title: Long-Term Follow-Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy.
abstract: BACKGROUND
  Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach.
  
  
  OBJECTIVE
  To evaluate the success of this approach at long-term follow-up.
  
  
  METHODS
  Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response).
  
  
  RESULTS
  Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified.
  
  
  CONCLUSIONS
  Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients.
authors: Department of Cardiology, University Hospital Coventry, Coventry, UK.
authors: Christopher J
authors: CJ
authors: McALOON
authors: Department of Cardiology, University Hospital Coventry, Coventry, UK.
authors: Benjamin M
authors: BM
authors: Anderson
authors: Department of Cardiology, University Hospital Coventry, Coventry, UK.
authors: Wadih
authors: W
authors: Dimitri
authors: Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK.
authors: Jonathan
authors: J
authors: Panting
authors: Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK.
authors: Shamil
authors: S
authors: Yusuf
authors: Department of Cardiology, University Hospital Coventry, Coventry, UK.
authors: Sunil K
authors: SK
authors: Bhudia
authors: Department of Cardiology, University Hospital Coventry, Coventry, UK. faizel.osman@btinternet.com.
authors: Faizel
authors: F
authors: Osman
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011183:Postoperative Complications; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods
keywords: cardiac resynchronization therapy; epicardial LV lead; minithoracotomy