Epicardial Left Ventricular Lead Research Articles

Epicardial left ventricular leads via minimally invasive technique: a role of steroid eluting leads

BackgroundWe retrospectively assessed two types of sutureless screw-in left ventricular (LV) leads (steroid eluting vs. non-steroid eluting) in cardiac resynchronization therapy (CRT) implantation with regards to their electrical performance.MethodsBetween March 2008 and May 2014 an epicardial LV lead was implanted in 32 patients after failed transvenous LV lead placement using a left-sided lateral minithoracotomy or video-assisted thoracoscopy (mean age 64 ± 9 years). Patients were divided into two groups according to the type of implanted lead. Steroid eluting (SE) group: 21 patients (Myodex™ 1084 T; St. Jude Medical) and non-steroid eluting (NSE) group: 11 patients (MyoPore® 511,212; Greatbatch Medical).ResultsAll epicardial leads could be placed successfully, without any intraoperative complications or mortality. With regard to the implanted lead following results were observed: sensing (mV): SE 8.8 ± 6.1 vs. NSE 10.1 ± 5.3 (p = 0.380); pacing threshold (V@0.5 ms): SE 1.0 ± 0.5 vs. NSE 0.9 ± 0.5 (p = 0.668); impedance (ohms): SE 687 ± 236 vs. NSE 790 ± 331 (p = 0.162). At the follow-up (2.6 ± 1.9 years) the following results were seen: sensing (mV): SE 8.7 ± 5.0 vs. NSE 11.2 ± 6.6 (p = 0.241), pacing threshold (V@0.5 ms): SE 1.4 ± 0.5 vs. NSE 1.0 ± 0.3 (p = 0.035), impedance (ohms): SE 381 ± 95 vs. NSE 434 ± 88 (p = 0.129).ConclusionsBased on the results no strong differences have been found between the both types of epicardial LV leads (steroid eluting vs. non-steroid eluting) in CRT implantation in short- and midterm.

Surgical placement of left ventricular lead for cardiac resynchronisation therapy after failure of percutaneous attempt.

SummaryObjectiveCardiac resynchronisation therapy has been shown to be an effective treatment to improve functional status and prolong survival of patients in advanced chronic heart failure. This study assessed the surgical outcomes of left anterior mini-thoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronisation therapy.MethodsOur study consisted of 30 consecutive patients who underwent cardiac resynchronisation therapy with a left thoracotomy between November 2010 and April 2012 in our clinic. Postoperative follow up included the assessment of New York Heart Association (NYHA) functional class, electrocardiography and echocardiography.ResultsThere were 22 male and eight female patients with a mean age of 68 ± 5.04 years. All patients were in NYHA class III or IV. Pre-procedure mean left ventricular ejection fraction was 28.1 ± 4.5% and post-procedural ejection fraction improved to 31.7 ± 5.1%. The pre-operative QRS duration changed from 171.7 ± 10.8 to 156.2 ± 4.4 ms after the operation. Also there was a significant reduction in left ventricular end-diastolic dimension from 6.98 ± 0.8 to 6.72 ± 0.8 mm (p < 0 .05), but no change in left ventricular end-systolic dimension and severity of mitral regurgitation. All patients had successful surgical left ventricular lead placement. There was no procedure-related mortality. The mean follow-up time was 40.4 months.ConclusionSurgical epicardial left ventricular lead placement procedure is a safe and effective technique in patients with a failed percutaneous attempt.

Long‐Term Follow‐Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy

Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach. To evaluate the success of this approach at long-term follow-up. Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response). Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified. Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients.

