Transvenous access to the pericardial space: An approach to epicardial lead implantation for cardiac resynchronization therapy

Steven R. Mickelsen, Hiroshi Ashikaga, Ranil Desilva, Amish N. Raval, Elliot Mcveigh, Fred Kusumoto

Research output: Contribution to journalArticle

Abstract

Background: Percutaneous access to the pericardial space (PS) may be useful for a number of therapeutic modalities including implantation of epicardial pacing leads. We have developed a catheter-based transvenous method to access the PS for implanting chronic medical devices. Methods: In eight pigs, a transseptal Mullins sheath and Brockenbrough needle were introduced into the right atrium (RA) from the jugular vein under fluoroscopic guidance. The PS was entered through a controlled puncture of the terminal anterior superior vena cava (SVC) (n = 7) or right atrial appendage (n = 1). A guidewire was advanced through the transseptal sheath, which was then removed leaving the wire in PS. The guidewire was used to direct both passive and active fixation pacing leads into the PS. Pacing was attempted and lead position was confirmed by cine fluoroscopy. Animals were sacrificed acutely and at 2 and 6 weeks. Results: All animals survived the procedure. Pericardial effusion (PE) during the procedure was hemodynamically significant in four of the eight animals. At necropsy, lead exit sites appeared to heal without complication at 2 and 6 weeks. Volume of pericardial fluid was 10.8 ± 6.2 mL and appeared normal in four of the six chronic animals. Moderate fibrinous deposition was observed in two animals, which had exhibited significant over-procedural PE. Conclusions: Access to the PS via a transvenous approach is feasible. Pacing leads can be negotiated into this region. The puncture site heals with the lead in place. Further development should focus on eliminating PE and performing this technique in appropriate heart failure models.

Original languageEnglish (US)
Pages (from-to)1018-1024
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume28
Issue number10
DOIs
StatePublished - Oct 2005

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Cardiac Resynchronization Therapy
Pericardium
Pericardial Effusion
Punctures
Atrial Appendage
Superior Vena Cava
Fluoroscopy
Jugular Veins
Heart Atria
Needles
Lead
Swine
Catheters
Heart Failure
Equipment and Supplies

Keywords

  • Epicardial
  • Pacing
  • Pericardial
  • Resynchronization
  • Technique
  • Transvenous

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transvenous access to the pericardial space : An approach to epicardial lead implantation for cardiac resynchronization therapy. / Mickelsen, Steven R.; Ashikaga, Hiroshi; Desilva, Ranil; Raval, Amish N.; Mcveigh, Elliot; Kusumoto, Fred.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 28, No. 10, 10.2005, p. 1018-1024.

Research output: Contribution to journalArticle

Mickelsen, Steven R. ; Ashikaga, Hiroshi ; Desilva, Ranil ; Raval, Amish N. ; Mcveigh, Elliot ; Kusumoto, Fred. / Transvenous access to the pericardial space : An approach to epicardial lead implantation for cardiac resynchronization therapy. In: PACE - Pacing and Clinical Electrophysiology. 2005 ; Vol. 28, No. 10. pp. 1018-1024.
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