Burger H, Kempfert J, van Linden A, Szalay Z, Schoenburg M, Walther T, Ziegelhoeffer T
Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.
Thorac Cardiovasc Surg. 2012 Feb;60(1):70-7. doi: 10.1055/s-0031-1280066. Epub 2011 Jul 25.
Epicardial left ventricular (LV) leads represent an alternative for CRT therapy if transvenous lead implantation fails. Data on endurance, performance, the impact of the surgical approach (lateral minithoracotomy vs. median sternotomy simultaneously with other cardiac surgery), and the optimal technical concept (screw-in vs. suture-on) is limited.
Over a period of 48 months we evaluated 130 consecutive patients with comparable characteristics. A total of 54 screw-in (MyoDex™ 1084T, SJM) and 76 suture-on (Capture Epi 4968, Medtronic) bipolar epicardial steroid-eluting LV leads were implanted either via a left lateral or a median thoracotomy. Sensing, pacing threshold, impedance and NYHA class were recorded at defined time points.
No surgery-related death or major complication was observed. At the time of implantation, the pacing threshold, sensing and NYHA class did not differ significantly between the two groups. The impedances of screw-in leads were significantly lower compared to those of suture-on leads. Suture-on leads showed a moderate initial drop in their pacing threshold but afterwards remained stable. Screw-in leads were characterized by a moderate but significant increase in the pacing threshold in the first year followed by a continuous decrease thereafter. Twenty-four months post-implantation no differences between both lead types could be detected. Sensing and NYHA class improved in both groups. The surgical approach had no significant impact on lead functionality.
Our study showed that the implantation of epicardial leads was safe with very low complication rates. There was no superior technical epicardial lead concept (screw-in vs. suture-on leads) and all epicardial leads demonstrated an excellent long-term performance and durability. Therefore, it seems that epicardial leads represent a good alternative to transvenous leads and surgeons should be encouraged to implant epicardial leads during concomitant cardiac surgery when the indications for CRT are present.
如果经静脉植入导线失败，心外膜左心室（LV）导线是心脏再同步化治疗（CRT）的一种替代方案。关于耐久性、性能、手术方式（外侧小切口开胸术与正中胸骨切开术联合其他心脏手术）的影响以及最佳技术理念（旋入式与缝合式）的数据有限。
在48个月的时间里，我们评估了130例具有可比特征的连续患者。通过左侧开胸或正中开胸术共植入了54根旋入式（MyoDex™ 1084T，圣犹达医疗用品公司）和76根缝合式（Capture Epi 4968，美敦力公司）双极心外膜类固醇洗脱LV导线。在规定时间点记录感知、起搏阈值、阻抗和纽约心脏协会（NYHA）心功能分级。
未观察到与手术相关的死亡或重大并发症。植入时，两组的起搏阈值、感知和NYHA心功能分级无显著差异。旋入式导线的阻抗明显低于缝合式导线。缝合式导线的起搏阈值在初期有适度下降，但之后保持稳定。旋入式导线的特点是在第一年起搏阈值有适度但显著的升高，此后持续下降。植入后24个月，两种导线类型之间未检测到差异。两组的感知和NYHA心功能分级均有改善。手术方式对导线功能无显著影响。
我们的研究表明，心外膜导线植入安全，并发症发生率极低。不存在优越的心外膜导线技术理念（旋入式与缝合式导线），所有心外膜导线均表现出出色的长期性能和耐久性。因此，心外膜导线似乎是经静脉导线的良好替代方案，当存在CRT指征时，应鼓励外科医生在同期心脏手术期间植入心外膜导线。
