Original article
Adult cardiac
Prophylactic Epicardial Left Ventricular Lead Implantation for Biventricular Pacing During Operations

https://doi.org/10.1016/j.athoracsur.2013.09.017Get rights and content

Background

Surgical epicardial left ventricular (LV) lead implantation for biventricular pacing has advantages over the transvenous approach in cardiac surgical patients. We investigated the benefit of concomitant prophylactic LV lead implantation during open heart operations and subsequent lead performance after patients with impaired LV function receive a biventricular device.

Methods

Retrospective data of 4,844 patients undergoing cardiac operations through a sternotomy between January 2001 and December 2011 were analyzed. Of these, 380 patients (7.8%) had severe impairment of LV function (contrast left ventriculogram showing grade 4 estimated ejection fraction or echocardiogram showing LV ejection fraction < 0.30). LV lead implantation was performed in patients in whom recovery of LV function was unlikely. Lead performance data were collected at follow-up.

Results

LV lead implantation occurred in 95 patients (25%), and 29 (30.5%) subsequently received a biventricular device. Of patients with impaired LV function, more patients with prophylactic LV leads underwent biventricular implant than those without LV leads (30.5% vs 1.1%, p < 0.0001). The median interval from LV lead implantation to connection to a biventricular device was 30 days (interquartile range, 5.5 to 145 days). At a median follow-up of 437.5 days (interquartile range, 13.8 to 1198 days), the mean pacing threshold (1.25 ± 0.46 vs 1.58 ± 0.66 volts, p = 0.069) and impedance (383.81 ± 70.33 vs 448.6 ± 200.1 Ohms, p = 0.168) remained stable compared with time of biventricular device connection.

Conclusions

A significant proportion of patients with poor LV function undergoing cardiac operations may benefit from concomitant LV lead implantation. Subsequent lead performance appears satisfactory. Epicardial LV lead placement is easily accomplished during open heart operations and should be considered before the operation.

Section snippets

Patients and Methods

The Institutional Ethics Committee approved publication of this study and the use of LV leads and patient data within the database.

The study included all patients undergoing cardiac operations between January 2001 and December 2011 in our institution. Data were retrieved retrospectively from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and from patient medical records. A detailed description of data collection and validation has been previously described [9].

Results

Between June 2001 and December 2011, 4,844 consecutive patients underwent cardiac operations with a median sternotomy. Full results are provided in Table 1.

Clinical symptoms of heart failure were evident in 3,308 patients (68.3%) with NYHA class II, III, or IV symptoms. According to our criteria, 380 patients (7.8%), with a mean age of 66.5 ± 11.0 years, had impaired LV function, and 338 (88.9%) were in NYHA class II, III, or IV. There were statistically significant differences in most

Comment

Our study identifies a significant subgroup of patients with impaired LV function who can benefit from concomitant prophylactic LV lead implantation. To our knowledge, this is the largest database of patients undergoing prophylactic LV lead implantation during cardiac operations.

Transvenous LV lead placement is currently considered the first-line approach for cardiac resynchronization therapy but is unsuccessful in up to 10% of patients due to technical factors, such as inability to cannulate

References (16)

  • A.S. Go et al.

    Heart disease and stroke statistics—2013 update: a report from the American Heart Association

    Circulation

    (2013)
  • D.J. Bradley et al.

    Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials

    JAMA

    (2003)
  • A.E. Epstein et al.

    2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society

    Circulation

    (2013)
  • J.P. Singh et al.

    Biventricular pacing: current trends and future strategies

    Eur Heart J

    (2012)
  • E.W. Lau

    Achieving permanent left ventricular pacing-options and choice

    Pacing Clin Electrophysiol

    (2009)
  • A. Barosi et al.

    Cardiac resynchronization therapy in patients undergoing open-chest cardiac surgery

    J Interv Card Electrophysiol

    (2011)
  • F. Mellert et al.

    Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function—a worthwhile procedure in concomitant surgical interventions?

    Thorac Cardiovasc Surg

    (2012)
  • U.F. Tesler et al.

    Cardiac resynchronization therapy as an adjunct to conventional surgical treatment for heart failure

    Tex Heart Inst J

    (2008)
There are more references available in the full text version of this article.

Cited by (0)

View full text