1
|
Backhoff D, Müller MJ, Wilberg Y, Eildermann K, Paul T, Zenker D, Krause U. Leadless epicardial pacing at the left ventricular apex: an animal study. Europace 2023; 25:euad303. [PMID: 37906433 PMCID: PMC10616611 DOI: 10.1093/europace/euad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
AIMS State-of-the-art pacemaker implantation technique in infants and small children consists of pace/sense electrodes attached to the epicardium and a pulse generator in the abdominal wall with a significant rate of dysfunction during growth, mostly attributable to lead failure. In order to overcome lead-related problems, feasibility of epicardial implantation of a leadless pacemaker at the left ventricular apex in a growing animal model was studied. METHODS AND RESULTS Ten lambs (median body weight 26.8 kg) underwent epicardial implantation of a Micra transcatheter pacing system (TPS) pacemaker (Medtronic Inc., Minneapolis, USA). Using a subxyphoid access, the Micra was introduced through a short, thick-walled tube to increase tissue contact and to prevent tilting from the epicardial surface. The Micra's proprietary delivery system was firmly pressed against the heart, while the Micra was pushed forward out of the sheath allowing the tines to stick into the left ventricular apical epimyocardium. Pacemakers were programmed to VVI 30/min mode. Pacemaker function and integrity was followed for 4 months after implantation. After implantation, median intrinsic R-wave amplitude was 5 mV [interquartile range (IQR) 2.8-7.5], and median pacing impedance was 2235 Ω (IQR 1725-2500), while the median pacing threshold was 2.13 V (IQR 1.25-2.9) at 0.24 ms. During follow-up, 6/10 animals had a significant increase in pacing threshold with loss of capture at maximum output at 0.24 ms in 2/10 animals. After 4 months, median R-wave amplitude had dropped to 2.25 mV (IQR 1.2-3.6), median pacing impedance had decreased to 595 Ω (IQR 575-645), and median pacing threshold had increased to 3.3 V (IQR 1.8-4.5) at 0.24 ms. Explantation of one device revealed deep penetration of the Micra device into the myocardium. CONCLUSION Short-term results after epicardial implantation of the Micra TPS at the left ventricular apex in lambs were satisfying. During mid-term follow-up, however, pacing thresholds increased, resulting in loss of capture in 2/10 animals. Penetration of one device into the myocardium was of concern. The concept of epicardial leadless pacing seems very attractive, and the current shape of the Micra TPS makes the device unsuitable for epicardial placement in growing organisms.
Collapse
Affiliation(s)
- David Backhoff
- Pediatric Heart Center, Justus-Liebig University Giessen, Feulgenstrasse 10-12, 35385 Gießen, Germany
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Yannic Wilberg
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Katja Eildermann
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Dieter Zenker
- Department of Thoracic and Cardiac Surgery, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| |
Collapse
|
2
|
Eltsov I, Sorgente A, de Asmundis C, La Meir M. First in human surgical implantation of a leadless pacemaker on the epicardial portion of the right atrial appendage in a patient with a cardiac electronic devices mediated dermatitis. Interact Cardiovasc Thorac Surg 2022; 35:6538742. [PMID: 35224625 PMCID: PMC9252116 DOI: 10.1093/icvts/ivac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
A 33-year-old woman with Sick Sinus Node syndrome and persistent atrial fibrillation underwent a Maze IV procedure in order treat atrial fibrillation and concomitant atrial epicardial implantation of a leadless pacemaker to manage her sinus node insufficiency. Last option has been chosen due to rare pocket complication after previous classic dual-chamber pacemaker implantation.
Collapse
Affiliation(s)
- Ivan Eltsov
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel , Brussels, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart , Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart , Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart , Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel , Brussels, Belgium
| |
Collapse
|