Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

Purpose Limited data exist on the safety and efficacy of epicardial left ventricular(LV) lead placement using video-assisted thoracoscopic surgery(VATS) for cardiac resynchronization therapy(CRT).Methods Acute and long-term outcomes of CRT were compared between patients with epicardial LV leads(Epicardial-LV group, n=13) and those with endocardial LV leads(Endocardial-LV group, n=243).Results Epicardial LV leads were implanted by VATS alone(n=8) or along with mini-thoracotomy(n=5) for failed endocardial implantation(n=11) or recurrent lead dislodgement(n=2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 2.3±0.6 hours without phrenic nerve stimulation. LV pacing thresholds in the Epicardial-LV(1.5±1.0V) and Endocardial-LV(1.3±0.8V) were comparable(P=0.651). All patients were discharged alive post-VATS 8.8±3.9days. During the follow-up(34.3±28.6months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14months and one heart transplantation post-CRT 30months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV(7/243,2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart failure-related hospitalization. Conclusion Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable long-term outcomes achieved by both approaches.