Abstract 3182: Optimal Timing for Initiation of Cardiac Resynchronization Therapy with Left Ventricular Epicardial Pacing Leads
Left ventricular (LV) pacing leads for cardiac resynchronization therapy (CRT) may be placed epicardially after failed transvenous leads or during concomitant cardiac surgery. Whether to connect leads to a CRT device immediately is unclear due to infection, ICD testing or hemodynamic issues.
Hypothesis: Intraoperative CRT device connection reduces postop complications, mortality and hospital length of stay (LOS).
Methods: Clinical and survival data were obtained on patients receiving LV epicardial leads 8/97–12/04. Postop complications, LOS, NYHA class and mortality were analyzed by CRT device connection time using standard statistics and survival analyses.
Results: Of 377 patients (72% male, age 66±11yrs, 68% ischemic cardiomyopathy [CM]), only 111 (29%) were connected to a CRT device pre-discharge, 76 (20%) intraop, and 29 (8%) post-discharge. Intraop connection was more likely in nonischemic CM (30 vs 16%, p= 0.001) but was associated with shorter ICU (1.6 vs 3.3 d, p<0.001) and postop (6.5 vs 12.1 d, p<0.001) LOS and less postop AF (18 vs 47%, p<0.001), VT/VF (0 vs 14.3%, p<0.001) or heart failure (inotrope requirement or diuretic use >4d, 1.3 vs 10.0%, p=0.014). NYHA class (mean 2.1 vs 2.0), LVEF (24.4 vs 23.9%) and infection rates were similar to 6 mos. Intraop connection was also associated with lower mortality on long-term follow-up (12.0 vs 25.3%, p=0.02).
Conclusions: Intraoperative connection of LV epicardial leads to CRT devices is associated with less ICU and hospital LOS, postop arrhythmias, heart failure and long-term mortality without increase in infection rates. These results support initiation of CRT pacing intraop for patients receiving LV epicardial leads.