Robotically assisted left ventricular epicardial lead implantation for biventricular pacing

Abstract

Robotic LV lead placement is an effective and novel technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular pacing.

2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

“…473 Implantation of 2 epicardial leads may be considered to provide backup capability if 1 lead should fail or become dislodged. 475 Steroid-eluting epicardial leads may be preferable to screw-on leads. 473 The choice of surgical procedure appears to influence hospital morbidity.…”

“…470,476 In contrast, thoracoscopic and robotic approaches have been reported to be associated with minimal morbidity and may be preferred. 472,473,475 These less invasive procedures generally require 60 to 90 minutes of operative time and a mean hospital stay of 4 to 5 days. 472 However, not all patients are candidates for minimally invasive or robotic procedures.…”

Implantation Techniques of Leads for Left Ventricular Pacing in Cardiac Resynchronization Therapy and Electrocardiographic Consequences of the Stimulation Site

“…Further post-implantation risks are similar to conventional pacing. However if placement of a LV lead or the re-implantation fails one should consider surgical placement of an epicardial LV lead, which also can be performed with robotic assistance (DeRose et al,2005) to provide the patient the benefit of CRT. In case surgery is contraindicated transseptal or transapical approaches with endocardial LV lead should be considered.…”

Advanced Techniques for CRT Implantation

“…This is an emerging second line, effective technique performed with endoscopic assistace (DeRose et al, 2003). The daVinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, California) is composed of a surgeon control console and a surgical arm, that positions and directs the micro-instruments.…”