Video-assisted thoracoscopic epicardial pacemaker implantation: a Colombian case series

Background: In patients needing cardiac resynchronization therapy (CRT) with poor to unavailable vascular access or with infected devices, a thoracoscopic [video-assisted thoracoscopic surgery (VATS)] approach can offer an excellent alternative to standard transvenous pacing. Placement of epicardial pacemakers through VATS, however, has not been published widely. Advances in VATS in Colombia have progressed during the years. Today, minimally invasive approaches for both cardiac and thoracic surgery have been made standard in many clinics throughout the country. Here we present a three-institution experience in Colombia with ten patients. Case Description: A retrospective description of ten (N=10) patients between 2019 to 2024 taken to VATS epicardial pacemaker placement at three centers in Colombia is presented. There were eight (N=8) male patients and two (N=2) female patients. Mean age was 59.6 years and mean left ventricular ejection fraction (LVEF) was 43%. Five patients (N=5) had multiple failed attempts by the electrophysiology department to access the coronary sinus. One patient (N=1) had a tricuspid bio-prosthetic endocarditis compromising the lead. All patients presenting with unfavorable vascular access were included in this series and none were excluded. Median postoperative intensive care unit stay was 2 days and discharge on postoperative day 3. Conclusions: VATS epicardial pacemaker placement is a feasible alternative to transvenous pacing, offering a less invasive approach and less manipulated mediastinum for patients deemed too fragile for a full sternotomy. Additionally, hospital stay is kept to a minimum along with non-inferior device function.