A prospective longitudinal evaluation of the benefits of epicardial lead placement for cardiac resynchronization therapy.
OBJECTIVE
Cardiac resynchronization therapy (CRT) is a recognized treatment for appropriate patients. However, placement of the transvenous left ventricular lead is unsuccessful in 5-10% of patients and a further 20% fail to respond. For these groups, epicardial left ventricular lead placement is one alternative. We prospectively evaluated the effects of epicardial vs. transvenous placed CRT.


RESULTS
Twenty-three subjects with unsuccessful transvenous coronary sinus lead placement underwent epicardial implantation. The subjects underwent clinical evaluation, cardiopulmonary exercise testing, and echocardiography before 3 and 6 months after. The results were compared with a control group (n = 35) who had received transvenous CRT. In both groups, there were significant improvements in all measures at 3 and 6 months. The improvement in peak VO(2) was delayed in the epicardial group compared with the transvenous group. At 6 months, the improvements seen in all variables showed no difference between the groups.


CONCLUSIONS
Epicardial lead placement is a viable option for patients with unsuccessful coronary sinus lead placement. The improvements in most variables were of a similar magnitude and over a similar time scale compared with transvenous placement. Improvements in peak VO(2) were delayed in the epicardial group, probably as a result of a prolonged recovery time.
Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
Ashish
A
Patwala
Paul
P
Woods
Richard
R
Clements
Khaled
K
Albouaini
Archana
A
Rao
David
D
Goldspink
Lip-Bun
LB
Tan
Aung
A
Oo
David
D
Wright
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium / Q000601:surgery*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome