title: Midterm Follow-up of Robotic Biventricular Pacing Demonstrates Excellent Lead Stability and Improved Response Rates.
abstract: BACKGROUND
  : Robotically assisted left ventricular (LV) lead placement is an effective minimally invasive rescue procedure for cardiac resynchronization in the setting of failed coronary sinus lead insertion. The long-term response rate and durability of this technique has not been reported. The authors evaluated the midterm outcome of biventricular pacing performed with robotically placed LV leads.
  
  
  METHODS
  : Forty-two patients underwent implantation of LV epicardial leads using robotic assistance and the posterior approach. Half of the patients had prior cardiac surgery. All leads were placed in an optimal site along the posterolateral surface of the LV. The patients were prospectively followed up for clinical response, LV reverse remodeling, and LV lead stability over a mean period of 16.7 ± 9.5 months (range, 3-34 months). A multivariate Cox proportional hazards model was used to determine predictors of response.
  
  
  RESULTS
  : All patients had successful LV lead placement with no postoperative mortality. Statistically significant improvements in left ventricular ejection fraction, NYHA heart failure class, systolic left ventricular internal dimension index, and diastolic left ventricular internal dimension index. The 3-month clinical response rate was 81% and dropped to 71% at average maximal follow-up. Multivariate analysis of 9 variables revealed only LVEF greater than 15% and absence of pulmonary hypertension to be predictors of response. No difference in operative time, response rate, or LV lead stability was detected when primary versus reoperative cases were compared.
  
  
  CONCLUSIONS
  : Robotic LV lead placement is a reliable technique for optimal lead placement with durable long-term results.
authors.affiliation: From the Divisions of *Cardiothoracic Surgery and †Cardiology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Derose
authors.forename: Sandhya
authors.initials: S
authors.lastname: Balaram
authors.forename: Charles
authors.initials: C
authors.lastname: Ro
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Swistel
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Sandeep
authors.initials: S
authors.lastname: Joshi
authors.forename: Robert C
authors.initials: RC
authors.lastname: Ashton