EXPEDITED REVIEW
Robotically assisted left ventricular epicardial lead implantation for biventricular pacing
Joseph J. DeRose, Jr, MD*,*,
Robert C. Ashton, Jr, MD*,
Scott Belsley, MD*,
Daniel G. Swistel, MD*,
Margot Vloka, MD, FACC ,
Frederick Ehlert, MD, FACC,
Roxana Shaw, PA*,
Jonathan Sackner-Bernstein, MD, FACC,
Zak Hillel, MD, PhD and
Jonathan S. Steinberg, MD, FACC
* Division of Cardiothoracic Surgery, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Division of Cardiology, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Manuscript received January 24, 2003;
revised manuscript received February 19, 2003,
accepted February 24, 2003.
* Reprint requests and correspondence: Dr. Joseph J. DeRose, Jr., 1090 Amsterdam Avenue, Suite 7A, New York, New York 10025, USA.
jjd11{at}columbia.edu
OBJECTIVES: Ventricular resynchronization might be achieved in a minimally invasive fashion using a robotically assisted, direct left ventricular (LV) epicardial approach.
BACKGROUND: Approximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus (CS) cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques.
METHODS: 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 CS cannulation. Mean patient age was 71 ± 12 years, LV ejection fraction (EF) was 12 ± 6%, and LV end-diastolic diameter was 7.1 ± 1.3 cm. Three patients had previous cardiac surgery, and five patients had a prior device implanted.
RESULTS: Nineteen epicardial leads were successfully placed on the posterobasal surface of the LV. Intraoperative lead threshold was 1.0 ± 0.5 V at 0.5 ms, R-wave was 18.6 ± 8.6 mV, and impedance was 1,143 ± 261 ohms at 0.5 V. Complications included an intraoperative LV injury and a postoperative pneumonia. Improvements in exercise tolerance (8 of 10 patients), EF (19 ± 13%, p = 0.04), and QRS duration (152 ± 21 ms, p = 0.006) have been noted at three to six months follow-up. Lead thresholds have remained unchanged (2.1 ± 1.4 V at 0.5 ms, p = NS), and a significant drop in impedance (310 ± 59 ohms, p < 0.001) has been measured.
CONCLUSIONS: Robotic LV 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.
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Abbreviations and Acronyms
| | CS | | coronary sinus | | EF | | ejection fraction | | ICD | | implantable cardioverter defibrillator | | LV | | left ventricle/ventricular | | NYHA | | New York Heart Association | | OM | | obtuse marginal |
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