109-05: Effects of epicardial versus transvenous left ventricular lead placement on cardiac perfusion, contractile force, and clinical performance in cardiac resynchronisation therapy; a randomized clinical trial

109-05: Effects of epicardial versus transvenous left ventricular lead placement on cardiac perfusion, contractile force, and clinical performance in cardiac resynchronisation therapy; a randomized clinical trial

216-67: Efficacy of surgical treatment of moderate to severe mitral regurgitation in patients scheduled for cardiac resynchronization therapy

Purpose of the study; Mitral regurgitation (MR) in heart failure (HF) patients is generally associated with a poor prognosis. Cardiac resynchronization therapy (CRT) can reduce the degree of MR, improve symptoms and prognosis of HF patients. However, the significant residual MR after CTR is considered as a predictor of poor prognosis. The purpose of this study is to evaluate the clinical efficacy and prognosis of surgical treatment of moderate to severe MR in patients scheduled for CRT. Method used; A total of 23 consecutive patients scheduled for CRT with moderate to severe MR were enrolled between 2008 and 2015. 13 patients were performed mitral valve surgery (valvuloplasty 5 (38%), valve replacement 8 (62%); surgical group), and 10 patients were not performed (non-surgical group). In the surgical group, also coronary artery bypass 7 (54%), tricuspid annuloplasty 8 (62%), left ventricular epicardial lead placement 10 (77%) were performed simultaneously, and CRT were completed by endocardial lead added. All patients were evaluated MR change and major adverse cardiac events after CRT. Summary of results; MR improvement after CRT was significantly higher in the surgical group (surgical group 13 (100%) vs non-surgical group 3 (30%); p < 0.01), and MR worsening (0 (0%) vs 4 (40%); p < 0.05) and moderate to severe residual MR (1 (8%) vs 7 (70%); p < 0.01) were significantly lower in the surgical group.During the follow-up period (mean 38 ± 19 months), there were no significant between group differences in the total mortality rate, but cardiac death (2 (15%) vs 7 (70%); p < 0.05), and HF death (1 (8%) vs 6 (60%); p < 0.05) were significantly lower in the surgical group. Furthermore the surgical group showed a significantly higher rate of survival free of HF readmission (62.5% vs 22.2%; p < 0.05). Conclusion; Surgical treatment of moderate to severe MR in patients scheduled for CRT can significantly reduce the residual MR after CRT, may contribute to improve the prognosis and quality of life.

Clinical Outcomes of Cardiac Resynchronization with Epicardial Left Ventricular Lead.

Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P < 0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P < 0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.

Four years follow-up of epicardial left ventricular pacing by mini-thoracotomy for cardiac resynchronisation therapy in congestive heart failure (four cases).

To establish whether left ventricular (LV) pacing by mini-thoracotomy is a safe and feasible procedure after failed transvenous cardiac resynchronisation therapy (CRT), we described four cases of patients who demonstrated congestive heart failure (CHF), had transvenous LV lead implantation failures, and underwent a mini-left-lateral thoracotomy and implantation of an epicardial LV lead. After a mean follow-up 45 ± 3.5 months, the haemodynamic benefits of CRT were apparent in four patients. Mean LV ejection fraction increased from 28.4 ± 6.5% to 44.5 ± 13.7% (p = 0.024), in association with a reduction of LV end-systolic diameters from 62.3 ± 10.3 mm to 53.0 ± 13.11 mm (p = 0.029). QRS width decreased from 162.5 ± 23.6 ms to 147.5 ± 18.9 ms (p = 0.014). New York Heart Association values significantly improved before and after the procedure. These results suggest that epicardial LV pacing by mini-thoracotomy for CRT in CHF is feasible and can bring satisfactory long-term results.

18 Epicardial Left Ventricular Lead Implantation is Safe and Effective: Experience From a Large Tertiary Centre

BackgroundCardiac Resynchronisation Therapy (CRT) is known to improve morbidity and mortality in selected patients with heart failure. The left ventricular (LV) lead is commonly placed percutaneously via the coronary sinus...

Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion

BackgroundIn cases of intravenous placement failure of the left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) and obliteration of the left pleural space, the alternative approach of transthoracic placement by video-assisted thoracoscopic surgery (VATS) is difficult and not commonly practiced.MethodsHere, we present a simple technique for transthoracic introduction of an epicardial LV lead using a wound retractor (ALEXIS®) in a patient with heart failure. This wound retractor enables atraumatic tissue retraction without rib spreading, an optimal direct view in the pleural space for surgical pleurolysis and a high degree of safety for the patient.ResultsNo perioperative complications occurred. The tube drainage was removed on the second postoperative day, and the patient was discharged on the third postoperative day.ConclusionsThe decided advantage of this new method is the lack of any need for rib spreading using a mechanical retractor. Especially in patients with a history of open-heart surgery (including internal mammary artery bypass grafting and/or revascularisation of the left lateral wall) or known pleural adhesions (e.g., pleuritis or lung operations), the described technique provides a rapid and save access with minimal surgical effort and greater safety.

