Abstract 5927: Do Surgically Placed Left Ventricular Leads Provide the Same Benefit as Percutaneous Leads for Cardiac Resynchronization?

Abstract

Objective : Cardiac resynchronization using a percutaneous left ventricular (LV) lead inserted via the coronary sinus improves symptoms of congestive heart failure (CHF), ejection fraction (EF), and survival. An epicardial LV lead is often placed surgically after failed percutaneous attempt, although it is unknown if they offer the same benefits. The objective of this study was to determine if patients with surgically placed LV leads derive the same therapeutic effect as those with percutaneously placed leads. Methods : Forty-five sequential patients who had surgically placed epicardial LV leads (via thoracotomy or thoracoscopy) after failed percutaneous lead attempt were 3:1 propensity score matched with 135 patients who had successful percutaneous placement. Patients’ scores were matched for the variables age, EF, and QRS interval using greedy methodology. Postoperative outcomes including mortality, CHF readmission, and New York Heart Association (NYHA) class were compared using standard univariate techniques. Results : Mean follow-up was 20±15 months. There were no differences in preoperative variables including age, EF, NYHA class, and etiology of CHF. No differences in 30-day mortality, long-term mortality, CHF readmission rate or EF % increase were identified between groups. Post-procedure complications of acute kidney injury (defined by creatinine increase >1.0: 26.2% vs. 4.9%, P<.001) and infection (11.9% vs. 2.4%, P=.026) were more common in the surgical group. Improvement in NYHA class was more common in the surgical group. Conclusions : Surgical LV lead placement offers functional benefits similar to percutaneous placement and possibly greater likelihood of NHYA class improvement. This comes with the greater risk of reversible acute kidney injury and post procedural infection.