Influence of Epicardial Left Ventricular Pacing Lead on the Response to Cardiac Resynchronization Therapy

Abstract

Objectives: Cardiac resynchronization therapy (CRT) represents a "gold standard“ in the treatment of advanced heart failure if pharmacological therapy alone is not sufficient. The rationale for CRT is the resynchronization of ventricular dyssynchrony and therefore improvement of the impaired pump function of failing ventricles. Moreover, a reverse remodeling of the ventricle may occur. However, it has been suggested that 20% to 30% of patients do not respond to CRT. A non-optimal LV pacing lead position may be a potential cause for nonresponse to CRT. Due to low invasivity nowadays almost all primary LV-lead implantations are conducted in a transvenous approach. In this scenario the presence of a suitable venous anatomy is prerequisite for placing of LV lead at its most effective position. Epicardial left ventricular (eLV) leads represent an alternative for CRT if transvenous lead implantation fails. However, this approach allows placing the leads independently of venous anatomy. In our study we retrospectively investigated the CRT response in patients with eLV.