VATS Epicardial LV Lead Placement

Excellent video. However, I have one query. How do you assess the best site for placing the lead. In the open technique, I usually apply the cable clips on different sites to look at the impedance and choose the site with the most favorable value. How do you propose to select the best site in VATS?

i am sorry for the delayed response. I look for the area that has clear and free muscle. If there is too much adipose tissue on the heart, than sometime you have to free that off with bovie until you see clear muscle. Then you place the lead there, and test it when you pull it out. Most of the time as long as you have good purchase into the muscle, the lead works great. If not, than I remove the original one, and place new. Just have to be careful not to cause any injury in removing the lead. If it is borderline, then I place another lead. Sometimes the thresholds and impedance improves with a little bit of time, and then you can pick the best one.