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Surgical placement of a left ventricular epicardial pacing lead is a valuable alternative to the standard approach of endovascular placement of a pacing lead in the coronary sinus for cardiac resynchronization therapy. Despite higher perioperative morbidity, surgically placed leads perform well with lower revision and dislocation rates.
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Although transseptal LV endocardial stimulation may offer the benefits of providing more physiological endocardial ventricular activation and may even be less proarrhythmic compared with epicardial LV pacing, this approach is limited by the thromboembolic risk, need for lifelong systemic anticoagulation, and concern for mechanical effects on .
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