Summary:
New York - Investigators at St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons have investiagted the utility of a robotically assisted, direct left ventricular (LV) epicardial implantation of biventricular pacing leads.
Approximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques.
Ten patients with congestive heart failure (New York Heart Association class 3.4 +/- 0.5) and a widened QRS complex (184 +/- 31 ms) underwent robotic LV lead placement after failed coronary sinus cannulation. Mean left ventricular ejection fraction (EF) was 12 +/- 6%.
Nineteen epicardial leads were successfully placed on the posterobasal surface of the left ventricle. Intraoperative lead threshold were excellent.
Complications included an intraoperative left ventricular injury injury and a postoperative pneumonia. Improvements in exercise tolerance (8 of 10 patients), ejection fraction (19 +/- 13%, p = 0.04), and QRS duration (152 +/- 21 ms, p = 0.006) have been noted at three to six months follow-up.
The investigators have concluded that robotic left ventricular lead placement is an effective and novel technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular pacing.
Diagnosisheart.com Editor's comment:
Epicardial leads have been successfully implanted in half a dozen centers around the world using robotic devices. This is the first reported series in the literature.
