Comparison of the efficacy of two surgical alternatives for cardiac resynchronization therapy: trans-apical versus epicardial left ventricular pacing

Background: Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans‐apical lead implantation is a minimally invasive technique that provides access to any LV segments. The aim of this prospective randomized study was to compare the outcome of patients undergoing either trans‐apical endocardial or epicardial LV pacing. Methods: In group I, 11 end‐stage heart failure (HF) patients (mean age 59.7 ± 7.9 years) underwent trans‐apical LV lead implantation. Epicardial LV leads were implanted in 12 end‐stage HF patients (group II; mean age 62.8 ± 7.3 years). Medical therapy was optimized in all patients. The following parameters were compared during an 18‐month follow‐up period: LV ejection fraction (LVEF), LV end‐diastolic diameter (LVEDD), LV end‐systolic diameter, and New York Heart Association (NYHA) functional class. Results: Nine out of 11 patients responded favorably to the treatment in group I (LVEF 39.7 ± 12.5 vs 26.0 ± 7.8%, P < 0.01; LVEDD 70.4 ± 13.6 mm vs 73.7 ± 10.5 mm, P = 0.002; NYHA class 2.2 ± 0.4 vs 3.5 ± 0.4, P < 0.01) and eight out of 12 in group II (LVEF 31.5 ± 11.5 vs 26.4 ± 8.9%, P = < 0.001; NYHA class 2.7 ± 0.4 vs 3.6 ± 0.4, P < 0.05). During the follow‐up period, one patient died in group I and three in group II. There was one intraoperative LV lead dislocation in group I and one early postoperative dislocation in each group. None of the patients developed thromboembolic complications. Conclusions: Our data suggest that trans‐apical endocardial LV lead implantation is an alternative to epicardial LV pacing. PACE 2012; 35:124–130)