18 Epicardial Left Ventricular Lead Implantation is Safe and Effective: Experience From a Large Tertiary Centre

Background Cardiac Resynchronisation Therapy (CRT) is known to improve morbidity and mortality in selected patients with heart failure. The left ventricular (LV) lead is commonly placed percutaneously via the coronary sinus with a 10–13% failure rate. Epicardial lateralLV lead placement via a left submammary incision is an alternative method when the percutaneous method fails. We report our experience from a large tertiary centre. Methods Retrospective study evaluating all patients having elective surgical epicardial LV lead placement via left submammary incision between November 2006 and November 2013. Data collected included baseline parameters, procedural and follow-up data, including NYHA class, hospital stay, 30 day readmission rate and mortality. Results Forty two patients underwent elective surgical epicardial LV lead placement. Table 1 demonstrates demographic and baseline data. Abstract 18 Table 1 Baseline characteristics n n Men 33 PCI 10 Mean Age 70.8+/-8.4 CABG 10 NYHA I 1 Smoking 20 NYHA II 3 Diabetes mellitus 11 NYHA III 36 Hypertension 24 NYHA IV 2 Hypercholesterolaemia 15 Myocardial infarction 23 Asthma/COPD/ILD 5 Angina 14 Chronic kidney disease 13 Atrial fibrillation 18 Stroke/TIA 10 All patients initially had an attempted transvenous procedure. Reasons for transvenous LV lead failure are outlined in Table 2. A further attempt at percutaneous placement was made in 12 patients. Abstract 18 Table 2 Reason for LV lead failure Immediate n Late N Venous access 4 Diaphragmatic stimulation 7 Coronary sinus access 10 Lead displaced 6 Access to suitable site/gain capture 10 Increased threshold 4 Diaphragmatic stimulation 1 30 day mortality was 2 patients (4.8%), both of whom died during their admission. One patient died from intra-operative haemorrhage. The other patient had intra-operative ventricular tachycardia, developing multiple organ failure and dying 7 days later. 39 patients spent one post-operative day on HDU and one patient was taken directly to the ward. The median hospital stay was 3 nights (range 1–13), with 4 patients transferred to another hospital. Other complications in 7 (16.7%) patients during follow-up included the LV lead not capturing requiring same day revision (n = 1), pneumonia/UTI treated with oral antibiotics (n = 1), pneumonia and wound infection treated with oral antibiotics (n = 1), wound infection treated with oral antibiotics (n = 1), box infection (n = 2, one requiring IV antibiotics), and late LV lead failure (n