Robotic left ventricular epicardial lead positioning

Cardiac resynchronization therapy is indicated in advanced heart failure patients with a wide QRS complex, because it restores the synchronicity of the atrioventricular, interventricular and intraventricular contractions. It is performed through endovascular implantation of one or more leads. Left cardiac lead positioning is one of the most challenging procedures in interventional cardiology; unfortunately, in up to 40% of cases no clinical improvements occur. Surgical implantation of a left ventricular lead is indicated in cases of failure or predicted unfeasibility of a transvenous positioning. Several surgical techniques have been described for implantation of left ventricular lead. Minimally invasive approaches, including video-assisted thoracic and robotic surgery, are favoured due to reduced trauma, pain and recovery time. Robotic surgery confers significant advantages for visualization and manoeuverability, which are important in patients with a history of cardiac surgery, in whom scarring and adhesions may render placement challenging. We describe here the surgical technique for robotic implantation of left ventricular leads in candidates for cardiac resynchronization therapy.