Faisal F Syed1, Christopher V DeSimone1, Elisa Ebrille1, Prakriti Gaba2, Dorothy J Ladewig3, Susan B Mikell3, Scott H Suddendorf4, Emily J Gilles3, Andrew J Danielsen3, Markéta Lukášová5, Jiří Wolf5, Pavel Leinveber5, Miroslav Novák5, Zdeněk Stárek5, Tomas Kara6, Charles J Bruce1, Paul A Friedman1, Samuel J Asirvatham7. 1. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 2. Mayo Medical School, Mayo Clinic, Rochester, MN. 3. Mayo Clinic Ventures, Mayo Clinic, Rochester, MN. 4. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. 5. ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic. 6. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic. 7. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
INTRODUCTION: Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. METHODS: In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards 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 facing away (median [IQR] mA: dogs 0.9 [0.4-1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2-1] vs 2.5 [0.5-6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). CONCLUSION: Selective electrode insulation confers directional pacing to a multielectrode 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.
INTRODUCTION: Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. METHODS: In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards 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 facing away (median [IQR] mA: dogs 0.9 [0.4-1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2-1] vs 2.5 [0.5-6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). CONCLUSION: Selective electrode insulation confers directional pacing to a multielectrode 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.
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