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Europace Advance Access published online on April 17, 2008
Europace, doi:10.1093/europace/eun090
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

CASE REPORT

New method for cardiac resynchronization therapy: transapical endocardial lead implantation for left ventricular free wall pacing

Imre Kassai1, Csaba Foldesi1, Andrea Szekely1 and Tamas Szili-Torok2,*

1 Gottsegen Gyorgy Hungarian Institute of Cardiology, Haller utca 29, 1096 Budapest, Hungary; 2 Department of Clinical Electrophysiology, Thoraxcentre, Erasmus Medical Center, Molewaterplein 40, kamer Ba 577, Postbus 2040, 3000 CA Rotterdam, The Netherlands

Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a significant dislocation rate during follow-up. For these patients, epicardial pacing lead implantation is the most frequently used alternative. The aim of this case report is to describe a fundamentally new approach for the endocardial LV lead implantation. An epicardial lead implantation was planned, but after thoracotomy, extensive pericardial adhesions were found. An active fixation lead was placed into the LV cavity using the standard Seldinger technique through the LV apex. After an uneventful post-operative period at the 3- and 6-month follow-up visits, the patient had effective CRT with unchanged pacing parameters. In conclusion, this is the very first report showing feasibility of transapical LV lead implantation.

* Corresponding author. Tel: +31104633991; fax: +3612151220 ext. 413. E-mail address: t.szilitorok{at}erasmusmc.nl

Manuscript submitted 31 January 2008. Accepted after revision 19 March 2008.


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