Original article Totally epicardial cardiac resynchronisation therapy system implantation in patients with heart failure undergoing CABG – description of 3 cases

Abstract

Introduction: Systolic dyssynchrony as an indication for cardiac resynchronisation therapy is present in a considerable subset of patients with congestive heart failure undergoing surgical coronary revascularisation. Coronary artery bypass grafting offers an optimal setting for totally epicardial cardiac resynchronisation system implantation. Aim: To assess the feasibility and safety of totally epicardial cardiac resynchronisation system implantation in patients with ischaemic heart disease and heart failure undergoing coronary artery bypass grafting. Methods: Three male patients with coronary artery disease and postinfarction functional class III congestive heart failure underwent a combined procedure of on-pump surgical coronary revascularisation and totally epicardial cardiac resynchronisation system implantation (all three leads implanted epicardially). In all patients intraventricular dyssynchrony was revealed in preoperative echocardiography. Results: There was no perioperative morbidity or mortality. The mean total time required for cardiac resynchronisation system implantation was 17.3±2.3 minutes. We obtained excellent pacing and sensing parameters at implant (left ventricular pacing thresholds: 0.8, 0.5, 0.5 V at 0.5 ms; left ventricular sensing thresholds: 17, 15, 20 mV, respectively in consecutive patients). After 12 months pacing and sensing parameters remained stable. Significant improvement in 6-minute walk test distance, functional class and echocardiographic parameters (left ventricular ejection fraction, intraventricular dyssynchrony) was observed in all patients. Conclusions: Totally epicardial cardiac resynchronisation system implantation is safe and can be regarded as an important supplement to surgical coronary revascularisation in the still growing population of patients with severe heart failure and systolic dyssynchrony, which can be used for the optimisation of treatment results.