title: Event-free survival following CRT with surgically implanted LV leads versus standard transvenous approach.
abstract: BACKGROUND
  While surgical epicardial lead placement is performed in a subset of cardiac resynchronization therapy patients, data comparing survival following surgical versus transvenous lead placement are limited. We hypothesized that surgical procedures would be associated with increased mortality risk.
  
  
  METHODS
  Long-term event-free survival was assessed for 480 consecutive patients undergoing surgical (48) or percutaneous (432) left ventricle (LV) lead placement at our institution from January 2000 to September 2008.
  
  
  RESULTS
  Baseline clinical and demographic characteristics were similar between groups. While there was no statistically significant difference in overall event-free survival (P = 0.13), when analysis was restricted to surgical patients with isolated surgical lead placement (n = 28), event-free survival was significantly lower in surgical patients (P = 0.015). There appeared to be an early risk (first approximately 3 months postimplantation) with surgical lead placement, primarily in LV lead-only patients. Event rates were significantly higher in LV lead-only surgical patients than in transvenous patients in the first 3 months (P = 0.006). In proportional hazards analysis comparing isolated surgical LV lead placement to transvenous lead placement, adjusted hazard ratios were 1.8 ([1.1,2.7] P = 0.02) and 1.3 ([1.0,1.7] P = 0.07) for the first 3 months and for the full duration of follow-up, respectively.
  
  
  CONCLUSIONS
  Isolated surgical LV lead placement appears to carry a small but significant upfront mortality cost, with risk extending beyond the immediate postoperative period. Long-term survival is similar, suggesting those surviving beyond this period of early risk derive the same benefit as coronary sinus lead recipients. Further work is needed to identify risk factors associated with early mortality following surgical lead placement.
authors.affiliation: Department of Medicine, Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts, USA. almiller@partners.org
authors.forename: Amy L
authors.initials: AL
authors.lastname: Miller
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kramer
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Bruce
authors.initials: B
authors.lastname: Koplan
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.forename: Usha
authors.initials: U
authors.lastname: Tedrow
mesh_terms: D000368:Aged; D001900:Boston / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome