Facilitated Minimally Invasive Left Ventricular Epicardial Lead Placement

2005 ◽  
Vol 79 (3) ◽  
pp. 1023-1025 ◽  
Author(s):  
Nicolas Doll ◽  
Ulrich T. Opfermann ◽  
Ardawan J. Rastan ◽  
Thomas Walther ◽  
Hendrik Bernau ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Left Ventricular ◽  
Epicardial Lead ◽  
Lead Placement

Robotic-Assisted or Minithoracotomy Incision for Left Ventricular Lead Placement a Single-Surgeon, Single-Center Experience

2012 ◽  
Vol 7 (3) ◽  
pp. 208-212 ◽  
Author(s):  
Castigliano Murthy Bhamidipati ◽  
Igor W. Mboumi ◽  
Keri A. Seymour ◽  
Roberta Rolland ◽  
Karikehalli Dilip ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Tactile Feedback ◽  
Pacing Threshold ◽  
Robotic Assisted ◽  
Single Center Experience ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Ventricular Lead

Objective Left ventricular (LV) resynchronization with epicardial lead placement after failed coronary sinus cannulation can be achieved with minimally invasive robotic-assisted (RA) or minithoracotomy (MT) incisions. We evaluated early outcomes and costs after RA and MT epicardial LV lead implantation at our academic center. Methods From 2005 to 2010, 24 patients underwent minimally invasive RA or MT epicardial LV lead placement for resynchronization. Patient characteristics, electrophysiologic features, outcomes, and costs were analyzed. Results Ten patients underwent RA and 14 underwent MT minimally invasive LV lead placement, with no 30-day mortality in either group. Younger patients underwent RA epicardial lead placement (63.8 ± 15.4 vs 75.6 ± 10.0 years; P = 0.03). In addition, although both groups had comparable body surface areas, RA patients had significantly higher body mass index versus MT patients (44.4 ± 17.5 vs 26.9 ± 7.1 kg/m2, respectively; P = 0.003). Premorbid risk and cardiovascular profiles were similar across groups. Importantly, pacing threshold, impedance, and postoperative QRS interval were equivalent between groups. Significantly, both operating room and mechanical ventilation durations were higher with RA epicardial placement (P < 0.001). Despite equivalent outcomes, incision-to-closure interval was 48 minutes shorter with MT (P = 0.002). Absolute differences in direct costs between groups were negligible. Despite these differences, resource utilization and lengths of stay were equivalent. Conclusions Epicardial LV lead placement is efficacious with either approach. Early outcomes and mortality are equivalent. Greater tactile feedback during operation and equivalent short-term outcomes suggest that MT minimally invasive LV lead placement is the more favorable approach for epicardial resynchronization.

Minimally Invasive Left Ventricular Epicardial Lead Placement: Surgical Techniques for Heart Failure Resynchronization Therapy

2005 ◽  
Vol 79 (5) ◽  
pp. 1536-1544 ◽  
Author(s):  
José L. Navia ◽  
Fernando A. Atik ◽  
Richard A. Grimm ◽  
Mario Garcia ◽  
Pablo Ruda Vega ◽  
...  
Keyword(s):  
Heart Failure ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Left Ventricular ◽  
Resynchronization Therapy ◽  
Epicardial Lead ◽  
Lead Placement

scholarly journals Left ventricular epicardial lead placement after Carillon placement in the coronary sinus

2019 ◽  
Vol 27 (10) ◽  
pp. 514-517
Author(s):  
C. A. da Fonseca ◽  
F. S. van den Brink ◽  
M. Feenema ◽  
K. Kraaier ◽  
T. N. Vossenberg
Keyword(s):  
Coronary Sinus ◽  
Left Ventricular ◽  
Epicardial Lead ◽  
Lead Placement

Minimally Invasive Surgical Placement of Left Ventricular Epicardial Lead: Letter 2

2006 ◽  
Vol 81 (1) ◽  
pp. 407-408 ◽  
Author(s):  
Helmut Mair ◽  
Ingo Kaczmarek ◽  
Martin Oberhoffer ◽  
Sabine Daebritz
Keyword(s):  
Minimally Invasive ◽  
Left Ventricular ◽  
Minimally Invasive Surgical ◽  
Epicardial Lead

scholarly journals Epicardial echocardiography for left ventricular epicardial lead placement during cardiac resynchronization

2021 ◽  
Vol 15 (2) ◽  
pp. 241
Author(s):  
ShrinivasV Gadhinglajkar ◽  
DonJose Palamattam ◽  
Santhosh Vilvanathan ◽  
Nagarjuna Panidapu
Keyword(s):  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Epicardial Echocardiography

scholarly journals Cardiac Resynchronisation Therapy – An Approach to Difficult Left Ventricular Lead Placement

2015 ◽  
Vol 01 (01) ◽  
pp. 25 ◽  
Author(s):  
Mayank Singhal ◽  
Manoj K Rohit ◽  
Parag Barwad ◽  
◽  
◽  
...  
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Ventricular Lead ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Left Ventricular Lead Placement

Left ventricular (LV) lead in cardiac resynchronisation therapy (CRT) is the most important and difficult lead to place, leading to abandonment of up to 10–15 % of procedures. Here we discuss various difficulties encountered in percutaneous placement of LV leads and what all can be done to ensure successful placement of the same and to prevent the already compromised patient from the requirement of epicardial lead placement.

