title: Left ventricular epicardial lead implantation for resynchronisation therapy using a video-assisted thoracoscopic approach.
abstract: BACKGROUND
  Cardiac resynchronisation therapy using a branch of the coronary sinus is the technique of choice for left ventricular (LV) pacing in patients with poor LV function. An alternative option is the surgical implantation of an epicardial LV lead under direct vision. We describe our initial experience with epicardial LV lead implantation.
  
  
  METHODS
  The records of 10 patients undergoing epicardial LV lead implantation at our institution were retrospectively reviewed. Epicardial leads were implanted on the LV free wall using video-assisted thoracoscopic surgery techniques.
  
  
  RESULTS
  Ten patients (seven men; three women; mean age 66.9 years) underwent surgery. All 10 patients suffered from congestive heart failure (CHF) and had a mean LV ejection fraction of 25%. All patients failed endocardial LV lead implantation via the coronary sinus because of lack of adequate branches or inability to cannulate the coronary sinus. There were no intraoperative complications, intrahospital or late deaths. The mean hospital stay was 5.2 days. Follow-up showed reversal of ventricular asynchrony and improvement in functional class in all patients.
  
  
  CONCLUSIONS
  Thoracoscopic epicardial LV lead implantation is a safe and feasible procedure in a population of high risk patients who need resynchronisation therapy after endocardial LV lead placement has failed.
authors.affiliation: Department of General Thoracic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Papiashvilli
authors.forename: Zoya
authors.initials: Z
authors.lastname: Haitov
authors.forename: Tirza
authors.initials: T
authors.lastname: Fuchs
authors.forename: Ilan
authors.initials: I
authors.lastname: Bar
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000601:surgery; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*