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TEE-guided left ventricular epicardial pacing lead placement for cardiac resynchronization therapy


1 Department of Cardiac Anaesthesia, Hero DMC Heart Institute, Ludhiana, Punjab, India
2 Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
3 Department of Cardiovascular and Thoracic Surgery, Hero DMC Heart Institute, Ludhiana, Punjab, India

Correspondence Address:
Rajesh Chand Arya
Department of Cardiac Anaesthesia, Hero DMC Heart Institute, Unit Dayanand Medical College and Hospital, Civil Lines, Ludhiana, Punjab - 141 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.97979

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Year : 2012  |  Volume : 15  |  Issue : 3  |  Page : 229-232

 

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Biventricular pacing has demonstrated improvement in cardiac functions in treating congestive cardiac failure patients. Recent trials have proven the clinical and functional benefits of cardiac resynchronization therapy in severe heart failure and intraventricular cardiac delays, mainly left bundle branch block. Biventricular pacing improves the exercise tolerance, quality of life, systolic heart function, reduces hospitalization and slows progression of the disease. A 54-year-old lady, a known case of dilated cardiomyopathy, was on biventricular pacing since 2 years. She presented in emergency with sudden deterioration of dyspnea to NYHA class III/IV. When investigated, the coronary sinus lead was found displaced; thus, left ventricle (LV) was not getting paced. After multiple failures to reposition the coronary sinus lead, it was decided to surgically place the epicardial lead for LV pacing under general anesthesia. Lateral thoracotomy was done and LV pacing lead was placed at different sites with simultaneous monitoring of cardiac output (CO) and stroke volume (SV) by transesophageal echocardiography (TEE). Baseline CO and SV were 1.9 l/min and 19.48 ml respectively and increased at different sites of pacing at LV, the best CO and SV were 4.2 l/min and 42.39 ml respectively on lateral surface. Intraoperative TEE can calculate beat to beat stroke volume and thus CO and helps to choose optimal site for placement of epicardial pacing lead.






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1 Department of Cardiac Anaesthesia, Hero DMC Heart Institute, Ludhiana, Punjab, India
2 Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
3 Department of Cardiovascular and Thoracic Surgery, Hero DMC Heart Institute, Ludhiana, Punjab, India

Correspondence Address:
Rajesh Chand Arya
Department of Cardiac Anaesthesia, Hero DMC Heart Institute, Unit Dayanand Medical College and Hospital, Civil Lines, Ludhiana, Punjab - 141 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.97979

Rights and Permissions

Biventricular pacing has demonstrated improvement in cardiac functions in treating congestive cardiac failure patients. Recent trials have proven the clinical and functional benefits of cardiac resynchronization therapy in severe heart failure and intraventricular cardiac delays, mainly left bundle branch block. Biventricular pacing improves the exercise tolerance, quality of life, systolic heart function, reduces hospitalization and slows progression of the disease. A 54-year-old lady, a known case of dilated cardiomyopathy, was on biventricular pacing since 2 years. She presented in emergency with sudden deterioration of dyspnea to NYHA class III/IV. When investigated, the coronary sinus lead was found displaced; thus, left ventricle (LV) was not getting paced. After multiple failures to reposition the coronary sinus lead, it was decided to surgically place the epicardial lead for LV pacing under general anesthesia. Lateral thoracotomy was done and LV pacing lead was placed at different sites with simultaneous monitoring of cardiac output (CO) and stroke volume (SV) by transesophageal echocardiography (TEE). Baseline CO and SV were 1.9 l/min and 19.48 ml respectively and increased at different sites of pacing at LV, the best CO and SV were 4.2 l/min and 42.39 ml respectively on lateral surface. Intraoperative TEE can calculate beat to beat stroke volume and thus CO and helps to choose optimal site for placement of epicardial pacing lead.






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