Thoracoscopic left ventricular lead implantation.
OBJECTIVE
Cardiac resynchronization therapy is a therapeutic option in patients with chronic heart failure. Epicardial lead implantation for biventricular pacing is usually the method of second choice after failed coronary sinus cannulation. The present study describes an initial experience with minimally invasive surgical lead implantation using thoracoscopy.


METHODS
Since August 2008, a total of 17 patients (mean age 69.6 + 11.1 years) with congestive heart failure, NYHA functional class 3.1 +/- 0.4, and depressed ejection function (24.8% +/- 5.7%) were referred for surgery because of failed left ventricular lead implantation through the coronary sinus. Under single-lung ventilation and video-assisted thoracoscopy, epimyocardial steroid-eluting screw-in leads were implanted on the left ventricular free wall.


RESULTS
There were no in-hospital deaths or major co-morbidities. The mean skin-to-skin operating time was 115.9 +/- 32.1 min, and the post-operative average length of stay was 8.4 +/- 2.5 days. Intraoperative acute threshold capture of the left ventricular lead was 0.88 +/- 0.54 V/0.5 ms, and the value of lead impedance was 434.7 +/- 110.8 Omega. Extension to a small thoracotomy was necessary in 1 patient to stop epicardial vein bleeding.


CONCLUSIONS
Minimally invasive left ventricular lead implantation is a safe procedure with excellent acute threshold capture.
Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic. marek.pojar@centrum.cz
Marek
M
Pojar
Jan
J
Vojacek
Miloslav
M
Tauchman
Petr
P
Parizek
Ales
A
Havlicek
Jan
J
Belohlavek
Ludek
L
Haman
D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome