Strategy for Failed Transvenous Left-Ventricular Lead Placement in Cardiac Resynchronization Therapy: Surrender or...

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Cardiac resynchronization therapy (CRT) is crucial for heart failure management.
• Transvenous LV lead placement can fail in certain patient groups.
• Alternative strategies are needed for CRT candidates with lead placement challenges or concomitant cardiac surgeries.

Purpose of the Study:

• To evaluate the efficacy and safety of surgically placed epicardial LV leads guided by electroanatomic mapping.
• To assess this technique as an alternative for patients with failed transvenous LV lead implantation.
• To determine its applicability in patients requiring simultaneous cardiac surgeries.

Main Methods:

• Electroanatomic mapping guided surgical positioning of epicardial LV leads.
• Lead placement targeted regions with latest LV activation and normal voltage, avoiding scar tissue.
• Consecutive implantation in 10 patients from April 2010 to September 2018.

Main Results:

• Successful implantation in all 10 patients, including 7 with prior failed transvenous attempts and 3 with concomitant surgeries.
• Significant reduction in QRS duration (149.3 to 125.1 ms, p=0.01).
• Significant improvement in LV ejection fraction at 6 months (31.0% to 42.2%, p=0.006), with stable parameters and improved NYHA class (2.9 to 1.8, p=0.002) during follow-up (mean 755 days).

Conclusions:

• Epicardial LV lead placement guided by electroanatomic mapping is a promising adjunctive strategy for CRT.
• This approach is effective for patients unable to undergo or refractory to conventional CRT.
• It can be safely applied in patients with concurrent surgical indications.