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Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

(1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with ep...

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Autores principales: Kim, Hye Ree, Lim, Kyunghee, Park, Seung-Jung, Park, Jong-Sung, Kim, Ju Youn, Chung, Suryeun, Jung, Dong-Seop, Park, Kyoung-Min, On, Young Keun, Kim, June Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9145737/
https://www.ncbi.nlm.nih.gov/pubmed/35621871
http://dx.doi.org/10.3390/jcdd9050160
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author Kim, Hye Ree
Lim, Kyunghee
Park, Seung-Jung
Park, Jong-Sung
Kim, Ju Youn
Chung, Suryeun
Jung, Dong-Seop
Park, Kyoung-Min
On, Young Keun
Kim, June Soo
author_facet Kim, Hye Ree
Lim, Kyunghee
Park, Seung-Jung
Park, Jong-Sung
Kim, Ju Youn
Chung, Suryeun
Jung, Dong-Seop
Park, Kyoung-Min
On, Young Keun
Kim, June Soo
author_sort Kim, Hye Ree
collection PubMed
description (1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches.
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spelling pubmed-91457372022-05-29 Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy Kim, Hye Ree Lim, Kyunghee Park, Seung-Jung Park, Jong-Sung Kim, Ju Youn Chung, Suryeun Jung, Dong-Seop Park, Kyoung-Min On, Young Keun Kim, June Soo J Cardiovasc Dev Dis Article (1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches. MDPI 2022-05-16 /pmc/articles/PMC9145737/ /pubmed/35621871 http://dx.doi.org/10.3390/jcdd9050160 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kim, Hye Ree
Lim, Kyunghee
Park, Seung-Jung
Park, Jong-Sung
Kim, Ju Youn
Chung, Suryeun
Jung, Dong-Seop
Park, Kyoung-Min
On, Young Keun
Kim, June Soo
Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title_full Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title_fullStr Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title_full_unstemmed Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title_short Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy
title_sort thoracoscopic implantation of epicardial left ventricular lead for cardiac resynchronization therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9145737/
https://www.ncbi.nlm.nih.gov/pubmed/35621871
http://dx.doi.org/10.3390/jcdd9050160
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