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Thoracoscopic Left Ventricle Epicardial Lead Implantation
Behnam Shakerian;
Shahrekord University of Medical Sciences, shahrekord, Iran, Islamic Republic of
BACKGROUND:Placement of permanent epicardial left ventricular leads through video- assisted thoracic surgery is a reasonable alternative to transvenous insertion of leads in the case of inadequate coronary sinus anatomy. A 42-years-old man a known case of ischemic cardiomyopathy since 4 years ago referred for implantation of implantable cardioverter defibrillator. He experienced 2 times of admissions for controlling of heart failure symptoms. His left ventricular ejection fraction was as low as 20%. He candid for implant cardiac resynchronization defibrillator device for primary prevention and failure management. After local anesthesia left subclavian vein accesses were obtained via seldinger method. Right ventricle high voltage lead inserted first and placed in mid apical portion with acceptable pacing threshold and R wave up to 11mv. Then we attempted to take coronary sinus. Because severe angulation of coronary sinus ostia, placement of lead impossible in selected site. Placement of atrial lead in right atrium appendix with good P wave and pacing threshold was done. At the end of procedure, the device pocket closed and scheduled the time for next week, to place epicardial lead through thoracoscopy guide. Once the lateral wall of the left ventricle was exposed, a left ventricle epicardial lead was inserted and fixed.
RESULTS:Cardiac resynchronization therapy is the technique of choice for heart pacing in patient with advanced heart failure. The surgical approach to the left ventricle can be carried out through thoracotomy but due to morbidity and mortality infrequently used in ventricular resynchronization. An alternative method is surgical implantation under direct vision by video-assisted thoracoscopy that currently used in a wide range of surgical procedure. Video-assisted thoracoscopy for insertion of an epicardial pace is less invasive, less pain, rapid recovery and permit easier access to best suitable site of the left ventricle for more effective mechanical synchronization and help avoid epicardial fat and fibrosis insertion of lead, that can cause conduction abnormality.
CONCLUSIONS:The video-assisted thoracoscopy approach for left ventricle lead implantation is safe and allows optimal site of implantation under direct vision with minimal complication.
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