Four years follow-up of epicardial left ventricular pacing by mini-thoracotomy for cardiac resynchronisation therapy in congestive heart failure (four cases).

BACKGROUND AND AIM To establish whether left ventricular (LV) pacing by mini-thoracotomy is a safe and feasible procedure after failed transvenous cardiac resynchronisation therapy (CRT), we described four cases of patients who demonstrated congestive heart failure (CHF), had transvenous LV lead implantation failures, and underwent a mini-left-lateral thoracotomy and implantation of an epicardial LV lead. METHODS After a mean follow-up 45 ± 3.5 months, the haemodynamic benefits of CRT were apparent in four patients. RESULTS Mean LV ejection fraction increased from 28.4 ± 6.5% to 44.5 ± 13.7% (p = 0.024), in association with a reduction of LV end-systolic diameters from 62.3 ± 10.3 mm to 53.0 ± 13.11 mm (p = 0.029). QRS width decreased from 162.5 ± 23.6 ms to 147.5 ± 18.9 ms (p = 0.014). New York Heart Association values significantly improved before and after the procedure. CONCLUSIONS These results suggest that epicardial LV pacing by mini-thoracotomy for CRT in CHF is feasible and can bring satisfactory long-term results.