title: Comparison of endovascular versus epicardial lead placement for resynchronization therapy.
abstract: Cardiac resynchronization therapy (CRT) has been shown to improve survival and symptoms in patients with severe left ventricular (LV) dysfunction, congestive heart failure, and prolonged QRS duration. LV lead placement is achieved by placing the lead in the coronary sinus, an endovascular approach, or by a minimally invasive robotic-assisted thoracoscopic epicardial approach. There are no data directly comparing the 2 methods. Patients eligible for CRT were randomized to the endovascular and epicardial arms. Coronary sinus lead placement was achieved using the standard technique, and epicardial leads were placed using a minimally invasive robotic-assisted thoracoscopic approach. The primary end point was a decrease in LV end-systolic volume index at 6 months. The secondary end points included 30-day mortality rate, measures of clinical improvement, 1-year electrical lead performance, and 1-year survival rate. The relative improvement of LV end-systolic volume index from baseline to 6 months was similar between the arms (28.8% for the transvenous [n = 12] vs 30.5% for the epicardial (n = 9) arm, p = 0.93). There were no significant differences in the secondary end points between the 2 groups. In conclusion, there were no differences in echocardiographic and clinical outcomes comparing a conventional endovascular approach versus robotic-assisted surgical epicardial LV lead placement for CRT in patients with heart failure. Surgical approaches are still a viable alternative when a transvenous procedure has failed or is not technically feasible.
authors.affiliation: Division of Cardiology, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
authors.forename: Naga V
authors.initials: NV
authors.lastname: Garikipati
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Division of Cardiology, The Mount Sinai Hospital, New York, New York.
authors.forename: Farooq
authors.initials: F
authors.lastname: Chaudhry
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Dan L
authors.initials: DL
authors.lastname: Musat
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Tina
authors.initials: T
authors.lastname: Sichrovsky
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Preminger
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Aysha
authors.initials: A
authors.lastname: Arshad
authors.affiliation: The Arrhythmia Institute, Valley Health System, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: steijo@valleyhealth.com.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data; D054326:Coronary Sinus; D004567:Electrodes, Implanted / Q000706:statistics & numerical data; D057510:Endovascular Procedures; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D010865:Pilot Projects; D019919:Prosthesis Implantation / Q000379:methods*; D015641:Radiography, Interventional; D013906:Thoracoscopy; D018487:Ventricular Dysfunction, Left / Q000628:therapy