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(Circulation. 2008;118:S_990.)
© 2008 American Heart Association, Inc.

Outcomes of Cardiac Disease in the Young

Abstract 5715: Development Of A Temporary Lead For In Utero Pacing: A New Approach For Cardiac Interventions In Fetuses

Younes Boudjemline¹; Jonathan Rosenblatt²; Damien Bonnet³; Jean-Marie Jouannic⁴

¹ Necker for Sick Children, Paris Cedex 15, France
² Trousseau Hosp, Paris Cedex 15, France
³ Necker for Sick Children, Paris Cedex 15, France
⁴ Trousseau Hosp, Paris Cedex 15, France

Background: Cardiac fetal intervention has been applied to human. It is presently limited to

1. the dilatation of obstructive valvular diseases and
   
2. the creation or dilatation of atrial septal defect in fetuses with hypoplastic left heart syndrome and restrictive atrial septal defect.
   

In this study, we propose a new application of fetal intervention represented by fetal pacing using a specially designed implantable pacing lead in the fetal lamb.

Methods and results: In twelve pregnant ewes (110 –112 days’ gestation), a 17 Gauge needle was placed in contact with cardiac chambers under echo-guidance. Using the lumen of the needle, a 3Fr unipolar pacing lead was advanced and fixed on the cardiac wall using a built-in screw. Pacing was, then, attempted using an external pacing system. Assessment of pacing was confirmed using ultrasound modalities. Pacing lead insertion was successful and uncomplicated in all 15 attempts (atrial and/or ventricular wall respectively n=3 and12) excepted one. In the first fetus, the needle was advanced too far into the right ventricle leading to pericardial bleeding after the retrieval of the needle. The fetal heart rate was overdriven in all at 220/min using the lead. After assessment, pacing lead was unscrewed and retrieved without any complication. Pregnancy was electively interrupted in 6 animals. The other six fetuses were delivered vaginally after an uneventful pregnancy and autopsy at day 3 did not show any significant injury.

Conclusion: Echo-guided fetal pacing is feasible using a specially designed lead. It enlarges present indications of human fetal cardiac interventions.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Boudjemline, Y. Articles by Jouannic, J.-M. PubMed Articles by Boudjemline, Y. Articles by Jouannic, J.-M.