Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead

Abstract

Introduction Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. Methods In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards and away from the epicardial surface. Results In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than facing away (median [IQR] mA: dogs 0.9 [0.4–1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2–1] vs 2.5 [0.5–6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). Conclusion Selective electrode insulation confers directional pacing to a multielectrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.

Percutaneous epicardial pacing using a novel transverse sinus device

“…16,[23][24][25][26] The current study, in addition to these studies, demonstrates that the transverse sinus can be leveraged successfully for epicardial pacing. 16,[23][24][25][26] The current study, in addition to these studies, demonstrates that the transverse sinus can be leveraged successfully for epicardial pacing.…”

“…6 Third, the presence of intracardiac shunts can result in systemic embolization from lead-related thrombus. 16 In our experience, active fixation of percutaneously placed epicardial leads was fraught with limitations, such as lead dislodgement, and theoretical risk of damage to coronary arteries or veins, or myocardial trauma resulting in ventricular tachycardia. 9 Surgically implanted epicardial leads are an alternative to transvenous leads and can overcome several of these limitations.…”

Near‐field impedance accurately distinguishes among pericardial, intracavitary, and anterior mediastinal position

“…Percutaneous epicardial access is a useful adjunct for catheter ablation of complex cardiac arrhythmias. Increasingly used for epicardial catheter ablation, this technique is also being used for left atrial appendage ligation and epicardial lead placement …”

A Novel Defibrillation Tool

“…We have previously shown feasibility of partially-insulated epicardial pacing leads(16). Thus, we sought to develop an entirely percutaneous defibrillator system coupled with partially-insulated epicardial defibrillation leads designed to focus energy on the heart.…”