[Case of epicardial left ventricular pacing lead implantation under general anesthesia in a patient with severe...

An 82-year-old man with severe cardiac dysfunction due to ischemic cardiac myopathy was diagnosed as indication for biventricular pacing. His left ventricular ejection fraction was 22%. Because of difficulty in coronary sinus lead fixation, epicardial lead implantation through a thoracotomy under general anesthesia was scheduled. Intraaortic balloon pumping (IABP) was started prior to the operation. Anesthesia was induced by midazolam and fentanyl, and maintained with fentanyl and low dose propofol infusion. Milrinone was infused throughout the operation. Except for just after the anesthesia induction, systolic blood pressure was kept well around 100 mmHg. The operation was completed without any ploblems. NYHA classification improved markedly (class IV to class II) by biventricular pacing. Using IABP, we could maintain blood pressure and stabilize hemodynamics during left ventricular lead implantation in a patient with severe heart failure.