PMID- 12611737
OWN - NLM
STAT- MEDLINE
DCOM- 20030422
LR  - 20191106
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 6
IP  - 1
DP  - 2002
TI  - Biventricular pacing for congestive heart failure: early experience in surgical 
      epicardial versus coronary sinus lead placement.
PG  - E1-6; discussion E1-6
AB  - OBJECTIVE: Biventricular pacing (BVP) has recently been introduced for the 
      treatment of refractory congestive heart failure. Coronary sinus lead placement 
      for left ventricular pacing is technically difficult, has a risk of lead 
      dislodgement, and has long procedure times. Surgical epicardial lead placement 
      has the potential advantage of the visual selection of an optimal pacing site, 
      does not need exposure to ionic radiation, and allows lead multiplicity, but it 
      does require a thoracotomy and general anesthesia. We report our early experience 
      of BVP with both modalities. METHODS: BVP was performed in 12 patients with New 
      York Heart Association (NYHA) class IV congestive heart failure (10 men, 2 
      women). Mean patient age was 68.7 years (range, 41-83 years). Surgical epicardial 
      leads were placed through a 2- to 3-inch incision via a left fourth or fifth 
      intercostal thoracotomy in 4 patients with single lung ventilation under general 
      anesthesia. The other 8 patients underwent transvenous coronary sinus lead 
      placement under conscious sedation. RESULTS: Postoperative NYHA class status 
      improved from class IV to class II in 8 patients and to class III in 3 patients. 
      In 5 of the 8 patients who had undergone follow-up echocardiography with mitral 
      regurgitation, the severity of the mitral regurgitation improved. The mean left 
      ventricular ejection fractions before and after BVP were 18.3% +/- 8.3% and 20.5% 
      +/- 8.0%, respectively (P =.16). Mean fluoroscopy and total procedure times for 
      transvenous lead placement were 77 +/- 19 minutes and 266 +/- 117 minutes, 
      respectively. The mean surgery time for epicardial lead placement was 122 +/- 13 
      minutes. There were no differences between the 2 methods in pacing threshold or 
      in lead dislodgement. There were no complications related to the surgery or the 
      laboratory procedure. CONCLUSION: In patients with NYHA class IV congestive heart 
      failure, epicardial lead placement through a minithoracotomy for BVP was 
      performed safely with benefits equivalent to those of coronary sinus lead 
      placement and with a shorter procedure time.
FAU - Izutani, Hironori
AU  - Izutani H
AD  - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 
      Ohio 44109-1998, USA.
FAU - Quan, Kara J
AU  - Quan KJ
FAU - Biblo, Lee A
AU  - Biblo LA
FAU - Gill, Inderjit S
AU  - Gill IS
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Pacing, Artificial/*methods
MH  - Female
MH  - Heart Failure/*therapy
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
EDAT- 2003/03/04 04:00
MHDA- 2003/04/23 05:00
CRDT- 2003/03/04 04:00
PHST- 2002/09/16 00:00 [received]
PHST- 2002/09/18 00:00 [accepted]
PHST- 2003/03/04 04:00 [pubmed]
PHST- 2003/04/23 05:00 [medline]
PHST- 2003/03/04 04:00 [entrez]
AID - 10.1532/hsf.1008 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2002;6(1):E1-6; discussion E1-6. doi: 10.1532/hsf.1008.