title: Feasibility of percutaneous implantation of transapical endocardial left ventricular pacing electrode for cardiac resynchronization therapy.
abstract: Failure of coronary sinus lead implantation for resynchronization therapy requires alternative approaches. For such events we have developed a transapical implantation technique as a feasible alternative. We report the outcome of this technique and its evolution from a minithoracotomy to a percutaneous approach. Twenty patients underwent alternative resynchronization therapy with transapical endocardial left ventricular (LV) pacing lead implantation in a multicentre, international study between October 2007 and March 2010. Eighteen patients underwent minithoracotomy and transapical puncture under direct observation. Two recent patients had transthoracic echocardiography-guided percutaneous apical puncture to enter the LV cavity. A 19 or 21 ga needle and two-stage Seldinger dilatation with 4 and 7 Fr sheaths were then used to introduce the lead. In the two patients with closed-chest insertion of the electrode there was no puncture related bleeding or lung damage. Lead dislocation occurred in two minithoracotomy patients. Repositioning was performed without re-opening the pleural cavity. One patient developed right-sided implanted cardiac defibrillator lead endocarditis requiring complete system removal. Twelve patients have >1 year follow-up; all have sustained and significant improvement in LV dimensions (diastolic Δ4.2 ± 2.9, systolic Δ7.2 ± 5.8 mm), ejection fraction (Δ9.5 ± 9.6%), and functional status (Δ1.1 ± 0.3). Transapical placement of LV endocardial pacing lead is an effective alternative strategy for cardiac resynchronization. A closed-chest, percutaneous approach is feasible and should offer even less invasive intervention.
authors.affiliation: Department of Cardiac Surgery, Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary. imrekassai@hotmail.com
authors.forename: Imre
authors.initials: I
authors.lastname: Kassai
authors.forename: Orsolya
authors.initials: O
authors.lastname: Friedrich
authors.forename: Chandi
authors.initials: C
authors.lastname: Ratnatunga
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Betts
authors.forename: Attila
authors.initials: A
authors.lastname: Mihálcz
authors.forename: Tamás
authors.initials: T
authors.lastname: Szili-Török
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects; D004567:Electrodes, Implanted / Q000009:adverse effects; D004696:Endocarditis / Q000453:epidemiology / Q000209:etiology; D004699:Endocardium / Q000503:physiopathology*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006814:Hungary; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*