Biventricular Pacing for Congestive Heart Failure: Early Experience in Surgical Epicardial versus Coronary Sinus Lead Placement

2005 ◽  
Vol 6 (1) ◽  
pp. 1 ◽  
Author(s):  
Hironori Izutani ◽  
Kara J. Quan ◽  
Lee A. Biblo ◽  
Inderjit S. Gill
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Coronary Sinus ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Left Ventricular ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Coronary Sinus Lead ◽  
Class Iv

<P>Objective: Biventricular pacing (BVP) has recently been introduced for the treatment of refractory congestive heart failure. Coronary sinus lead placement for left ventricular pacing is technically difficult, has a risk of lead dislodgement, and has long procedure times. Surgical epicardial lead placement has the potential advantage of the visual selection of an optimal pacing site, does not need exposure to ionic radiation, and allows lead multiplicity, but it does require a thoracotomy and general anesthesia. We report our early experience of BVP with both modalities. </P><P>Methods: BVP was performed in 12 patients with New York Heart Association (NYHA) class IV congestive heart failure (10 men, 2 women). Mean patient age was 68.7 years (range, 41-83 years). Surgical epicardial leads were placed through a 2- to 3-inch incision via a left fourth or fifth intercostal thoracotomy in 4 patients with single lung ventilation under general anesthesia. The other 8 patients underwent transvenous coronary sinus lead placement under conscious sedation. </P><P>Results: Postoperative NYHA class status improved from class IV to class II in 8 patients and to class III in 3 patients. In 5 of the 8 patients who had undergone follow-up echocardiography with mitral regurgitation, the severity of the mitral regurgitation improved. The mean left ventricular ejection fractions before and after BVP were 18.3% � 8.3% and 20.5% � 8.0%, respectively (P = .16). Mean fluoroscopy and total procedure times for transvenous lead placement were 77 � 19 minutes and 266 � 117 minutes, respectively. The mean surgery time for epicardial lead placement was 122 � 13 minutes. There were no differences between the 2 methods in pacing threshold or in lead dislodgement. There were no complications related to the surgery or the laboratory procedure. </P><P>Conclusion: In patients with NYHA class IV congestive heart failure, epicardial lead placement through a minithoracotomy for BVP was performed safely with benefits equivalent to those of coronary sinus lead placement and with a shorter procedure time.</P>

Thoracoscopic Epicardial Lead Implantation as an Alternative to Failed Endovascular Insertion for Cardiac Pacing and Resynchronization Therapy

2014 ◽  
Vol 9 (6) ◽  
pp. 427-431
Author(s):  
Nahum Nesher ◽  
Amir Ganiel ◽  
Yosef Paz ◽  
Amir Kramer ◽  
Refael Mohr ◽  
...  
Keyword(s):  
Cardiac Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Double Lumen Endotracheal Tube ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Rescue Treatment ◽  
First Choice ◽  
Pacing Lead

Objective Numerous anomalies or postprocedural stricture of the venous system prevent optimal endovascular implantation of a pacing lead in more than 10% of patient indicated for permanent pacing or cardiac resynchronization therapy. The purpose of this report was to summarize our experience and immediate postoperative results of thoracoscopic lead implantation as a lesser invasive solution to an unsuccessful endovascular lead insertion. Methods From January 2008 to April 2013, 11 epicardial leads were introduced thoracoscopically at our center as a rescue treatment after failed endovascular attempts. Patients were ventilated using a double-lumen endotracheal tube. A 5-mm 30-degree lance thoracoscope was used with either 2 or 3 additional working ports. A screw-in pacing lead (Medtronic Model 5071 Pacing lead, Minneapolis, MN USA) was inserted into the left ventricular epicardium. After the lead placement and assessment for threshold less than 1 V, the lead was brought to the chest wall and tunneled to the pacemaker generator pocket. At the end of the procedure, a small, flexible 14F thoracic drain, was left inside the pleural cavity for the next 24 hours. Results There were no mortality or any major surgical complications among these patients. All patients responded to the epicardial lead implantation in terms of appropriate pacing and conductivity. No clinical failure was observed, and no patient required a repeat procedure. Conclusions Thoracoscopic lead insertion is safe and easy to perform. We believe it should be offered as the first choice after failed endovascular pacing lead implantation.

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