{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:28:13Z","timestamp":1789576093182,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,12,14]],"date-time":"2019-12-14T00:00:00Z","timestamp":1576281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Epicardial placement of the left ventricular (LV) lead via a video\u2010assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>Long\u2010term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The VAT procedure is performed under general anesthesia, with oro\u2010tracheal intubation and right\u2010sided ventilation, and requires two 5\u2009mm and one 15\u2009mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>105 patients were referred to our center for epicardial LV lead implantation. After pre\u2010operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8\u2009\u00b1\u20090.5\u2009V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75\u2009min. During a median follow\u2010up of 24\u2009months, there were no differences in terms of death, cardiovascular hospitalizations or device\u2010related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23300","type":"journal-article","created":{"date-parts":[[2019,12,14]],"date-time":"2019-12-14T08:39:44Z","timestamp":1576312784000},"page":"284-290","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video\u2010assisted thoracoscopic technique: Long\u2010term outcome"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9388-3292","authenticated-orcid":false,"given":"Massimiliano","family":"Marini","sequence":"first","affiliation":[{"name":"Department of Cardiology S. 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Chiara Hospital  Trento Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Belotti","sequence":"additional","affiliation":[{"name":"Department of Cardiology Treviglio, ASST Bergamo Ovest  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Molon","sequence":"additional","affiliation":[{"name":"Department of Cardiology IRCCS Sacro Cuore Don Calabria Hospital  Negrar Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Guarracini","sequence":"additional","affiliation":[{"name":"Department of Cardiology S. Chiara Hospital  Trento Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Coser","sequence":"additional","affiliation":[{"name":"Department of Cardiology S. 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