Epicardial lead considerations

Three groups of patients typically undergo epicardial pacing systems

•Pts undergoing cardiac surgery for another indication, for latter implantation-typical of LV lead.

•Pts with a prosthetic tricuspid valve, a congenital anomaly or atresia of the tricuspid valve without access to the CS. Although leads are compatible with bioprostehic valves, it’s best to protect the valve as much as possible.

•Patients with ventricular septal defects or RàL shunts in whom the possibility for systemic embolization exists.

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Two surgical procedures have been described for placement of epicardial leads

•Subxiphoid or left costal approach

•Left lateral thoracotomy

These leads are often tunnelled to the IPG either in the pectoral or abdominal area.

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Epicardial leads have a higher incidence of lead fracture.