Children's National Medical Center, Washington, DC.
Ann Thorac Surg. 2013 Dec;96(6):2210-3. doi: 10.1016/j.athoracsur.2013.07.057.
We developed a minimally invasive epicardial pacemaker implantation method for infants and congenital heart disease patients for whom a transvenous approach is contraindicated. The piglet is an ideal model for technical development.
In 5 piglets we introduced a needle through subxiphoid approach under thoracoscopic guidance, inserting a wire into the pericardial space. Pacing leads were affixed to the left ventricular free wall and left atrial appendage. After verifying functionality with atrial and ventricular pacing and sensing, animals were euthanized. Pacemaker monitoring occurred daily for 4 days in the fifth animal.
Through minimally invasive pericardial access, we directly visualized and fixated pacing leads to the left ventricle and left atrial appendage, successfully pacing atrium and ventricle. Epicardial structures were visualized. One piglet had contralateral pneumothorax, which resolved with needle decompression. No other adverse events occurred.
Minimally invasive epicardial pacemaker implantation in an infant model is feasible and effective. This innovation may be of value for pacing and resynchronization in infants and congenital heart disease patients. Survival studies with permanent generator implantation are under way.
我们为经静脉途径禁忌的婴儿和先天性心脏病患者开发了一种微创心外膜起搏器植入方法。小猪是技术开发的理想模型。
在 5 只小猪中，我们在胸腔镜引导下经剑突下入路引入一根针，将一根导丝插入心包腔。起搏导线固定在左心室游离壁和左心耳上。在用心房和心室起搏和感知验证功能后，动物被安乐死。第五只动物在第 4 天每天进行起搏器监测。
通过微创心包入路，我们直接观察并将起搏导线固定到左心室和左心耳，成功起搏心房和心室。心外膜结构可见。一只小猪出现对侧气胸，经针减压后缓解。没有发生其他不良事件。
在婴儿模型中进行微创心外膜起搏器植入是可行和有效的。这项创新可能对婴儿和先天性心脏病患者的起搏和再同步化有价值。正在进行带有永久性发生器植入的生存研究。
