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Europace 2009 11(10):1323-1329; doi:10.1093/europace/eup251
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and Cardiac Resynchronization Therapy

A prospective longitudinal evaluation of the benefits of epicardial lead placement for cardiac resynchronization therapy

Ashish Patwala1, Paul Woods2, Richard Clements2, Khaled Albouaini1, Archana Rao1, David Goldspink2, Lip-Bun Tan3, Aung Oo1 and David Wright1,*

1 Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; 2 RISES, Liverpool John Moores University, Liverpool, UK; 3 Academic Unit of Molecular Vascular Medicine, University of Leeds, Leeds, UK

Aims: Cardiac resynchronization therapy (CRT) is a recognized treatment for appropriate patients. However, placement of the transvenous left ventricular lead is unsuccessful in 5–10% of patients and a further 20% fail to respond. For these groups, epicardial left ventricular lead placement is one alternative. We prospectively evaluated the effects of epicardial vs. transvenous placed CRT.

Methods and results: Twenty-three subjects with unsuccessful transvenous coronary sinus lead placement underwent epicardial implantation. The subjects underwent clinical evaluation, cardiopulmonary exercise testing, and echocardiography before 3 and 6 months after. The results were compared with a control group (n = 35) who had received transvenous CRT. In both groups, there were significant improvements in all measures at 3 and 6 months. The improvement in peak VO2 was delayed in the epicardial group compared with the transvenous group. At 6 months, the improvements seen in all variables showed no difference between the groups.

Conclusion: Epicardial lead placement is a viable option for patients with unsuccessful coronary sinus lead placement. The improvements in most variables were of a similar magnitude and over a similar time scale compared with transvenous placement. Improvements in peak VO2 were delayed in the epicardial group, probably as a result of a prolonged recovery time.

Key Words: Epicardial leads, Cardiac resynchronization therapy, Exercise testing, Cardiac power output, Cardiac reserve

* Corresponding author. Tel: +44 151 600 1457, Fax: +44 151 600 1696, Email: jaywright34{at}hotmail.com

Manuscript submitted 21 June 2009. Accepted after revision 10 August 2009.


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