Epicardial versus transvenous left ventricular lead placement in patients receiving cardiac resynchronization therapy: results from a randomized prospective study.

BACKGROUND: The aim of this prospective study was to determine the differences in left ventricular (LV) lead positioning for cardiac resynchronization therapy (CRT): comparing a percutaneous transvenous approach via the coronary sinus versus epimyocardial placement via a left lateral mini-thoracotomy.

METHODS: Eighty consecutive patients with symptomatic left ventricular dysfunction and an indication for CRT were randomized to receive either a transvenous (n = 40) or epicardial (n = 40) LV-lead placement. Postoperative follow-up included assessment of NYHA functional class, ECG and echocardiography.

RESULTS: The transvenous group had a shorter ICU stay (0.66 vs. 3.8 days) and shorter ventilation times (0.34 vs. 3.2 h). The epicardial group had less exposure to radiation (7.4 vs. 23 min) and required less use of contrast medium (3.24 vs. 61 ml). At 6 months follow-up, no major differences in LV-lead parameters (threshold, sensing, and impedance) were observed.

CONCLUSION: Both epicardial and transvenous LV-lead placement for CRT therapy are safe and effective. The transvenous approach is less invasive and should be considered the standard procedure for patients without renal insufficiency. However, in a case of difficult coronary venous anatomy with the inability to position the lead as desired, epicardial LV-lead placement remains an alternative option.