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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg Rep 2022; 11(01): e61-e63
DOI: 10.1055/s-0042-1757788
Case Report: Cardiac

Concomitant Transatrial and Transapical CRT-D Lead Implantation in a Patient with Chest Burn Injury

Adam Riba 
1   Department of Cardiology, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary
,
Aref Rashed
2   Department of Cardiac Surgery, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary
,
Roland Toth
2   Department of Cardiac Surgery, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary
,
Tamas Tahin
1   Department of Cardiology, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary
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Abstract

Cardiac resynchronization therapy device with defibrillator (CRT-D) implantation is indicated for patients with a history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS, or high-degree atrioventricular block. A 67-year-old patient with dilated cardiomyopathy received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue. We decided to perform surgical reimplantation of the device using minithoracotomy: right atrial and right ventricular leads were introduced through the right atrial appendage and the left ventricular lead was inserted transapically. The device was implanted under the less scabby abdominal skin. We successfully applied the combination of transatrial and transapical lead placement, which has not been reported in the literature yet. It serves as an alternative method if the standard approach is not feasible.

Keywords

heart failure - minimally invasive surgery (includes port access, minithoracotomy) - wound healing


Publication History

Received: 10 July 2022

Accepted: 29 August 2022

Article published online:
09 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Glikson M, Nielsen JC, Kronborg MB. et al; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42 (35) 3427-3520
    CrossrefPubMedGoogle Scholar
  • 2 Kassai I, Pozzoli A, Friedrich O. et al. Transapical approach to optimize left ventricular resynchronization in patients with dilated cardiomyopathy (in Eng). Multimed Man Cardiothorac Surg 2017; 2017 DOI: 10.1510/mmcts.2017.005.
    CrossrefPubMedGoogle Scholar
  • 3 Gellér L, Salló Z, Molnár L. et al. Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation. Europace 2019; 21 (08) 1237-1245
    CrossrefPubMedGoogle Scholar
  • 4 Chaggar PS, Skene C, Williams SG. The transfemoral approach for cardiac resynchronization therapy. Europace 2015; 17 (02) 173 DOI: 10.1093/europace/euu340.
    CrossrefPubMedGoogle Scholar