1
|
John M, Post A, Burkland DA, Greet BD, Chaisson J, Heberton GA, Saeed M, Rasekh A, Razavi M. Confirming pericardial access by using impedance measurements from a micropuncture needle. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:593-601. [PMID: 32333406 DOI: 10.1111/pace.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardial access is complicated by two difficulties: confirming when the needle tip is in the pericardial space, and avoiding complications during access, such as inadvertently puncturing other organs. Conventional imaging tools are inadequate for addressing these difficulties, as they lack soft-tissue markers that could be used as guidance during access. A system that can both confirm access and avoid inadvertent organ injury is needed. METHODS A 21G micropuncture needle was modified to include two small electrodes at the needle tip. With continuous bioimpedance monitoring from the electrodes, the needle was used to access the pericardium in porcine models (n = 4). The needle was also visualized in vivo by using an electroanatomical map (n = 2). Bioimpedance data from different tissues were analyzed retrospectively. RESULTS Bioimpedance data collected from the subcutaneous space (992.8 ± 13.1 Ω), anterior mediastinum (972.2 ± 14.2 Ω), pericardial space (323.2 ± 17.1 Ω), mid-myocardium (349.7 ± 87.6 Ω), right ventricular cavity (235.0 ± 9.7 Ω), lung (1142.0 ± 172.0 Ω), liver (575.0 ± 52.6 Ω), and blood (177.5 ± 1.9 Ω) differed significantly by tissue type (P < .01). Phase data in the frequency domain correlated well with the needle being in the pericardial space. A simple threshold analysis effectively separated lung (threshold = 1120.0 Ω) and blood (threshold = 305.9 Ω) tissues from the other tissue types. CONCLUSIONS Continuous bioimpedance monitoring from a modified micropuncture needle during pericardial access can be used to clearly differentiate tissues. Combined with traditional imaging modalities, this system allows for confirming access to the pericardial space while avoiding inadvertent puncture of other organs, creating a safer and more efficient needle-access procedure.
Collapse
Affiliation(s)
- Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - David A Burkland
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Brian D Greet
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jordan Chaisson
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - George A Heberton
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mohammad Saeed
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Abdi Rasekh
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
2
|
Burkland DA, Ganapathy AV, John M, Greet BD, Saeed M, Rasekh A, Razavi M. Near-field impedance accurately distinguishes among pericardial, intracavitary, and anterior mediastinal position. J Cardiovasc Electrophysiol 2017; 28:1492-1499. [PMID: 28833720 DOI: 10.1111/jce.13325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Epicardial catheter ablation is increasingly used to treat arrhythmias with an epicardial component. Nevertheless, percutaneous epicardial access remains associated with a significant risk of major complications. Developing a technology capable of confirming proper placement within the pericardial space could decrease complication rates. The purpose of this study was to examine differences in bioimpedance among the pericardial space, anterior mediastinum, and right ventricle. METHODS An ovine model (n = 3) was used in this proof-of-concept study. A decapolar catheter was used to collect bipolar impedance readings; data were collected between each of five electrode pairs of varying distances. Data were collected from three test regions: the pericardial space, anterior mediastinum, and right ventricle. A control region in the inferior vena cava was used to normalize the data from the test regions. Analysis of variance was used to test for differences among regions. RESULTS A total of 10 impedance values were collected in each animal between each of the five electrode pairs in the three test regions (n = 340) and the control region (n = 145). The average normalized impedance values were significantly different among the pericardial space (1.760 ± 0.370), anterior mediastinum (3.209 ± 0.227), and right ventricle (1.024 ± 0.207; P < 0.0001). In post hoc testing, the differences between each pair of regions were significant, as well (P < 0.001 for all). CONCLUSION Impedance values are significantly different among these three anatomical compartments. Therefore, impedance can be potentially used as a means to guide percutaneous epicardial access.
Collapse
Affiliation(s)
- David A Burkland
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Anand V Ganapathy
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mathews John
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Brian D Greet
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mohammad Saeed
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Abdi Rasekh
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mehdi Razavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|