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Long-Term Follow-Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy.
- Source :
-
Pacing & Clinical Electrophysiology . Oct2016, Vol. 39 Issue 10, p1052-1060. 9p. - Publication Year :
- 2016
-
Abstract
- Background Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach. Aim To evaluate the success of this approach at long-term follow-up. Methods Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response). Results Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified. Conclusion Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ACADEMIC medical centers
*CARDIAC pacing
*CONFIDENCE intervals
*ELECTRODES
*FISHER exact test
*GOODNESS-of-fit tests
*ARTIFICIAL implants
*MICROSURGERY
*PROBABILITY theory
*T-test (Statistics)
*LOGISTIC regression analysis
*TREATMENT effectiveness
*RETROSPECTIVE studies
*DATA analysis software
*DESCRIPTIVE statistics
*ODDS ratio
*MANN Whitney U Test
*THORACOTOMY
Subjects
Details
- Language :
- English
- ISSN :
- 01478389
- Volume :
- 39
- Issue :
- 10
- Database :
- Academic Search Index
- Journal :
- Pacing & Clinical Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 118669183
- Full Text :
- https://doi.org/10.1111/pace.12932