Concomitant Surgical Transatrial and Transapical Approach for CRT-D Implantation in A Patient with Severe Chest Burn Skin Injury: Case Report

Abstract Introduction: According to the current clinical guidelines, CRT-D implantation is indicated for patients with history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS or high-degree AV block. Case presentation: A patient with DCM received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. We believed, that the 40 years old burn injury was the reason for the necrosis, resulted from the altered microcirculation of the skin. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue. We decided to perform surgical reimplantation of the device using mini thoracotomy: right atrial and right ventricular leads were introduced through the right atrial appendage and the left ventricular lead was inserted transapically. The device was implanted under the less scabby abdominal skin. 6 weeks later there was no sign of other complications and the surgical wounds were healed completely.Conclusions: We successfully applied the combination of trans-atrial and trans-apical lead placement, which has not been reported in the literature yet. It serves as an alternative method, if the standard approach is not feasible.