Percutaneous Epicardial Pacing using a Novel Insulated Multi-electrode Lead

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Electrophysiology

Background:

• Epicardial cardiac resynchronization therapy (CRT) offers flexible electrode placement but requires surgery and risks phrenic nerve stimulation.
• Novel approaches are needed to improve CRT delivery and minimize complications.

Purpose of the Study:

• To evaluate the efficacy of novel, selectively insulated electrodes for epicardial CRT.
• To determine if these shielded electrodes can achieve myocardial capture without extracardiac stimulation.

Main Methods:

• A percutaneous approach was used in canine and swine models to deploy leads with selectively insulated electrodes.
• Bipolar pacing thresholds were measured with electrodes facing towards and away from the epicardial surface.

Main Results:

• Electrode thresholds facing the myocardium were significantly lower than those facing away in both dogs and swine (p<0.0001).
• Myocardial capture was achieved without extracardiac stimulation at all tested sites.
• A significant threshold margin was observed at high-output stimulation sites (p=0.004).

Conclusions:

• Selective electrode insulation provides directional pacing for epicardial leads.
• This technology enables percutaneous epicardial CRT with optimal lead placement, independent of phrenic nerve or coronary vein anatomy.