Percutaneous epicardial pacing in infants using direct visualization: A feasibility animal study

Area of Science:

• Pediatric cardiology
• Minimally invasive surgery
• Biomedical engineering

Background:

• Pacemaker implantation in infants typically requires open chest surgery.
• Existing methods for epicardial lead placement are invasive.
• A minimally invasive approach is needed for pediatric pacemaker implantation.

Purpose of the Study:

• To evaluate the safety and feasibility of a novel percutaneous pericardial access tool kit.
• To assess the ability to implant pacemaker leads on the epicardium under direct visualization.
• To establish a less invasive method for pediatric pacemaker procedures.

Main Methods:

• A custom sheath with integrated optical fibers was used for illumination.
• A Veress needle and fiberscope were employed for pericardial access.
• A modified Seldinger technique facilitated guidewire and sheath placement.
• Pacemaker leads were implanted percutaneously under direct visualization in piglets.

Main Results:

• Successful epicardial lead implantation was achieved in all six neonatal piglets.
• The pericardial space was visualized and accessed in all subjects.
• Median procedure time was 16 minutes.
• Clinically acceptable acute pacing parameters (R wave sensing and capture thresholds) were observed.
• No complications occurred during the procedures.

Conclusions:

• Percutaneous epicardial lead implantation under direct visualization is feasible and safe in neonatal piglets.
• The novel technique provides clinically acceptable acute pacing parameters.
• This minimally invasive approach offers a promising alternative to open chest surgery for pediatric pacemaker implantation.