title: Prophylactic epicardial left ventricular lead implantation for biventricular pacing during operations.
abstract: BACKGROUND
  Surgical epicardial left ventricular (LV) lead implantation for biventricular pacing has advantages over the transvenous approach in cardiac surgical patients. We investigated the benefit of concomitant prophylactic LV lead implantation during open heart operations and subsequent lead performance after patients with impaired LV function receive a biventricular device.
  
  
  METHODS
  Retrospective data of 4,844 patients undergoing cardiac operations through a sternotomy between January 2001 and December 2011 were analyzed. Of these, 380 patients (7.8%) had severe impairment of LV function (contrast left ventriculogram showing grade 4 estimated ejection fraction or echocardiogram showing LV ejection fraction<0.30). LV lead implantation was performed in patients in whom recovery of LV function was unlikely. Lead performance data were collected at follow-up.
  
  
  RESULTS
  LV lead implantation occurred in 95 patients (25%), and 29 (30.5%) subsequently received a biventricular device. Of patients with impaired LV function, more patients with prophylactic LV leads underwent biventricular implant than those without LV leads (30.5% vs 1.1%, p<0.0001). The median interval from LV lead implantation to connection to a biventricular device was 30 days (interquartile range, 5.5 to 145 days). At a median follow-up of 437.5 days (interquartile range, 13.8 to 1198 days), the mean pacing threshold (1.25±0.46 vs 1.58±0.66 volts, p=0.069) and impedance (383.81±70.33 vs 448.6±200.1 Ohms, p=0.168) remained stable compared with time of biventricular device connection.
  
  
  CONCLUSIONS
  A significant proportion of patients with poor LV function undergoing cardiac operations may benefit from concomitant LV lead implantation. Subsequent lead performance appears satisfactory. Epicardial LV lead placement is easily accomplished during open heart operations and should be considered before the operation.
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. Electronic address: leonard.shan3001@gmail.com.
authors.forename: Leonard
authors.initials: L
authors.lastname: Shan
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Buratto
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Conaglen
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Davis
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Yii
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Nixon
authors.affiliation: Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D010496:Pericardium; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
keywords: 24