Sparse appearance learning based automatic coronary sinus segmentation in CTA.

Interventional cardiologists are often challenged by a high degree of variability in the coronary venous anatomy during coronary sinus cannulation and left ventricular epicardial lead placement for cardiac resynchronization therapy (CRT), making it important to have a precise and fully-automatic segmentation solution for detecting the coronary sinus. A few approaches have been proposed for automatic segmentation of tubular structures utilizing various vesselness measurements. Although working well on contrasted coronary arteries, these methods fail in segmenting the coronary sinus that has almost no contrast in computed tomography angiography (CTA) data, making it difficult to distinguish from surrounding tissues. In this work we propose a multiscale sparse appearance learning based method for estimating vesselness towards automatically extracting the centerlines. Instead of modeling the subtle discrimination at the low-level intensity, we leverage the flexibility of sparse representation to model the inherent spatial coherence of vessel/background appearance and derive a vesselness measurement. After centerline extraction, the coronary sinus lumen is segmented using a learning based boundary detector and Markov random field (MRF) based optimal surface extraction. Quantitative evaluation on a large cardiac CTA dataset (consisting of 204 3D volumes) demonstrates the superior accuracy of the proposed method in both centerline extraction and lumen segmentation, compared to the state-of-the-art.

Abstract 18378: Apical and Anterior Lead Location of Surgically Implanted Epicardial Left Ventricular Leads in Cardiac Resynchronization Therapy is Associated With Lower Survival Rate

Introduction: Surgically implanted epicardial left ventricular (eLV) lead is an alternative approach when transvenous LV (tLV) lead implantation in CRT patients has failed. With advancement in surgical technique and free from limitations of cardiac venous anatomy, operators have the freedom to choose the most optimal LV pacing site. Recent literatures noted differential clinical response in tLV-CRT patients with different LV lead locations. However, to the best of the authors’ knowledge, no such analysis has been published for eLV-CRT patients. Hypothesis: We hypothesize that optimal LV lead location in eLV-CRT is similar to tLV-CRT and similar clinical response is expected. Methods: After unsuccessful attempt(s) of tLV-CRT implantation, 44 (Age 63±15, 28M) patients received eLV-CRT from UCSD and Mayo Clinics between 2002 and 2013. Two-view (PA, lateral) chest radiographs were used to determine lead location by blinded independent observers. 9 patients were partially excluded from lead location analysis due to congenital cardiac anomaly or unavailable lateral chest radiograph. eLV lead locations were classified as basal, mid, or apical on the PA view; and anterior, anterolateral, lateral, posterolateral, or posterior on the lateral view. Survival data were collected from the national death and location database. Results: During an average follow up of 65 months, 15 patients have died following eLV-CRT implant. No death was attributed to acute surgical complication to eLV-CRT implantation. Kaplan-Meyer survival estimate showed anterior and apical eLV lead positions had lower survival rate as compared to non-anterior (p&lt;0.01, figure A) and non-apical location (p=0.07, figure B). Conclusion: In this two-center study, apical and anterior eLV lead locations were associated with significantly lower survival rate. The study implies apical and/or anterior locations should be avoided, if possible, during eLV-CRT implantation.

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy

Background Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit. This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure. Methods Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class III-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6±9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6±7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement. Results Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from III-IV preoperatively to II-III postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9±12.7) mm to (61.2±7.1) mm (P&lt;0.05), and LVEF increased from (33.6±7.4)% to (42.2±8.8)% (P&lt;0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4±31.6) ms to (57.3±23.8) ms (P&lt;0.05). Conclusions Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal target location.

