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Circ Arrhythm Electrophysiol. 2015 Jun;8(3):659-66. doi: 10.1161/CIRCEP.114.002076. Epub 2015 Mar 31.

Acute and chronic performance evaluation of a novel epicardial pacing lead placed by percutaneous subxiphoid approach in a canine model.

Author information

1
From the Brigham and Women's Hospital, Boston, MA (R.M.J.); St. Jude Medical, Inc, Sylmar, CA (K.M., M.E.B.); Charles River Laboratories, Frederick, MD (L.H.B.); and Haut-Lévêque Hospital, Pessac, Bordeaux, France (P.J.). rjohn2@partners.org.
2
From the Brigham and Women's Hospital, Boston, MA (R.M.J.); St. Jude Medical, Inc, Sylmar, CA (K.M., M.E.B.); Charles River Laboratories, Frederick, MD (L.H.B.); and Haut-Lévêque Hospital, Pessac, Bordeaux, France (P.J.).

Abstract

BACKGROUND:

Endovascularly implanted leads risk vascular injury and endocarditis, and can be difficult to locate in desired positions for LV pacing. We evaluated the acute and long-term stability, electric performance and histopathology of a percutaneously placed intrapericardial lead (IPL).

METHODS AND RESULTS:

Twelve adult mongrel dogs underwent defibrillator implants incorporating IPLs. Successful uncomplicated percutaneous implantation of an IPL was achieved in all. Early fluoroscopic shift noted with 3 of 6 of the initial version IPL-1 was not seen with the modified IPL-2. Mean±95% confidence interval bipolar capture threshold at 0.5-ms pulse width for the IPL increased from 0.69±0.14 V at implant to 1.50±0.34 V (P=0.003) at 12 weeks. The 12-week thresholds were higher for IPL compared with right ventricular endocardial leads (0.75±0.33 V; P=0.001) but not different compared with coronary sinus leads (1.33±0.58 V; P=0.994). IPL impedance increased from 742±46 Ω at implant to 1066±207 Ω at 12 weeks (P=0.007). R-wave amplitude at 12 weeks was 8.37±1.52 mV. There was no important phrenic nerve stimulation from IPL pacing. Histopathology in 8 animals showed adequate adhesion of the electrodes or mesh to the epicardium without damage to underlying vasculature. There was no evidence for late pericardial inflammation or effusion.

CONCLUSIONS:

The IPL demonstrated adequate stability of position and acceptable electric parameters without chronic pericardial inflammation in this canine model and offers a potential alternative to endocardial pacing leads.

KEYWORDS:

cardiac pacemaker, artificial; epicardial pacing; percutaneous epicardial pacing; pericardium

PMID:
25829164
DOI:
10.1161/CIRCEP.114.002076
[Indexed for MEDLINE]

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