A Novel Defibrillation Tool. Percutaneously Delivered, Partially Insulated Epicardial Defibrillation

Ammar M. Killu, Niyada Naksuk, Zdeněk Stárek, Christopher V. DeSimone, Faisal F. Syed, Prakriti Gaba, Jiří Wolf, Frantisek Lehar, Martin Pesl, Pavel Leinveber, Michal Crha, Dorothy Ladewig, Joanne Powers, Scott Suddendorf, David O. Hodge, Gaurav Satam, Miroslav Novák, Tomas Kara, Charles J Bruce, Paul Andrew Friedman & 1 others Samuel J Asirvatham

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: We aimed to develop a percutaneous defibrillation system with partially insulated epicardial coils to focus electrical energy on the myocardium and prevent or minimize extracardiac stimulation. Background: Epicardial defibrillation systems currently require surgical access. Methods: We tested 2 prototypes created for percutaneous introduction into the pericardial space via a steerable sheath. This testing included a partially insulated defibrillation coil and a defibrillation mesh with a urethane balloon acting as an insulator to the face of the mesh not in contact with the epicardium. The average energy associated with a chance of successful defibrillation 75% of the time was calculated for each experiment. Results: Of 16 animal experiments, 3 pig experiments had malfunctioning mesh prototypes such that results were unreliable; these were excluded. Therefore, 13 animal experiments were analyzed, 6 in canines (29.8 ± 4.0 kg) and 7 in pigs (41.1 ± 4.4 kg). The overall chance of successful defibrillation 75% of the time was 12.8 ± 6.7 J (10.9 ± 9.1 J for canines and 14.4 ± 3.9 J in pigs; p = 0.37). The lowest chance of successful defibrillation 75% of the time obtained in canines was 2.5 J, whereas in pigs it was 9.5 J. The lowest energy resulting in successful defibrillation was 2 J in canines and 5 J in pigs. There was no evidence of coronary vessel injury or trauma to extrapericardial structures. Conclusions: Percutaneous, epicardial defibrillation using a partially insulated coil is feasible and seems to be associated with low defibrillation thresholds. Focusing insulation may limit extracardiac stimulation and potentially lower energy requirements for efficient defibrillation.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Aug 22 2016

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Swine
Canidae
Pericardium
Urethane
Wounds and Injuries
Coronary Vessels
Myocardium

Keywords

  • Arrhythmia
  • Defibrillation
  • Epicardial
  • ICD
  • Insulation
  • Percutaneous

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

A Novel Defibrillation Tool. Percutaneously Delivered, Partially Insulated Epicardial Defibrillation. / Killu, Ammar M.; Naksuk, Niyada; Stárek, Zdeněk; DeSimone, Christopher V.; Syed, Faisal F.; Gaba, Prakriti; Wolf, Jiří; Lehar, Frantisek; Pesl, Martin; Leinveber, Pavel; Crha, Michal; Ladewig, Dorothy; Powers, Joanne; Suddendorf, Scott; Hodge, David O.; Satam, Gaurav; Novák, Miroslav; Kara, Tomas; Bruce, Charles J; Friedman, Paul Andrew; Asirvatham, Samuel J.

In: JACC: Clinical Electrophysiology, 22.08.2016.

Research output: Contribution to journalArticle

Killu, AM, Naksuk, N, Stárek, Z, DeSimone, CV, Syed, FF, Gaba, P, Wolf, J, Lehar, F, Pesl, M, Leinveber, P, Crha, M, Ladewig, D, Powers, J, Suddendorf, S, Hodge, DO, Satam, G, Novák, M, Kara, T, Bruce, CJ, Friedman, PA & Asirvatham, SJ 2016, 'A Novel Defibrillation Tool. Percutaneously Delivered, Partially Insulated Epicardial Defibrillation', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2016.12.025
Killu, Ammar M. ; Naksuk, Niyada ; Stárek, Zdeněk ; DeSimone, Christopher V. ; Syed, Faisal F. ; Gaba, Prakriti ; Wolf, Jiří ; Lehar, Frantisek ; Pesl, Martin ; Leinveber, Pavel ; Crha, Michal ; Ladewig, Dorothy ; Powers, Joanne ; Suddendorf, Scott ; Hodge, David O. ; Satam, Gaurav ; Novák, Miroslav ; Kara, Tomas ; Bruce, Charles J ; Friedman, Paul Andrew ; Asirvatham, Samuel J. / A Novel Defibrillation Tool. Percutaneously Delivered, Partially Insulated Epicardial Defibrillation. In: JACC: Clinical Electrophysiology. 2016.
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abstract = "Objectives: We aimed to develop a percutaneous defibrillation system with partially insulated epicardial coils to focus electrical energy on the myocardium and prevent or minimize extracardiac stimulation. Background: Epicardial defibrillation systems currently require surgical access. Methods: We tested 2 prototypes created for percutaneous introduction into the pericardial space via a steerable sheath. This testing included a partially insulated defibrillation coil and a defibrillation mesh with a urethane balloon acting as an insulator to the face of the mesh not in contact with the epicardium. The average energy associated with a chance of successful defibrillation 75{\%} of the time was calculated for each experiment. Results: Of 16 animal experiments, 3 pig experiments had malfunctioning mesh prototypes such that results were unreliable; these were excluded. Therefore, 13 animal experiments were analyzed, 6 in canines (29.8 ± 4.0 kg) and 7 in pigs (41.1 ± 4.4 kg). The overall chance of successful defibrillation 75{\%} of the time was 12.8 ± 6.7 J (10.9 ± 9.1 J for canines and 14.4 ± 3.9 J in pigs; p = 0.37). The lowest chance of successful defibrillation 75{\%} of the time obtained in canines was 2.5 J, whereas in pigs it was 9.5 J. The lowest energy resulting in successful defibrillation was 2 J in canines and 5 J in pigs. There was no evidence of coronary vessel injury or trauma to extrapericardial structures. Conclusions: Percutaneous, epicardial defibrillation using a partially insulated coil is feasible and seems to be associated with low defibrillation thresholds. Focusing insulation may limit extracardiac stimulation and potentially lower energy requirements for efficient defibrillation.",
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AU - Killu, Ammar M.

