Epicardial versus Transvenous Left Ventricular Lead Placement in Patients Receiving Cardiac Resynchronization Therapy: Results from a Randomized Prospective Study

Abstract

Both epicardial and transvenous LV-lead placement for CRT therapy are safe and effective. The transvenous approach is less invasive and should be considered the standard procedure for patients without renal insufficiency. However, in a case of difficult coronary venous anatomy with the inability to position the lead as desired, epicardial LV-lead placement remains an alternative option.

Epicardial leads in adult cardiac resynchronization therapy recipients: A study on lead performance, durability, and safety

“…Several studies have reported on epicardial lead performance in the early days of CRT, but advances made in both lead technology as well as implantation techniques make it difficult to compare these results to the present clinical situation. 8,11,12,18 Furthermore, studies investigating contemporary epicardial LV lead performance were lacking in either population size or follow-up. 9,10,18-20 Therefore, the current study provides novel data on the performance of epicardial LV leads in adult CRT-D recipients.…”

“…[15][16][17] Moreover, there has been a renewed interest in epicardial LV leads, with the development of novel implantation techniques and new lead technologies. 8,18 However, because the available data on epicardial leads in adults consist of small patient groups or limited follow-up, concerns remain regarding long-term epicardial lead performance in adult patients. 9,[18][19][20] The aim of this study was to evaluate long-term performance of epicardial LV leads in a large population of adult CRT recipients.…”

“…8,18 However, because the available data on epicardial leads in adults consist of small patient groups or limited follow-up, concerns remain regarding long-term epicardial lead performance in adult patients. 9,[18][19][20] The aim of this study was to evaluate long-term performance of epicardial LV leads in a large population of adult CRT recipients. Therefore, the focus of the current study was on electrical parameters rather than echocardiographic response to CRT.…”

A transatrial pericardial access: lead placement as proof of concept

“…Multiple factors may account for this lack of clinical improvement, with suboptimal LV lead placement considered a major reason for nonresponse (26). In a recent study, the placement of LV leads using a standard transveous method and a transthoracic pericardial access method was shown to have similar pacing characteristics 6 mo postimplant (7). However, the use of the standard transveous method was recommended as the preferred approach for lead Fig.…”

“…Epicardial mapping and lead placement hold the promise of significantly improving responder rates and improving CRT therapy adoption (11). Epicardial lead placement techniques (thoracotomy, full or mini) are a significant procedural barrier for implanting electrophysiologists and cardiologists (7). Transvenous epicardial access may also enable sensor placement on the epicardium without crossing the tricuspid valve.…”