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Long‐Term Follow‐Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy
Author(s) -
McALOON CHRISTOPHER J.,
ANDERSON BENJAMIN M.,
DIMITRI WADIH,
PANTING JONATHAN,
YUSUF SHAMIL,
BHUDIA SUNIL K.,
OSMAN FAIZEL
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12932
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , lead (geology) , implant , heart failure , ejection fraction , surgery , geomorphology , geology
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. Aim 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. Conclusion 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.