Prophylactic Epicardial Left Ventricular Lead Implantation for Biventricular Pacing During Operations

Surgical epicardial left ventricular (LV) lead implantation for biventricular pacing has advantages over the transvenous approach in cardiac surgical patients. We investigated the benefit of concomitant prophylactic LV lead implantation during open heart operations and subsequent lead performance after patients with impaired LV function receive a biventricular device. Retrospective data of 4,844 patients undergoing cardiac operations through a sternotomy between January 2001 and December 2011 were analyzed. Of these, 380 patients (7.8%) had severe impairment of LV function (contrast left ventriculogram showing grade 4 estimated ejection fraction or echocardiogram showing LV ejection fraction<0.30). LV lead implantation was performed in patients in whom recovery of LV function was unlikely. Lead performance data were collected at follow-up. LV lead implantation occurred in 95 patients (25%), and 29 (30.5%) subsequently received a biventricular device. Of patients with impaired LV function, more patients with prophylactic LV leads underwent biventricular implant than those without LV leads (30.5% vs 1.1%, p<0.0001). The median interval from LV lead implantation to connection to a biventricular device was 30 days (interquartile range, 5.5 to 145 days). At a median follow-up of 437.5 days (interquartile range, 13.8 to 1198 days), the mean pacing threshold (1.25±0.46 vs 1.58±0.66 volts, p=0.069) and impedance (383.81±70.33 vs 448.6±200.1 Ohms, p=0.168) remained stable compared with time of biventricular device connection. A significant proportion of patients with poor LV function undergoing cardiac operations may benefit from concomitant LV lead implantation. Subsequent lead performance appears satisfactory. Epicardial LV lead placement is easily accomplished during open heart operations and should be considered before the operation.

The Impact of cardiac resynchronization therapy on TGF signal pathway in ischemic cardiomyopathy

Objective: To investigate the latent impact of cardiac resynchronization therapy on TGF-β1 signal pathway in Beagles with ischemic cardiomyopathy. Methods: Twenty adult Beagles were divided into group A (CRT group) and group B (non-CRT group). All of them were chest opened and had heart failure after a ligature in the first diagonal branch. A left ventricular epicardial lead, a right atrium and a right ventricle leads together with the pacemaker were implanted. The pacing was started in group A after myocardial infarction, but was not started in group B. After 4 weeks of CRT, group A was divided into group C (CRT response group) and group D (CRT non-response group). Myocardial tissues were collected from the marginal area of myocardial infarction. The expressions of TGF-β1, p-Smad2/3, and Smad2/3 in group B, group C, and group D were investigated, respectively. Results: The TGF-β1, p-Smad2/3, and Smad2/3 were expressed at low levels in normal myocardial tissues. There showed a significant elevation of the expression of TGF-β1, p-Smad2/3, and Smad2/3 at the marginal area of myocardial infarction after the first diagonal branch was ligatured. The expression of TGF-β1, p-Smad2/3, and Smad2/3 in Group C and Group D were both higher than that in normal myocardial tissues. The collagen fibers of the marginal area of myocardial infarction in group C were significant less than that in group B or group D, meanwhile the expression of TGF-β1, p-Smad2/3, and Smad2/3 in group C were also lower than that in group B and group D (p<0.05). Conclusions: In the responders of Beagles with ischemic cardiomyopathy, CRT can inhibit the expression of TGF-β1, p-Smad2/3, and Smad2/3 and reduce the deposition of collagen fibers, which leads to the improvement of cardiac function.

Goldilocks and the importance of AV intervals in cardiac resynchronization—How to best find the AV interval that is not too long, not too short, but just right for patients

