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(4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches. Keywords: cardiac resynchronization therapy; epicardial; heart failure; thoracoscopy. Grant support. This research received .One of the common challenges encountered during the implantation of cardiac implantable electronic devices (CIEDs) is stenosis and occlusion of the venous system in the thorax. This is more relevant during an upgrade procedure with the addition of LV leads in patients with preexisting device systems.

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