Synchronous intra-myocardial ventricular pacing without crossing the tricuspid valve or entering the coronary sinus

Tomas Konecny, Christopher V. DeSimone, Paul Andrew Friedman, Charles J Bruce, Samuel J Asirvatham

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the "atrio-ventricular septum" without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.

Original languageEnglish (US)
Pages (from-to)137-138
Number of pages2
JournalCardiovascular Revascularization Medicine
Volume14
Issue number3
DOIs
StatePublished - May 2013

Fingerprint

Tricuspid Valve
Coronary Sinus
Ventricular Septum
Electrodes
Cardiac Resynchronization Therapy
Heart Atria
Mitral Valve
Canidae
Technology
Safety

Keywords

  • Atrioventricular septum
  • Coronary sinus
  • CRT
  • Intramyocardial
  • Synchronous pacing
  • Tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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abstract = "Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the {"}atrio-ventricular septum{"} without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.",
keywords = "Atrioventricular septum, Coronary sinus, CRT, Intramyocardial, Synchronous pacing, Tricuspid valve",
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AU - Konecny, Tomas

AU - DeSimone, Christopher V.

AU - Friedman, Paul Andrew

AU - Bruce, Charles J

AU - Asirvatham, Samuel J

PY - 2013/5

Y1 - 2013/5

N2 - Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the "atrio-ventricular septum" without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.

AB - Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the "atrio-ventricular septum" without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.

KW - Atrioventricular septum

KW - Coronary sinus

KW - CRT

KW - Intramyocardial

KW - Synchronous pacing

KW - Tricuspid valve

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