Minimally invasive percutaneous epicardial placement of a prototype miniature pacemaker with a leadlet under direct visualization: A feasibility study in an infant porcine model

Rohan N. Kumthekar, Justin D. Opfermann, Paige Mass, Bradley C. Clark, Jeffrey P. Moak, Elizabeth D. Sherwin, Teresa Whitman, Mark Marshall, Charles I. Berul

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy. Objective: The purpose of this study was to evaluate the safety and feasibility of acute implantation of a prototype miniature pacemaker in an infant porcine model. Methods: A self-anchoring 2-channel access port was inserted into a 1-cm incision left of the subxiphoid space. A rigid thoracoscope with variable viewing angle was inserted through the main channel to visualize the heart under insufflation. An 18-G needle through the second channel accessed the pericardial space, which was secured with a 7-F sheath. The leadlet was affixed against the epicardium using a distal helical side-biting electrode. The sheath, thoracoscope, and port were removed, and the pacemaker was tucked into the incision. Ventricular sensing, lead impedances, and capture thresholds were measured. Results: Twelve piglets (weight 4.8 ± 1.9 kg) had successful device implantation. The median time from incision to leadlet fixation was 21 minutes (interquartile range [IQR] 18–31 minutes). The median lead impedance was 510 Ω (IQR 495–620 Ω). The median R-wave amplitude was 5.7 mV (IQR 4.2–7.0 mV). The median capture threshold was 1.63 V (IQR 1.32–2.97 V) at 0.4 ms pulse width and 1.50 V (IQR 1.16–2.38 V) at 1.0 ms pulse width. There were no complications. Conclusion: Minimally invasive epicardial placement of a prototype miniature pacemaker under thoracoscopy was safe and avoided open chest surgery and creation of an abdominal generator pocket.

Original languageEnglish (US)
Pages (from-to)1261-1267
Number of pages7
JournalHeart Rhythm
Volume16
Issue number8
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Keywords

  • Epicardial
  • Minimally invasive
  • Pacemaker
  • Pediatric
  • Porcine
  • Thoracoscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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