Physiological optimization of robotic endoscopic epicardial CRT-D implantation using multielectrode electroanatomic mapping

Multielectrode epicardial mapping during robotic implantation of cardiac resynchronization-defibrillator system. Robotically assisted endoscopic implantation of cardiac implantable devices is well documented to be both feasible and safe, and this technique provides particular benefit in patients with limited vascular access. In a patient meeting Class I indication for cardiac resynchronization therapy with defibrillator and inaccessible vascular access, we describe in this case an optimization strategy for intraoperative left ventricular lead placement utilizing robotic epicardial electroanatomic mapping as well as the feasibility of implanting a totally epicardial biventricular cardioverter-defibrillator system.