Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function – a worthwhile procedure in cardiac surgery procedures?

Objective: Biventricular pacing (bv) is an effective tool for treatment of heart failure. The present study estimates how many open heart-surgery pts may benefit from implantation of permanent lv-pacing leads. A protocol for identifying potential responders was established. It has to be investigated, if additional costs are justified.

Methods: To establish a protocol, 1059 pts were retrospectively investigated according to lv-function, left BBB and QRS duration. Afterwards, adequate cardiosurgical pts were selected out of 1420 consecutive pts and epicardial lv-leads (Medtronic 5071(ME) or Enpath (EP)) were implanted with concomitant procedures. Mean follow-up time was 6.3±5.5 months, postoperative NYHA class was documented.

Results: Initially, 24 pts (2.3%) potentially would profit from bv-pacing. After establishing our protocol, 22 pts (1.6%) were identified and finally received an epicardial lead. No lead related complications occurred. Acute capture threshold was 0.9±0.4 V (ME, n=17) and 0.5±0.2 V (EP, n=5). While leads in 18 Group A pts were implanted as an upgrade of existing pacemaker or ICD technology, 4 Group B pts had prophylactic implantation with no device attached. In 3 Group B pts (75%), bv-ICDs were implanted 1 to 12 months postop. In Group A, QRS duration decreased (189±35 to 152±16ms, p<0.02) and postoperative mean NYHA functional class improved significantly (2.2±0.5 versus 2.8±0.6).

Conclusion: A small group of cardiosurgical pts may benefit from lv-lead implantation with concomitant cardiosurgical procedures. A protocol for responder- identification is useful. Existing devices should be upgraded to bv-systems. As ICD-implantation is frequent, lv-leads should be implanted routinely.