Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years' experience
| Autor: | László Hejjel, Attila Kónyi, Marianna Németh, László Melczer |
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| Rok vydání: | 2020 |
| Předmět: |
Epicardial Mapping
Male medicine.medical_specialty medicine.medical_treatment Bundle-Branch Block Cardiac resynchronization therapy cardiac resynchronization therapy heart failure 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Hematoma Internal medicine medicine Devices Humans 030212 general & internal medicine Aged Retrospective Studies Ejection fraction Epicardial mapping Proportional hazards model business.industry Left bundle branch block General Medicine Middle Aged medicine.disease Thoracotomy Heart failure Ventricular fibrillation Cardiology minithoracotomy Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Pacing and Clinical Electrophysiology |
| ISSN: | 1540-8159 |
| Popis: | Background Cardiac resynchronization therapy (CRT) is considered an efficient method to improve the left ventricular (LV) dysfunction with left bundle branch block. However, coronary venous anatomy is not appropriate in about 10% of the cases; thus other alternatives, such as epicardial lead implantation via minithoracotomy are needed. Methods During the period 2007‐2017, a total of 57 patients were operated at our institute via left anterior minithoracotomy after an unsuccessful transvenous CRT. The best position of the LV epicardial electrode was determined by intraoperative epicardial mapping, that is locating the latest activation spot relative to the right ventricular (RV) electrode. The authors analyzed the survival by Kaplan‐Meier estimator with Tarone‐Ware equality test and multiple Cox regression analysis, the changes of the LV ejection fraction (LVEF) and dimensions, the development of the impedance and threshold of the LV epicardial electrode, the possible associations between the survival and intraoperative sensed RV‐LV activation delay. Results The intraoperative RV‐LV activation delay was 92.250 ± 26.538 milliseconds. There were no intraoperative complications except ventricular fibrillation in three patients. Within 30 days there were neither wound healing complications nor pocket hematoma. There was no significant difference in survival with regard to gender or etiology, but significantly better survival was found in the cohort with intraoperative sensed RV‐LV activation delay >86 milliseconds. The LVEF and dimensions improved following the operation and continued to be improved in the survivors. Conclusion CRT via minithoracotomy with epicardial mapping is a safe, efficient, simple, and reproducible second‐line alternative to the transvenous method. |
| Databáze: | OpenAIRE |
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