Abstract 15945: A Novel Defibrillation Tool: Percutaneously Delivered, Partially-insulated Epicardial Defibrillation
Introduction: Epicardial defibrillator systems typically require surgical access for implantation.
Hypothesis: To develop an entirely percutaneous defibrillator system with partially insulated epicardial coils to focus electrical energy on the myocardium and prevent or minimize extra-cardiac stimulation.
Methods: We designed and tested two prototypes (50 cm long, 12 Fr size), created to be percutaneously introduced into the pericardial space via a steerable sheath. This included a partially insulated defibrillation coil in a forked configuration and a defibrillation mesh constructed from 0.008” stranded nitinol mesh wire with a urethane balloon acting as an insulator to the face of the mesh not in contact with the epicardium.
Results: Of 11 animal experiments, 2 pig experiments had malfunctioning prototypes such that the results were highly variable and unreliable; these were excluded. Therefore, 9 animal experiments were analyzed. This included 6 canine (mean weight 29.8±4.0 kg) and 3 pig (mean weight 40.2±3.0 kg) experiments. The overall average ED75 (energy associated with 75% defibrillation success) was 15 J (10.9 J for canines and 24.2 J in pigs[P=0.08]). The lowest ED75 obtained in canines was 2.5 J while in pigs it was 16.2 J. The lowest energy resulting in successful defibrillation was 2 J in canines and 10 J in pigs. There was no evidence of coronary vessel injury, hemorrhage, or trauma to extra-pericardial structures. When lead directionality was changed such that the noninsulated portion of coil was facing away from the myocardium, animal movement with the same energy shock delivery was noted to be considerably exaggerated.
Conclusion: Percutaneous, epicardial defibrillation using a partially insulated coil is feasible and appears to be associated with low defibrillation thresholds. Focusing insulation may limit extra-cardiac stimulation.
Author Disclosures: A. Killu: None. N. Naksuk: None. C. DeSimone: None. F. Syed: None. P. Gaba: None. D. Ladewig: None. J. Powers: None. S. Suddendorf: None. D.O. Hodge: None. G. Satam: None. M. Crha: None. M. Pesl: None. F. Lehar: None. J. Wolf: None. P. Leinveber: None. M. Novak: None. Z. Starek: None. T. Kara: None. C. Bruce: Other; Modest; Intellectual property. P. Friedman: Other; Modest; Intellectual property. S. Asirvatham: Other; Modest; Intellectual property.
- © 2016 by American Heart Association, Inc.