High‐Density Epicardial Activation Mapping to Optimize the Site for Video‐Thoracoscopic Left Ventricular Lead Implant

Background Epicardial placement of the left ventricular (LV) lead via a video‐assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique. Hypothesis Long‐term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques. Methods The VAT procedure is performed under general anesthesia, with oro‐tracheal intubation and right‐sided ventilation, and requires two 5 mm and one 15 mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device. Results 105 patients were referred to our center for epicardial LV lead implantation. After pre‐operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8 ± 0.5 V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75 min. During a median follow‐up of 24 months, there were no differences in terms of death, cardiovascular hospitalizations or device‐related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status. Conclusions Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.

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“…Previous studies have been published on the VAT technique . We showed that the VAT approach is safe and effective.…”

Section: Discussionmentioning

confidence: 58%

“…19 Previous studies have been published on the VAT technique. [19][20][21]24,[28][29][30][31][32][33][34][35][36] We showed that the VAT approach is safe and effective. We included both patients who had undergone unsuccessful de novo transvenous LV lead implantation and patients who had…”

Section: Discussionmentioning

confidence: 73%

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Marini

Branzoli

Moggio

et al. 2019

Clinical Cardiology

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“…Since transvenous LV lead reimplantation is frequently not feasible because of the anatomy of the coronary sinus and its tributaries, the benefits and risks of a surgical procedure should be considered. 18 We have recently developed a simple technique of thoracoscopic epicardial mapping during LV lead implantation, 19 which seems safe and efficacious for improvement of LV lead electric position. Whether such an intervention should be performed and when-that is, either early after suboptimum transvenous LV lead implant in all patients or reserved for those with subsequent absence of clinical and echocardiographic response to CRT-remains to be established in future prospective studies.…”

Section: Study Implicationsmentioning

confidence: 99%

Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy

Roubíček

Wichterle

Kučera

et al. 2015

Circ: Arrhythmia and Electrophysiology

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We retrospectively analyzed data from a prospective database of patients with an implanted biventricular pacemaker or defibrillator at the Regional Hospital Liberec, Czech Republic, between June 2005 and © 2015 American Heart Association, Inc. Original ArticleBackground-Electric left ventricular lead position, assessed by the electric delay from the beginning of the QRS complex to the local LV electrogram (QLV), was found in previous studies to be a strong predictor of short-term response to cardiac resynchronization therapy. We hypothesized that suboptimum electric position of the left ventricular lead is associated with an excess of heart failure events and mortality. Methods and Results-We analyzed the clinical outcome of patients with left bundle branch block or intraventricular conduction delay treated with cardiac resynchronization therapy at our institution during 9 years. Baseline clinical characteristics, QLV/ QRS duration (QLV ratio) at cardiac resynchronization therapy implant, and data about heart failure hospitalization and mode of death were collected in 329 patients who were followed for a period of 3.3±1.9 years. Of them, 83 were hospitalized for heart failure and 83 died. Event rates for all-cause mortality, cardiac mortality, noncardiac mortality, heart failure mortality, and sudden death were 25.2%, 14.9%, 10.3%, 12.2%, and 2.1%, respectively. Patients with a QLV ratio ≤0.70 had significantly worse event-free survival for all study end points-hazard ratio, 1.6; 95% confidence interval, 1.0 to 2.4; P=0.05 for heart failure hospitalization; hazard ratio, 2.9; 95% confidence interval, 1.6 to 5.5; P=0.001 for heart failure mortality; hazard ratio, 1.8; 95% confidence interval, 1.1 to 2.7; P=0.01 for cardiac mortality; and hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.7; P=0.01 for all-cause mortality. In multivariable analysis, QLV ratio ≤0.70 remained associated with all study end points. Conclusions-Electric left ventricular lead position in cardiac resynchronization therapy patients was a significant predictor of heart failure hospitalization and mortality.

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“…2 In this regard, the literature shows robotic videothoracoscopic epicardial QLV mapping using a duodecapolar catheter to be highly successful in identifying the optimal LV pacing site using QLV which mirrors our findings. 3 In addition, the use of 3D-EAM serves to provide real-time QLV mapping at the time of surgery thereby offering enhanced precision for optimal LV lead positioning. WEY ET AL.…”

Section: Discussionmentioning

confidence: 99%

Physiological optimization of robotic endoscopic epicardial CRT‐D implantation using multielectrode electroanatomic mapping

Wey

Chua

Balkhy

et al. 2019

Cardiovasc electrophysiol

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Multielectrode epicardial mapping during robotic implantation of cardiac resynchronization‐defibrillator system. Robotically assisted endoscopic implantation of cardiac implantable devices is well documented to be both feasible and safe, and this technique provides particular benefit in patients with limited vascular access. In a patient meeting Class I indication for cardiac resynchronization therapy with defibrillator and inaccessible vascular access, we describe in this case an optimization strategy for intraoperative left ventricular lead placement utilizing robotic epicardial electroanatomic mapping as well as the feasibility of implanting a totally epicardial biventricular cardioverter‐defibrillator system.

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High‐Density Epicardial Activation Mapping to Optimize the Site for Video‐Thoracoscopic Left Ventricular Lead Implant

Cited by 13 publications

References 32 publications

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy

Physiological optimization of robotic endoscopic epicardial CRT‐D implantation using multielectrode electroanatomic mapping

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