Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing☆

Abstract

Surgical epicardial lead placement revealed excellent long-term results and a lower LV-related complication rate compared to CS-leads. Although, the approach via limited thoracotomy for biventricular pacing is associated with 'more surgery', it is a safe and reliable technique and should be considered as an equal alternative.

Expanding Applications of Defibrillators and Cardiac Resynchronization Therapy to Include Adult Congenital Heart Disease

“…Transvenous attempts at coronary sinus cannulation may also result in failure to deliver a appropriately positioned lead. Mair et al in a comparative study, also demonstrated a higher complication rate with transvenous CS lead placement than with epicardial implantation via a mini-thoracotomy procedure (26). A video-assisted thoroscopy creating a minimally invasive percutaneous approach may be a solution but the option requires expertise and is dependent on centre availability (28).…”

“…Perhaps a more guided approach such as that suggested by Dekker et al using intra-procedural pressurevolume loop monitoring may have altered the outcome (25). Epicardial pacing systems have been more frequently associated, than transvenous systems, with higher pacing thresholds, diaphragmatic stimulation, lead fracture and insulation breaks (26).The use of steroid eluting leads, does alleviate some of the deterioration in pacing parameters but this unfortunately did not offer an advantage in the second patient (27). Due to previous surgery, the location of viable myocardium for pacing is difficult and www.intechopen.com…”

“…Published online 26 The only known effective therapy for lethal disturbances in cardiac rhythm is deï¬ brillation, the delivery of a strong electric shock to the heart. This technique constitutes the most important means for prevention of sudden cardiac death.…”

Cardiac resynchronisation therapy and the role of optimal device utilisation

“…Ultimately, a guided epicardial lead positioning may be an option. 7 Optimalisation of device programming After implantation of the device, programming of the device is of pivotal importance and should be optimised for the individual patient. Initially, an AV optimalisation is needed to ensure an optimal diastolic filling time and to abolish presystolic mitral valve regurgitation, frequently seen in chronic heart failure patients due to ventricular dilation or papillary muscle dyssynchrony.…”

Epicardial Wireless Pacemaker for Improved Left Ventricular Resynchronization (Conceptual Design)

“…The implant procedure for an LV lead is more challenging because physicians must locate a region where good capture thresholds can be achieved and the site of most delay for left ventricular mechanical activation. 18 Without a well positioned LV lead, CRT devices lose their ability to perform cardiac resynchronization. Other complications with LV implant include lead dislodgement, coronary sinus thrombosis, loss of pacing capture, and stimulation of the diaphragm.…”