Copyright © 2004 by the European Society of Cardiology.
Clinical research
Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronisation therapy delivery
a Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
b Niguarda Ca'Granda Hospital, Milan, Italy
c "LaSapienza" University, Rome, Italy
d S. Camillo Hospital, Rome, Italy
e Medtronic Italy, Milan, Italy
* Corresponding author. Tel.: +39066837208; fax: +390668300746
E-mail address: puglisiandrea{at}hotmail.com
Received 24 November 2003; revised 18 March 2004; accepted 2 April 2004
Abstract
Aims Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory.
Methods and results We enrolled 33 patients (8 females, 65±10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51±28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3±0.7 V, bi-ventricular pacing impedance was 476±201 
and R-wave amplitude was 15.0±6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters.
Conclusion Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
Key Words: Thoracotomy • Resynchronisation therapy • Heart failure
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. Atoui, V. Essebag, V. Wu, Y. Ge, M.-H. Auclair, T. Hadjis, and D. Shum-Tim Biventricular pacing for end-stage heart failure: early experience in surgical vs. transvenous left ventricular lead placement Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 839 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gras, D. Bocker, M. Lunati, H.J.J. Wellens, M. Calvert, N. Freemantle, R. Gervais, L. Kappenberger, L. Tavazzi, E. Erdmann, et al. Implantation of cardiac resynchronization therapy systems in the CARE-HF trial: procedural success rate and safety Europace, July 1, 2007; 9(7): 516 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review JAMA, June 13, 2007; 297(22): 2502 - 2514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R.M. Jongbloed, H. J. Lamb, J. J. Bax, J. D. Schuijf, A. de Roos, E. E. van der Wall, and M. J. Schalij Noninvasive visualization of the cardiac venous system using multislice computed tomography J. Am. Coll. Cardiol., March 1, 2005; 45(5): 749 - 753. [Abstract] [Full Text] [PDF]
|
|