Introduction: Surgical epicardial LV lead implantation (CRT-S) is an acceptable alternative when lead placement via the coronary sinus is not feasible.
Methods: In the last 7.5 years 29 pts (7 F, 22 M), mean age 65.9±8.2 years (49.9-78.5) with NYHA class III (21 pts) and IV (8 pts) underwent CRT-S. 10 pts (34%) had sustained AF with high-degree AV block (5 pts after AV junction ablation). The remaining pts were in sinus rhythm.
All pts met the ESC inclusion criteria for CRT. The reasons for left ventricular lead placement via lateral thoracotomy were: CS cannulation failure (23 pts), high LV pacing threshold or diaphragm stimulation (3 pts), left subclavian vein occlusion preventing LV lead placement in patients with previous pacemaker implantation (3 pts). 11/29 pts had previous surgical intervention (10 pts after CABG). In all pts RV and/or atrial leads were placed transvenously, and then LV lead distal end was attached surgically to the postero-lateral wall in the sub-annular upper part of the left ventricle and tunneled to the left subclavian pocket.
Results: The mean follow-up was 37±29 months (4.5-93.6). There were 7 (24%) deaths: one death caused by stroke in the early post-operative period, 6 deaths due to worsened heart failure. The QRS width was shortened after CRT-S (167±26 vs 143±21 ms, p<0.001). Comparison of the surviving pts with dead pts is presented in the table.
Conclusions: Surviving pts are characterized by initially wider QRS complex and greater degree of QRS narrowing after CRT-S.