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Left heart pacing lead implantation using subxiphoid videopericardioscopy
Marco A Zenati1, Gianluca Bonanomi, Albert K Chin
1Center for Minimally Invasive Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Journal of Cardiovascular Electrophysiology
|September 3, 2003
Summary
This study demonstrates a new, minimally invasive method for left heart pacing lead implantation without thoracotomy. Subxiphoid videopericardioscopy enables accurate epicardial lead placement, improving pacing strategies.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
- Biomedical Engineering
Background:
- Left heart pacing shows clinical utility, but transvenous lead implantation has limitations.
- Direct epicardial approaches are advantageous but traditionally require thoracotomy.
- A novel method for thoracotomy-free epicardial lead implantation was investigated.
Purpose of the Study:
- To assess the feasibility of epicardial lead implantation without thoracotomy.
- To evaluate a subxiphoid videopericardioscopy technique for left heart pacing.
Main Methods:
- Percutaneous epicardial access was achieved in five swine using subxiphoid videopericardioscopy.
- A specialized device allowed endoscopic visualization and lead introduction.
- Standard active fixation pacing leads were implanted on the left atrium and ventricle under direct visualization.
Main Results:
- Successful implantation of atrial and ventricular leads on the left heart.
- Low capture thresholds were consistently achieved.
- Postmortem examination confirmed accurate, uncomplicated lead fixation without trauma to coronary vessels.
Conclusions:
- Subxiphoid videopericardioscopy allows for uncomplicated and anatomically accurate left heart epicardial pacing lead implantation.
- This thoracotomy-free approach offers a promising alternative for left heart pacing lead placement.