[Surgical Cardiac Resynchronization Therapy for Patients with Severe Left Ventricular Systolic Dysfunction]

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Two patients presented with severe left ventricular (LV) systolic dysfunction and dyssynchronous ventricular activation, characterized by complete left bundle branch block and atrial fibrillation.
• One patient had ischemic dilated cardiomyopathy with coronary artery aneurysms, and the other had dilated cardiomyopathy with mitral valve regurgitation.
• Both patients exhibited significantly impaired LV ejection fractions and enlarged LV dimensions.

Observation:

• Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) was combined with concomitant cardiac surgery for lead implantation.
• Epicardial LV leads were surgically placed on the posterolateral wall in both patients.
• The surgical approach allowed lead placement independent of the LV venous anatomy.

Findings:

• CRT-D successfully resynchronized LV contraction in both patients, leading to improved cardiac function.
• Both patients experienced an uneventful postoperative course and were discharged in stable condition.
• Surgical epicardial lead placement demonstrated a key advantage by overcoming limitations of transvenous lead placement.

Implications:

• Combined CRT-D and cardiac surgery may be a viable therapeutic option for select patients with severe LV systolic dysfunction and complex cardiac conditions.
• This approach expands treatment possibilities for patients who may not be suitable candidates for standard transvenous CRT.
• Further research into surgical epicardial lead placement for CRT could optimize outcomes in challenging patient populations.