: Video-assisted thoracoscopic implantation of the left ventricular pacing lead for cardiac resynchronization therapy.
abstract: 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 +/- 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.
authors.affiliation: Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK. jutley@btinternet.com
authors.forename: Rajwinder S
authors.initials: RS
authors.lastname: Jutley
authors.forename: David A
authors.initials: DA
authors.lastname: Waller
authors.forename: Ian
authors.initials: I
authors.lastname: Loke
authors.forename: Douglas
authors.initials: D
authors.lastname: Skehan
authors.forename: Andre
authors.initials: A
authors.lastname: Ng
authors.forename: Peter
authors.initials: P
authors.lastname: Stafford
authors.forename: Derek
authors.initials: D
authors.lastname: Chin
authors.forename: T J
authors.initials: TJ
authors.lastname: Spyt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000473:pathology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000517:prevention & control