Percutaneous epicardial pacing using a novel transverse sinus device.

Area of Science:

• Cardiovascular device engineering
• Cardiac electrophysiology
• Minimally invasive surgical techniques

Background:

• Transvenous lead implantation for cardiac pacing carries significant risks and complications.
• Epicardial lead placement offers a potential alternative to mitigate these drawbacks.
• The transverse sinus (TS) presents a unique anatomical target for novel lead anchoring.

Purpose of the Study:

• To design and evaluate a novel percutaneously implanted epicardial pacing lead anchored within the transverse sinus.
• To assess the feasibility, safety, and efficacy of this new lead design in a preclinical setting.

Main Methods:

• A novel multielectrode pacing device with four bipole electrode pairs was designed.
• The device was percutaneously advanced through the transverse sinus in canine models.
• Acute canine experiments (n=6) were conducted to evaluate electrogram recording and pacing thresholds.
• Electrophysiological parameters, pacing characteristics, and anatomical placement were assessed.

Main Results:

• The transverse sinus device successfully recorded atrial and ventricular electrograms.
• Acceptable ventricular and atrial pacing thresholds were achieved (median V: 1.1 mA, A: 2.4 mA at 0.5 ms pulse width).
• Pacing morphologies consistent with right/left ventricular and atrial stimulation were observed.
• Simultaneous biventricular pacing reduced QRS duration (116 ms to 91 ms).
• The device was safely located in the TS with minimal acute complications (one instance of TS abrasion).

Conclusions:

• This study demonstrates a novel approach for epicardial pacing utilizing the transverse sinus anatomy.
• Percutaneous implantation of a transverse sinus-anchored lead is safe and feasible.
• The developed device shows promise for effective atrial and ventricular pacing with acceptable thresholds.