Surgical Cardiac Resynchronization Therapy for Patients with Severe Left Ventricular Systolic Dysfunction

: We applied cardiac resynchronization therapy with an implantable cardioverter-defibrillator( CRT-D) and with concomitant cardiac surgery to 2 patients with left ventricular (LV) systolic dysfunction and dyssynchronous ventricular activation. A patient had severe ischemic dilated cardiomyopathy with coronary artery aneurysms (LV ejection fraction 12%, LV diastolic dimension 81 mm, LV systolic dimension 75 mm and atrial fibrillation, with complete left bundle branch block). Another patient had severe dilated cardiomyopathy with mitral valve regurgitation (LV ejection fraction 25%, LV diastolic dimension 75 mm, LV systolic dimension 61 mm atrial fibrillation, and complete left bundle branch block). Both epicardial LV leads were surgically implanted on the posterolateral wall. CRT-D achieved the resynchronization of the LV contraction, and improved cardiac function. The patients had an uneventful postoperative course and were discharged from hospital after operation. A key advantage of surgical epicardial lead placement is that lead placement is not confined to anatomic branches of the LV venous circulation as is the case with transvenous placement. CRT-D combined with cardiac surgery might be available for patients with LV systolic dysfunction.