Background:

Atrial fibrillation is common in patients with heart-failure. Therefore, the prevalence of atrial fibrillation is high in patients receiving CRT implantation. In patients not suitable for transvenous LV-lead implantation epicardial LV-lead implantation represents a valuable alternative. Epicardial LV-lead placement can be achieved thoracoscopically or via minimally invasive left lateral thoracotomy. In patients with atrial fibrillation, concomitant LAA clipping is feasible though the same access.  

Methods:

Between December 2019 and October 2021, 8 patients received minimally invasive left atrial LV-lead implantation with concomitant LAA closure using the Atriclip. Transesophageal echocardiography was performed to intraoperatively guide and control LAA closure. We retrospectively investigated safety and efficacy of epicardial LV lead implantation and concomitant LAA clipping via minimally invasive left-lateral thoracotomy.

Results:

Mean patients age was 64 years, 67% were male patients. Minimally invasive left-lateral thoracotomy was used in 6 patients while a totally thoracoscopic approach was performed in 2 cases. Epicardial lead implantation was successfully performed in all patients with good pacing threshold (mean 0.8 +/- 0.2) and sensing values (10.1 +/- 2.3). Posterolateral position of the LV lead was achieved in all patients. Furthermore, successful LAA closure was confirmed during transesophageal echocardiography in all patients. No procedure-related complications occurred in any of the patients.  2 patients additionally received simultaneous laser lead extraction during the same procedure. Complete lead extraction was achieved in both patients. All patients were extubated in the OR and had an uneventful postoperative course. 

Conclusion

The minimally invasive totally thoracoscopic- as well as left-lateral thoracotomy approach allows for a posterolateral LV lead position and the possibility to successfully occlude the left atrial appendage.