Minimally Invasive Video-Assisted Epicardial Lead Cardiac Resynchronization Therapy for the Dilated Cardiomyopathy Heart Failure Cases

Objective: Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement in treating congestive heart failure. Traditional CRT through coronary sinus lead method is difficult to perform. Minimally invasive video-assisted epicardial lead (Epi-lead) CRT for the dilated cardiomyopathy heart failure cases was explored. Methods: From April 2007 to June 2009, a total of 12 patients (age, 63 +/- 9 years) with depressed systolic left ventricular (LV) function (ejection fraction, <35%), left bundle branch block (mean QRS [Q wave, R wave, S wave], 158 +/- 15 milliseconds), and congestive heart failure of New York Heart Association class III/IV were enrolled. The patients received minimally invasive video-assisted epicardial steroid-eluting LV lead implantation for the CRT. The right atrial and right ventricle leads were implanted, guided by x-ray. The mean follow-up time was 13.7 months ( range, 7-27 months). Results: All patients received LV lead implantation at the most late-activated site. The mean QRS duration decreased significantly from 158 +/- 15 to 124 +/- 11 milliseconds (P < 0.05). There was no surgical or hospital mortality in the entire series. The mean procedure duration ( skin to skin) of the LV lead implantation was 52.4 +/- 15.8 minutes. The mean postoperative stay was 7.1 +/- 2.7 days. During the follow-up, cardiac function improved significantly in 11 patients. Threshold capture of the Epi-leads remained stable at 1.12 +/- 0.3 V/0.5 ms during the follow-up. None died during the follow-up. Conclusions: Surgical Epi-lead placement for the resynchronization therapy is a safe and reliable technique and should be considered as an equal alternative.