Article révisé par les pairs
Résumé : Aims Left ventricular (LV) lead implantation through the coronary sinus (CS) can be limited and sometimes not possible- alternative approaches are needed. Minimally invasive, robotically guided LV lead implantation has major advantages, but there are little published data about the short- and long-term follow-ups, in terms of feasibility, safety, electrical performance, and impact on clinical outcome. Methods and results A total of 21 heart failure patients underwent robotically guided LV lead implantation using the Da Vinci Robotic System. Indications were failed implant with conventional approach through the CS (n = 16) and non-response to conventional cardiac resynchronization therapy (n = 5). During the procedure, the entire LV free wall was exposed through 3 transthoracic ports (10 mmdiameter each) allowing ample choice of stimulation site and the ability to implant 2 LV leads via a Y connector. Patients were prospectively followed up for 1 year. The two LV leads were successfully implanted in all patients. No peri-procedural complications were observed. After a mean stay in the intensive care unit of 1.2+4 days, the 21 patients were hospitalized in the EP department for 6.7+2.9 days. Acute LV thresholds were excellent (1.0 V+0.6/0.4 ms) and stayed stable at 1-year follow-up (1.5 V+0.6/0.4 ms, P = 0.21). Four patients demonstrated an increased threshold (.2 V/0.4 ms). There was no phrenic nerve stimulation. After 12 months, in the failed implant group, 69% of the patients were echocardiographic and clinical responders. Conclusion The robotic approach was feasible, safe, and minimally invasive. Accordingly, robotically guided LV lead implantation seems to offer a new alternative when conventional approaches are not suitable.

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