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Related Experiment Videos

Pericardiocentesis guided by a pulse generator.

J S Tweddell1, A N Zimmerman, C M Stone

  • 1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

Journal of the American College of Cardiology
|October 1, 1989
PubMed
Summary

Pulse generator-guided pericardiocentesis offers a reliable method for epicardial contact detection. This approach using a pacing current is more effective than traditional ST segment monitoring for guiding the procedure safely.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Procedures

Background:

  • Traditional pericardiocentesis relies on ST segment elevation monitoring for epicardial contact, which has shown limitations in accuracy.
  • Accurate identification of epicardial contact is crucial to prevent myocardial perforation and ensure procedural success during pericardiocentesis.

Purpose of the Study:

  • To compare the efficacy of pulse generator-guided pericardiocentesis using a pacing current versus traditional ST segment monitoring.
  • To determine the optimal stimulus strength for reliable epicardial contact detection during pulse generator-guided pericardiocentesis.

Main Methods:

  • Evaluated ST segment elevation at various distances from the epicardium to assess its predictive value for epicardial contact.
  • Conducted pacing studies with unipolar stimulus strengths (2-10 mA) in dogs with and without pericardial effusion to find the optimal pacing threshold.

Related Experiment Videos

  • Utilized a 4 mA unipolar cathodal stimulus, identifying epicardial contact by ventricular capture during pericardiocentesis in a canine model.

    • Main Results:

    • ST segment monitoring demonstrated limited reliability in determining epicardial contact, with a 2 mV elevation showing the highest predictive values (86% positive, 79% negative).
    • A 4 mA unipolar cathodal stimulus was identified as optimal, consistently capturing the ventricle only upon direct epicardial contact.
    • Pulse generator-guided pericardiocentesis successfully guided needle entry into the effusion and epicardial contact in all 10 dogs without complications.

    Conclusions:

    • Pulse generator-guided pericardiocentesis using a pacing current is a reliable and safe method for identifying epicardial contact.
    • This pacing-based guidance system offers an improvement over traditional ST segment monitoring for pericardiocentesis procedures.