Single-incision percutaneous pericardial ICD lead placement in a piglet model

Bradley C. Clark, Justin D. Opfermann, Tanya D. Davis, Axel Krieger, Charles I. Berul

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Introduction: Our group has demonstrated the feasibility of percutaneous pericardial ICD lead placement in a piglet model utilizing direct visualization from a lateral thoracoscopic approach. Development of a novel delivery tool that incorporates visualization allows for the procedure to be performed with a 1 cm subxiphoid incision. Methods and results: A 1 cm incision is made in the subxiphoid area and a novel self-anchoring delivery tool is inserted. A rigid thoracoscope and needle are inserted into two crossed working channels of the tool. After needle visualization, pericardial needle access, followed by sheath access is obtained. A modified side-biting ICD lead is inserted and fixated to the ventricular epicardial surface. The lead is connected to an ICD generator and lead testing followed by defibrillation threshold testing (DFT) is performed. Single-incision ICD lead placement was performed in 6 piglets without acute complications. Median time from subxiphoid incision to DFT testing was 64 minutes; median time from thoracoscope insertion to lead fixation was 16.5 minutes (range 9–30). All had adequate ventricular sensing and pacing at implant and underwent successful defibrillation (range 3–5 J). Survival period ranged from 1 to 16 weeks. Two piglets had survival periods of 12 and 16 weeks with mean weight gain of 7 kg; both had successful repeat DFT at 10 J. All survival animals had stable lead impedances and R-wave amplitudes throughout the survival period. Conclusion: Percutaneous pericardial placement of an ICD lead using our novel access tool can be safely performed through a 1 cm incision without complications.

Original languageEnglish (US)
Pages (from-to)1098-1104
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

Keywords

  • access tool
  • animal model
  • defibrillator
  • minimally invasive
  • thoracoscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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