J Korean Med Sci.  2012 Dec;27(12):1595-1597. 10.3346/jkms.2012.27.12.1595.

Thoracoscopic Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy

• Jeong DS
• Park PW
• Lee YT
• Park SJ
• Kim JS
• On YK

• KMID: 2157989
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1595

Abstract

Cardiac resynchronization therapy is known to reduce morbidity and mortality in patients with advanced heart failure as a result of dyssynchrony and systolic dysfunction of the left ventricle. Placement of the left ventricular (LV) lead via the coronary sinus can be difficult. When LV lead implantation is difficult, a video-assisted epicardial approach can be a good alternative. Although there are several reports of video-assisted epicardial LV lead implantation, mini-thoracotomy and lead implantation under direct vision have been used in most series. A 49-yr-old woman with dilated cardiomyopathy underwent the video-assisted epicardial LV lead implantation because percutaneous transvenous approach was difficult due to small cardiac veins. The patient was discharged without problems and showed improved cardiac function at the 3 follow-up months. We report the first successful total thoracoscopic LV lead implantation (without mini-thoracotomy) in Korea.

Keyword

Cardiac Resynchronization Therapy; Thoracoscopy

MeSH Terms

*Cardiac Resynchronization Therapy
Cardiomyopathy, Dilated/diagnosis
*Defibrillators, Implantable
Echocardiography
Female
Humans
Middle Aged
Thoracic Surgery, Video-Assisted
Tomography, X-Ray Computed
Ventricular Dysfunction, Left/radiography/surgery/*therapy

Figure

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  Fig. 1 Chest X-ray after LV lead implantation.

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  Fig. 2 Electrocardiograms before and after LV lead implantation. (A) Preoperative electrocardiogram. (B) Postoperative electrocardiogram.

Reference

1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002. 346:877–883.

2. Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation. 1989. 79:845–853.

3. Xiao HB, Lee CH, Gibson DG. Effect of left bundle branch block on diastolic function in dilated cardiomyopathy. Br Heart J. 1991. 66:443–447.

4. Erlebacher JA, Barbarash S. Intraventricular conduction delay and functional mitral regurgitation. Am J Cardiol. 2001. 88:A783–86.

5. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001. 344:873–880.

6. Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schondube F, Wolfhard U, Bocker D, et al. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol. 2002. 39:2026–2033.

7. Kleine P, Gronefeld G, Dogan S, Hohnloser SH, Moritz A, Wimmer-Greinecker G. Robotically enhanced placement of left ventricular epicardial electrodes during implantation of a biventricular implantable cardioverter defibrillator system. Pacing Clin Electrophysiol. 2002. 25:989–991.

8. Fernandez AL, Garcia-Bengochea JB, Ledo R, Vega M, Amaro A, Alvarez J, Rubio J, Sierra J, Sanchez D. Minimally invasive surgical implantation of left ventricular epicardial leads for ventricular resynchronization using video-assisted thoracoscopy. Rev Esp Cardiol. 2004. 57:313–319.

9. Jansens JL, Jottrand M, Preumont N, Stoupel E, de Canniere D. Robotic-enhanced biventricular resynchronization: an alternative to endovenous cardiac resynchronization therapy in chronic heart failure. Ann Thorac Surg. 2003. 76:413–417.

10. Morgan JA, Ginsburg ME, Sonett JR, Morales DL, Kohmoto T, Gorenstein LA, Smith CR, Argenziano M. Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology. Eur J Cardiothorac Surg. 2003. 23:883–887.

11. Alonso C, Leclercq C, d'Allonnes FR, Pavin D, Victor F, Mabo P, Daubert JC. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects. Heart. 2001. 86:405–410.

12. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005. 352:1539–1549.

13. Perisinakis K, Theocharopoulos N, Damilakis J, Manios E, Vardas P, Gourtsoyiannis N. Fluoroscopically guided implantation of modern cardiac resynchronization devices: radiation burden to the patient and associated risks. J Am Coll Cardiol. 2005. 46:2335–2339.

14. Mair H, Sachweh J, Meuris B, Nollert G, Schmoeckel M, Schuetz A, Reichart B, Daebritz S. Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. Eur J Cardiothorac Surg. 2005. 27:235–242.

15. Jutley RS, Waller DA, Loke I, Skehan D, Ng A, Stafford P, Chin D, Spyt TJ. Video-assisted thoracoscopic implantation of the left ventricular pacing lead for cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2008. 31:812–818.