Biventricular pacing for end-stage heart failure: early experience in surgical versus transvenous left ventricular lead placement
Rony Atoui 1*,
Vidal Essebag 2,
Valerie We 1,
Yin Ge 1,
Marie-Helene Auclair 1,
Tom Hadjis 2,
Dominique Shum-Tim 1
1 McGill University Health Center, Montreal, Quebec, Canada
2 McGill University Health Center and Sacre-Coeur Hospital, Montreal, Quebec, Canada
* To whom correspondence should be addressed. E-mail: rony.atoui{at}mail.mcgill.ca.
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Abstract |
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Transvenous coronary sinus lead placement is currently the standard approach for left ventricular pacing. The aim of this study is to assess whether a mini-thoracotomy approach would be feasible and safe when used for cases in which transvenous procedures were ineffective or judged unlikely to succeed. Biventricular pacing was performed in 138 consecutive patients with 47 patients undergoing a mini-thoracotomy procedure. NYHA status, quality of life, electrical and echocardiographic data were assessed in the two groups over a follow-up period of 17.6±4.2 weeks. There was no significant difference in the preoperative characteristics in both groups other than a greater prevalence of renal failure and previous cardiac surgery among the surgical patients. The mean procedure time was significantly longer in the transvenous group. No significant differences were noted in the immediate or long-term pacing parameters. Two mortalities were observed in the surgical group > 2 weeks following the procedure. During the follow-up period, we noted a comparable improvement in the echocardiographic parameters, QRS duration and NYHA status with both approaches. Our results suggest that even when performed on high-risk patients, epicardial lead placement through a mini-thoracotomy is beneficial and feasible as a 'rescue' procedure after a failed transvenous approach. Keywords: Mini-thoracotomy; Chronic resynchronization therapy; Epicardial leads; Biventricular pacing; Congestive heart failure
