Left ventricular epicardial lead implantation via left minithoracotomy

The transvenous placement of left ventricular epicardial leads is limited by long procedure times, high procedural failure rates and limited sites for lead placement. Open surgical approaches are used primarily after failure of the transvenous approach but provide additional important benefits. This study assesses the surgical outcomes of left anterior minithoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronization therapy.

Eleven patients were referred for open left ventricular epicardial lead placement. Mean patient age was 66.2 (59-77) years. The patients had New York Heart Association class III (II-IV) heart failure, a mean left ventricular ejection fraction of 18 +/- 5 % and mean QRS duration of 177 +/- 29 milliseconds.

Left ventricular epicardial leads were successfully placed in all patients. Mean surgery time was 101 +/- 33 minutes and intraoperative lead parameters were: R wave 14.5 +/- 9.8 millivolts, lead threshold 1.4 +/- 0.9 volts at 0.5 milliseconds, impedance 1127 +/- 693 ohms. Impedance was statistically different at 40 +/- 25 weeks with 571 +/- 199 ohms ( P = 0.033).

Left ventricular epicardial lead implantation via left anterior minithoracotomy is safe and effective.