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@article{1322175,
author = {Syed, Faisal F. and DeSimone, Christopher V. and Ebrille, Elisa and Gaba, Prakriti and Ladewig, Dorothy J. and Mikell, Susan B. and Suddendorf, Scott H. and Gilles, Emily J. and Danielsen, Andrew J. and Lukášová, Markéta and Wolf, Jiří and Leinveber, Pavel and Novák, Miroslav and Stárek, Zdeněk and Kara, Tomas and Bruce, Charles J. and Friedman, Paul A. and Asirvatham, Samuel J.},
article_location = {New York},
article_number = {4},
doi = {http://dx.doi.org/10.1016/j.jacep.2015.04.012},
keywords = {bioelectrical therapy; biventricular pacing; cardiac resynchronization therapy; epicardial mapping; epicardial pacing; minimally invasive; multisite pacing; pericardial intervention; phrenic nerve stimulation; steerable pericardial sheath},
language = {eng},
issn = {2405-500X},
journal = {JACC: Clinical Electrophysiology},
title = {Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead},
volume = {1},
year = {2015}
}
TY - JOUR
ID - 1322175
AU - Syed, Faisal F. - DeSimone, Christopher V. - Ebrille, Elisa - Gaba, Prakriti - Ladewig, Dorothy J. - Mikell, Susan B. - Suddendorf, Scott H. - Gilles, Emily J. - Danielsen, Andrew J. - Lukášová, Markéta - Wolf, Jiří - Leinveber, Pavel - Novák, Miroslav - Stárek, Zdeněk - Kara, Tomas - Bruce, Charles J. - Friedman, Paul A. - Asirvatham, Samuel J.
PY - 2015
TI - Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead
JF - JACC: Clinical Electrophysiology
VL - 1
IS - 4
SP - 273-283
EP - 273-283
PB - Elsevier
SN - 2405500X
KW - bioelectrical therapy
KW - biventricular pacing
KW - cardiac resynchronization therapy
KW - epicardial mapping
KW - epicardial pacing
KW - minimally invasive
KW - multisite pacing
KW - pericardial intervention
KW - phrenic nerve stimulation
KW - steerable pericardial sheath
N2 - Objectives This study hypothesized that shielded electrodes could capture myocardium without extracardiac stimulation. Background Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this therapy requires surgical placement of device leads and risks unwanted phrenic nerve stimulation. Methods In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart and deployed novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at pre-specified sites were tested to compare electrode threshold data, facing both toward and away from the epicardial surface. Results In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than those facing away (median threshold of 0.9 [interquartile range (IQR): 0.4 to 1.6] mA vs. 4.6 [IQR: 2.1 to >10.0] mA, respectively, for dogs, p < 0.0001; and 0.5 [IQR: 0.2 to 1.0] mA vs 2.5 [IQR: 0.5 to 6.8] mA, respectively, for swine, p < 0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin of 3.6 ± 0.7 mA at sites of high output extracardiac stimulation (p = 0.004). Conclusions Selective electrode insulation confers directional pacing to a multi-electrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.
ER -
SYED, Faisal F., Christopher V. DESIMONE, Elisa EBRILLE, Prakriti GABA, Dorothy J. LADEWIG, Susan B. MIKELL, Scott H. SUDDENDORF, Emily J. GILLES, Andrew J. DANIELSEN, Markéta LUKÁŠOVÁ, Jiří WOLF, Pavel LEINVEBER, Miroslav NOVÁK, Zdeněk STÁREK, Tomas KARA, Charles J. BRUCE, Paul A. FRIEDMAN a Samuel J. ASIRVATHAM. Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead. \textit{JACC: Clinical Electrophysiology}. New York: Elsevier, 2015, roč.~1, č.~4, s.~273-283. ISSN~2405-500X. Dostupné z: https://dx.doi.org/10.1016/j.jacep.2015.04.012.
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