Chronic performance of subxiphoid minimally invasive pericardial Model 20066 pacemaker lead insertion in an infant anima
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Chronic performance of subxiphoid minimally invasive pericardial Model 20066 pacemaker lead insertion in an infant animal model Bradley C. Clark 1,2
&
Rohan Kumthekar 3 & Paige Mass 4 & Justin D. Opfermann 4 & Charles I. Berul 3,4,5
Received: 12 June 2019 / Accepted: 10 September 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose To describe chronic performance of subxiphoid minimally invasive pacemaker lead insertion in a piglet model. Methods Minimally invasive pacemaker lead implantation was performed through a 10-mm incision under direct visualization using the PeriPath port. Epicardial access was obtained and the commercially available Medtronic Model 20066 pacemaker lead was inserted into the pericardial space and epicardial fixation was performed using the side-action helix. The lead was connected to a pacemaker generator in a para-rectus pocket. Animals underwent a 12–14-week observation period and lead impedances, Rwave amplitudes, and ventricular capture thresholds were tested biweekly. After the survival period, animals were euthanized and gross and histopathology were performed. Results Subxiphoid minimally invasive pacemaker lead placement was performed in 8 animals (median 4.9 kg) with 100% acute success. Median procedure time was 65 min (IQR 60.5–77). At implant, median lead impedance was 650 Ω (IQR 244–984), Rwave amplitude 11.1 mV (IQR 8–12.3), and ventricular capture threshold 1.5 V @ 0.4 ms (IQR 1–2.6). Over a median survival period of 13 weeks, there was a median lead impedance change of + 262 Ω (IQR 5.3–618.3), R-wave change of − 4.5 mV (IQR − 7.1–− 2.7) and capture threshold change (1.0 ms) of + 1.5 V (IQR 0–3.3). At autopsy, epicardial fixation sites showed fibrovascular proliferation and minimal chronic inflammation. Conclusions Subxiphoid pericardial pacemaker placement is safe and effective in a piglet model. Further study and development of leads designed for pericardial placement are warranted. Keywords Pacemaker . Pericardial . Subxiphoid . Minimally invasive . Animal model
1 Introduction Advanced heart block, including high-grade 2nd-degree or 3rd-degree block, in pediatric patients is relatively rare but often requires the placement of a permanent pacemaker (PM). The most common causes of advanced heart block in pediatric and adult congenital heart disease (CHD) patients are postoperative from repair of CHD and auto-immune * Bradley C. Clark [email protected] 1
Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
2
Albert Einstein College of Medicine, Bronx, NY, USA
3
Children’s National Medical Center, Washington, DC, USA
4
Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA
5
George Washington University School of Medicine, Washington, DC, USA
secondary to maternal systemic lupus erythematous (SLE) and Sjogren’s syndrome. Heart block due to SLE and Sjogren’s syndrome occurs as the result of the maternal transfer of anti-Ro/SSA antibodies that affect the conduction syste
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