AU - Naksuk, Niyada

AU - Stárek, Zdeněk

AU - DeSimone, Christopher V.

AU - Syed, Faisal F.

AU - Gaba, Prakriti

AU - Wolf, Jiří

AU - Lehar, Frantisek

AU - Pesl, Martin

AU - Leinveber, Pavel

AU - Crha, Michal

AU - Ladewig, Dorothy

AU - Powers, Joanne

AU - Suddendorf, Scott

AU - Hodge, David O.

AU - Satam, Gaurav

AU - Novák, Miroslav

AU - Kara, Tomas

AU - Bruce, Charles J

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

PY - 2016/8/22

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N2 - Objectives: We aimed to develop a percutaneous defibrillation system with partially insulated epicardial coils to focus electrical energy on the myocardium and prevent or minimize extracardiac stimulation. Background: Epicardial defibrillation systems currently require surgical access. Methods: We tested 2 prototypes created for percutaneous introduction into the pericardial space via a steerable sheath. This testing included a partially insulated defibrillation coil and a defibrillation mesh with a urethane balloon acting as an insulator to the face of the mesh not in contact with the epicardium. The average energy associated with a chance of successful defibrillation 75% of the time was calculated for each experiment. Results: Of 16 animal experiments, 3 pig experiments had malfunctioning mesh prototypes such that results were unreliable; these were excluded. Therefore, 13 animal experiments were analyzed, 6 in canines (29.8 ± 4.0 kg) and 7 in pigs (41.1 ± 4.4 kg). The overall chance of successful defibrillation 75% of the time was 12.8 ± 6.7 J (10.9 ± 9.1 J for canines and 14.4 ± 3.9 J in pigs; p = 0.37). The lowest chance of successful defibrillation 75% of the time obtained in canines was 2.5 J, whereas in pigs it was 9.5 J. The lowest energy resulting in successful defibrillation was 2 J in canines and 5 J in pigs. There was no evidence of coronary vessel injury or trauma to extrapericardial structures. Conclusions: Percutaneous, epicardial defibrillation using a partially insulated coil is feasible and seems to be associated with low defibrillation thresholds. Focusing insulation may limit extracardiac stimulation and potentially lower energy requirements for efficient defibrillation.

AB - Objectives: We aimed to develop a percutaneous defibrillation system with partially insulated epicardial coils to focus electrical energy on the myocardium and prevent or minimize extracardiac stimulation. Background: Epicardial defibrillation systems currently require surgical access. Methods: We tested 2 prototypes created for percutaneous introduction into the pericardial space via a steerable sheath. This testing included a partially insulated defibrillation coil and a defibrillation mesh with a urethane balloon acting as an insulator to the face of the mesh not in contact with the epicardium. The average energy associated with a chance of successful defibrillation 75% of the time was calculated for each experiment. Results: Of 16 animal experiments, 3 pig experiments had malfunctioning mesh prototypes such that results were unreliable; these were excluded. Therefore, 13 animal experiments were analyzed, 6 in canines (29.8 ± 4.0 kg) and 7 in pigs (41.1 ± 4.4 kg). The overall chance of successful defibrillation 75% of the time was 12.8 ± 6.7 J (10.9 ± 9.1 J for canines and 14.4 ± 3.9 J in pigs; p = 0.37). The lowest chance of successful defibrillation 75% of the time obtained in canines was 2.5 J, whereas in pigs it was 9.5 J. The lowest energy resulting in successful defibrillation was 2 J in canines and 5 J in pigs. There was no evidence of coronary vessel injury or trauma to extrapericardial structures. Conclusions: Percutaneous, epicardial defibrillation using a partially insulated coil is feasible and seems to be associated with low defibrillation thresholds. Focusing insulation may limit extracardiac stimulation and potentially lower energy requirements for efficient defibrillation.

KW - Arrhythmia

KW - Defibrillation

KW - Epicardial

KW - ICD

KW - Insulation

KW - Percutaneous

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