Background Cardiac Resynchronisation Therapy (CRT) is known to improve morbidity and mortality in selected patients with heart failure. The left ventricular (LV) lead is commonly placed percutaneously via the coronary sinus with a 10–13% failure rate. Epicardial lateralLV lead placement via a left submammary incision is an alternative method when the percutaneous method fails. We report our experience from a large tertiary centre.
Methods Retrospective study evaluating all patients having elective surgical epicardial LV lead placement via left submammary incision between November 2006 and November 2013. Data collected included baseline parameters, procedural and follow-up data, including NYHA class, hospital stay, 30 day readmission rate and mortality.
Results Forty two patients underwent elective surgical epicardial LV lead placement. Table 1 demonstrates demographic and baseline data.
All patients initially had an attempted transvenous procedure. Reasons for transvenous LV lead failure are outlined in Table 2. A further attempt at percutaneous placement was made in 12 patients.
30 day mortality was 2 patients (4.8%), both of whom died during their admission. One patient died from intra-operative haemorrhage. The other patient had intra-operative ventricular tachycardia, developing multiple organ failure and dying 7 days later. 39 patients spent one post-operative day on HDU and one patient was taken directly to the ward. The median hospital stay was 3 nights (range 1–13), with 4 patients transferred to another hospital.
Other complications in 7 (16.7%) patients during follow-up included the LV lead not capturing requiring same day revision (n = 1), pneumonia/UTI treated with oral antibiotics (n = 1), pneumonia and wound infection treated with oral antibiotics (n = 1), wound infection treated with oral antibiotics (n = 1), box infection (n = 2, one requiring IV antibiotics), and late LV lead failure (n = 1). Two patients (4.8%) were readmitted within 30 days.
35 patients were followed up at a median of 7 weeks (range 1–32). 12 of these had a documented reduction in their NYHA class. 6 out of 25 patients who were on diuretics prior to lead placement had these reduced within this follow-up.
Conclusion Epicardial LV lead placement is safe and effective when endocardial lead placement is not possible. Postoperative recovery in such high risk patients is good and has comparable outcomes. Precise anatomic placement could be considered for optimisation.
- Epicardial Lead
- Cardiac Resynchronisation Therapy
- Heart Failure
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