Abstract 10987: Minimally Invasive Percutaneous Pericardial ICD Placement in an Infant Piglet Model: Head-to-Head Comparison With an Open Surgical Thoracotomy Approach
Introduction: Epicardial ICD placement in infants, small children, and patients with complex cardiac anatomy requires an open thoracotomy and is associated with increased pain, longer length of stay, and higher cost. We compared a surgical epicardial approach with percutaneous pericardial placement of an ICD lead system in an infant piglet model.
Methods: Animals were randomized to undergo either epicardial placement by direct suture fixation through a left mini-thoracotomy or minimally invasive pericardial insertion with thoracoscopic visualization. Pericardial access was achieved through sub-xiphoid insertion of a pericardiocentesis needle followed by 7-French sheath insertion over a guide wire. An ICD lead (Medtronic) was passed through the sheath and fixed to the epicardium. In both groups, the lead was connected to an ICD generator placed within a sub-rectus abdominal pocket. Lead testing and defibrillation threshold testing (DFT) were performed. All piglets underwent a 2 week survival period followed by repeat lead testing and DFT prior to euthanasia.
Results: Minimally invasive pericardial placement was performed in 8 piglets and surgical epicardial placement in 7 piglets (3-4 kg) without procedural morbidity or mortality. Mean initial DFT was 10.5 Joules (range 3-28J) in the pericardial group and 10 Joules (range 5-35J) in the surgical group (p = N.S.). After the survival period, mean DFT was 12 Joules (range 3-20J) in the pericardial group and 12.3 Joules (range 3-35J) in the surgical group (p = N.S.). All lead and shock impedances, R-wave amplitudes, and ventricular pacing thresholds remained stable throughout the survival period and showed no significant difference between the two groups.
Conclusions: Compared to surgically placed epicardial ICD leads, percutaneous pericardial placement shows a nearly identical ability to effectively defibrillate the heart and has demonstrated similar lead stability. This can provide a means of defibrillator implantation without the need for open chest approach and its attendant pain and morbidity. With continued operator experience, the minimally invasive method may provide a viable alternative to epicardial ICD lead placement in infants, children, and adults at risk for sudden cardiac death.
- Implantable cardioverter-defibrillator (ICD)
- Minimally invasive
- Congenital heart disease
- Defibrillation threshold testing
Author Disclosures: B.C. Clark: None. T.D. Davis: None. M.M. El-Sayed Ahmed: None. N. Ishibashi: None. C.P. Jordan: None. T.D. Kane: None. P.C. Kim: None. A. Krieger: None. D.S. Nath: None. J.D. Opfermann: None. C.I. Berul: Research Grant; Modest; Medtronic.
- © 2015 by American Heart Association, Inc.