OPEN IN READ APP
JOURNAL ARTICLE

Minimally Invasive Percutaneous Epicardial Placement of a Prototype Miniature Pacemaker with Leadlet under Direct Visualization: A Feasibility Study in an Infant Porcine Model

Rohan N Kumthekar, Justin D Opfermann, Paige Mass, Bradley C Clark, Jeffrey P Moak, Elizabeth D Sherwin, Teresa Whitman, Mark Marshall, Charles I Berul
Heart Rhythm: the Official Journal of the Heart Rhythm Society 2019 February 28
30826423

BACKGROUND: Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy.

OBJECTIVES: To evaluate the safety and feasibility of acute implantation of a prototype miniature pacemaker in an infant porcine model.

ANIMALS AND METHODS: A self-anchoring two-channel access port was inserted into a 1 cm incision left of the subxiphoid space. A rigid thoracoscope with variable viewing angle was inserted through the main channel to visualize the heart under insufflation. An 18-gauge needle through the second channel accessed the pericardial space, which was secured with a 7-French sheath. The leadlet was affixed against the epicardium using a distal helical side-biting electrode. The sheath, thoracoscope and port were removed, and the pacemaker was tucked into the incision. Ventricular sensing, lead impedances, and capture thresholds were measured.

RESULTS: Twelve piglets (weight 4.8 ± 1.9 kg) had successful device implantation. Median time from incision to leadlet fixation was 21 (IQR 18 - 31) minutes. Median lead impedance was 510 (IQR 495 - 620) ohms. Median R-wave amplitude was 5.7 (IQR 4.2 - 7.0) mV. Median capture threshold was 1.63 (IQR 1.32 - 2.97) at 0.4 ms pulse width and 1.50 (IQR 1.16 - 2.38) V at 1.0 ms pulse width. There were no complications.

CONCLUSION: Minimally invasive epicardial placement of a prototype miniature pacemaker under thoracoscopy was safe and avoided open-chest surgery and creation of an abdominal generator pocket.

Comments

You need to log in or sign up for an account to be able to comment.

No comments yet, be the first to post one!

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
30826423
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"