Endurance and performance of two different concepts for left ventricular stimulation with bipolar epicardial leads in long-term follow-up

H Burger; T Schwarz; W Ehrlich; W Klövekorn; B Ziegelhöffer

doi:10.1055/s-0029-1247086

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Thorac Cardiovasc Surg 2010; 58 - P152
DOI: 10.1055/s-0029-1247086

Endurance and performance of two different concepts for left ventricular stimulation with bipolar epicardial leads in long-term follow-up

H Burger ¹, T Schwarz ¹, W Ehrlich ¹, W Klövekorn ¹, B Ziegelhöffer ¹

¹Kerckhoff-Klinik, Herzchirurgie, Bad Nauheim, Germany

Congress Abstract

Objectives: Epicardial left ventricular (LV) leads represent an alternative for CRT-therapy if transvenous lead implantation fails. Data concerning endurance, performance, impact of surgical access (lateral vs. medial thoracotomy simultaneous to other cardiac surgery), and optimal technical concept (screw-in vs. suture-on) are still underrepresented and/or missing at all.

Methods: We evaluated over a period of 107310 days 112 patients with comparable characteristics. 42 screw-in (EnPath 1084T, SJM) and 70 suture-on (Capture Epi 4968, Medtronic) bipolar epicardial steroid-eluting LV-leads were implanted either via left lateral or medial thoracotomy. Sensing, pacing threshold, impedance and NYHA-class were recorded at defined time points.

Results: Overall, no surgery-associated death and only one infection have been noted. At implantation time pacing threshold, sensing and NYHA-class did not differ significantly. Impedances of screw-in leads were significantly lower in comparison to suture-on leads. Suture-on leads showed moderate initial drop in pacing threshold but afterwards remain stable. Screw-in leads were characterized by significant increase in pacing threshold within the first year followed by its continuous decrease thereafter. Three years post implantation no differences between the leads could be anymore detected. Sensing increased and NYHA-class improved continuously in both groups. The influence of surgical access could be excluded.

Conclusions: Both lead concepts showed an excellent long-term performance, however, with lead-specific differences independently of surgical access. Particularly, excellent results were observed when implanting the leads simultaneously to other cardiac surgical procedures indicating that they should be implanted when criteria for LV-stimulation are fulfilled and open chest cardiac surgery is performed.