TY - JOUR
T1 - Percutaneous epicardial pacing using a novel insulated multi-electrode lead
AU - Syed, Faisal F.
AU - DeSimone, Christopher V.
AU - Ebrille, Elisa
AU - Gaba, Prakriti
AU - Ladewig, Dorothy J.
AU - Mikell, Susan B.
AU - Suddendorf, Scott H.
AU - Gilles, Emily J.
AU - Danielsen, Andrew J.
AU - Lukášová, Markéta
AU - Wolf, Jiří
AU - Leinveber, Pavel
AU - Novák, Miroslav
AU - Stárek, Zdeněk
AU - Kara, Tomas
AU - Bruce, Charles J.
AU - Friedman, Paul A.
AU - Asirvatham, Samuel J.
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation PUBLISHED BY ELSEVIER INC.
PY - 2015/8
Y1 - 2015/8
N2 - Objectives This study hypothesized that shielded electrodes could capture myocardium without extracardiac stimulation. Background Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this therapy requires surgical placement of device leads and risks unwanted phrenic nerve stimulation. Methods In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart and deployed novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at pre-specified sites were tested to compare electrode threshold data, facing both toward 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 those facing away (median threshold of 0.9 [interquartile range (IQR): 0.4 to 1.6] mA vs. 4.6 [IQR: 2.1 to >10.0] mA, respectively, for dogs, p < 0.0001; and 0.5 [IQR: 0.2 to 1.0] mA vs 2.5 [IQR: 0.5 to 6.8] mA, respectively, for swine, p < 0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin of 3.6 ± 0.7 mA at sites of high output extracardiac stimulation (p = 0.004). Conclusions Selective electrode insulation confers directional pacing to a multi-electrode 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.
AB - Objectives This study hypothesized that shielded electrodes could capture myocardium without extracardiac stimulation. Background Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this therapy requires surgical placement of device leads and risks unwanted phrenic nerve stimulation. Methods In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart and deployed novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at pre-specified sites were tested to compare electrode threshold data, facing both toward 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 those facing away (median threshold of 0.9 [interquartile range (IQR): 0.4 to 1.6] mA vs. 4.6 [IQR: 2.1 to >10.0] mA, respectively, for dogs, p < 0.0001; and 0.5 [IQR: 0.2 to 1.0] mA vs 2.5 [IQR: 0.5 to 6.8] mA, respectively, for swine, p < 0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin of 3.6 ± 0.7 mA at sites of high output extracardiac stimulation (p = 0.004). Conclusions Selective electrode insulation confers directional pacing to a multi-electrode 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.
KW - bioelectrical therapy
KW - biventricular pacing
KW - cardiac resynchronization therapy
KW - epicardial mapping
KW - epicardial pacing
KW - minimally invasive
KW - multisite pacing
KW - pericardial intervention
KW - phrenic nerve stimulation
KW - steerable pericardial sheath
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U2 - 10.1016/j.jacep.2015.04.012
DO - 10.1016/j.jacep.2015.04.012
M3 - Article
AN - SCOPUS:84944031968
SN - 2405-500X
VL - 1
SP - 273
EP - 283
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 4
ER -