Long before cardiac resynchronization (CRT) became standard therapy for patients with QRS prolongation and drug-refractory heart failure, standard dual chamber pacing in the right atrium and right ventricle using short atrioventricular (AV) delays was undertaken. The proponents of this procedure performed in patients without traditional bradycardia indications for pacing theorized that a shortened AV delay would decrease symptoms of heart failure by decreasing mitral and tricuspid valve regurgitation. Several case reports and case studies demonstrated favorable outcomes of improvement in cardiac output and decrease in symptoms of breathlessness in patients randomized to right ventricular pacing with short AV intervals. 1,2 Right ventricular pacing solely to improve symptomatic heart failure in patients without bradycardia was no longer thought useful after the publication of a double-blind randomized crossover trial of 12 patients, which demonstrated no difference in hemodynamic parameters or symptoms of heart failure between the times spent in the backup VVI 40 beats/min mode vs the VDD mode with an AV delay of 100 ms. The importance of AV intervals was realized even in the early days of left ventricular pacing for the treatment of heart failure. In a substudy of the Pacing Therapies in Congestive Heart Failure (PATH-CHF) trial, patients with a left bundle branch block treated with an epicardial left ventricular lead had significant differences in acute hemodynamic parameters as the AV interval was varied. There were significant variations in the optimal AV interval among individual patients, but the greatest benefit was seen as improvements in aortic pulse pressure, aortic systolic pressure, and left ventricular contractility if the AV interval was not too short and not too long. 3

Video-Assisted Thoracoscopic Left Ventricular Pacing in Patients With and Without Previous Sternotomy

Left ventricular epicardial lead placement via video-assisted thoracoscopy (VAT) is a recognized surgical technique to achieve cardiac resynchronization therapy (CRT) when conventional lead placement has failed. Its role in patients with previous sternotomy is uncertain. We describe our experience in a cohort of patients including those with previous sternotomy. This was a retrospective review of consecutive patients undergoing VAT lead implantation for CRT in a single center between 2004 and 2011. All patients fulfilled conventional criteria for CRT and were followed up at 4 to 6 weeks and then at 3-month intervals. Clinical and pacing parameters were compared at baseline and at the latest review. Thirty-two patients (27 men; mean age, 67 ± 9 years) underwent VAT left ventricular lead implantation. Mean follow-up duration was 704 ± 450 days. Ten patients (31%) had undergone previous sternotomy. Thoracoscopic lead implantation was successful in 31 patients (97%): 1 patient with two previous sternotomies required conversion to open thoracotomy due to bleeding with multiple adhesions. Satisfactory implantation pacing thresholds of 2 volts or less at 0.5 ms were achieved in all patients. Despite a longer operative time in those with previous sternotomy, all clinical and pacing outcomes, including complications, clinical response to CRT, and long-term pacing variables were similar between the groups. VAT left ventricular lead placement appears safe and effective in selected patients with previous sternotomy, including coronary artery bypass operations, with postoperative outcomes comparable with those patients without previous sternotomy.

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

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&lt;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.

THE IMPACT OF CARDIAC RESYNCHRONISATION THERAPY ON TGF-β 1 SIGNAL PATHWAY IN ISCHAEMIC CARDIOMYOPATHY

ObjectivesTo investigate the latent impact of cardiac resynchronisation therapy on TGF-β 1 signal pathway in Beagles with ischaemic cardiomyopathy.MethodsTwenty adult Beagles were divided into group A (CRT group) and group...

Ultrasound-guided thoracotomy for implantation of an epicardial left ventricular lead after left pneumonectomy

Surgical placement of a left ventricular epicardial pacing lead is a valuable alternative to the standard approach of endovascular placement of a pacing lead in the coronary sinus for cardiac resynchronization therapy. Despite higher perioperative morbidity, surgically placed leads perform well with lower revision and dislocation rates. Moreover, surgery is the only option when an endovascular approach proves to be unsuccessful. We report a successful implantation of an epicardial left ventricular lead through an ultrasound-guided lateral left mini-thoracotomy in a patient with a severely disturbed thoracic anatomy due to left pneumonectomy.

Systolic left ventricular apical bulging after biventricular pacing mimicking takotsubo cardiomyopathy.

Resolution of the issue of nonresponsiveness to cardiac resynchronization therapy (CRT) remains crucial to the successful treatment of conduction disturbances in heart failure. In this study, a patient with refractory heart failure including left bundle branch block was treated via surgical CRT. The epicardial left ventricular (LV) lead, implanted using thoracoscopic guidance, was unexpectedly located on the apical side. Echocardiographic findings of the LV motion mimicked takotsubo cardiomyopathy. The LV lead was successfully re-implanted along a lateral branch of the cardiac vein using an endovascular approach, resulting in restored contractility and reversal of the LV remodeling.