Abstract 19740: Epicardial Left Ventricular Lead Placement: Unfavorable Lead Location and Impact on Clinical Response

Abstract

Background: Epicardial placement of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) is performed in patients with failed percutaneous placement or prophylactically in patients undergoing open heart surgery and having a high likelihood of needing a LV lead in future. We indended to evaluate the incidence of unfavorable epicardial LV lead location and the correlation with the type of procedure and clinical response. Methods: We performed a retrospective evaluation of all consecutive patients undergoing LV lead placement epicardially in a large academic hospital. Baseline characteristics, procedural variables, lead locations as identified on two-view chest-X rays and clinical follow-up data were collected and analyzed. Apical and anterior lead locations were considered unfavorable locations. Results: A total of 148 patients underwent epicardial LV lead placement of which lead locations were available in 134 patients. Mean age of the population was 65 years with 75% males. Ischemic cardiomyopathy was seen in 64% of the patients. Mean left ventricular ejection fraction (LVEF) was 29% and mean QRS duration was 141msec. Leads were placed with a lateral minithoracotomy (MT) in 52 (39%) and open heart surgery (OH) in the remaining 82 (61%) patients. Unfavorable lead locations were seen in 32 (24%) of the patients. Patients undergoing MT were much more likely to have an unfavorable lead location compared to the OH surgery patients (42% vs 12%; p<0.001). The maximum distance between the electrodes was much shorter in MT patients compared to OH surgery patients 2.06 vs 3.16; p=0.005). Complete follow-up data with clinical response (increase in LVEF by 5% and or improvement in heart failure functional class) was available in 108 patients. Overall positive CRT response was seen in 62% of the patients with no significant difference between patients with or without an unfavorable location of the LV leads (63% vs 61%; p=0.873). Conclusions: Patients undergoing LV lead placement by minithoracotomy are more likely to have an unfavorable location of the lead with no significant deleterious impact on the CRT response rate.