John Roy M, Morgan Kevin, Brennecke Lucas H, Benser Michael E, Jais Pierre
From the Brigham and Women's Hospital, Boston, MA (R.M.J.); St. Jude Medical, Inc, Sylmar, CA (K.M., M.E.B.); Charles River Laboratories, Frederick, MD (L.H.B.); and Haut-Lévêque Hospital, Pessac, Bordeaux, France (P.J.).
Circ Arrhythm Electrophysiol. 2015 Jun;8(3):659-66. doi: 10.1161/CIRCEP.114.002076. Epub 2015 Mar 31.
Endovascularly implanted leads risk vascular injury and endocarditis, and can be difficult to locate in desired positions for LV pacing. We evaluated the acute and long-term stability, electric performance and histopathology of a percutaneously placed intrapericardial lead (IPL).
Twelve adult mongrel dogs underwent defibrillator implants incorporating IPLs. Successful uncomplicated percutaneous implantation of an IPL was achieved in all. Early fluoroscopic shift noted with 3 of 6 of the initial version IPL-1 was not seen with the modified IPL-2. Mean±95% confidence interval bipolar capture threshold at 0.5-ms pulse width for the IPL increased from 0.69±0.14 V at implant to 1.50±0.34 V (P=0.003) at 12 weeks. The 12-week thresholds were higher for IPL compared with right ventricular endocardial leads (0.75±0.33 V; P=0.001) but not different compared with coronary sinus leads (1.33±0.58 V; P=0.994). IPL impedance increased from 742±46 Ω at implant to 1066±207 Ω at 12 weeks (P=0.007). R-wave amplitude at 12 weeks was 8.37±1.52 mV. There was no important phrenic nerve stimulation from IPL pacing. Histopathology in 8 animals showed adequate adhesion of the electrodes or mesh to the epicardium without damage to underlying vasculature. There was no evidence for late pericardial inflammation or effusion.
The IPL demonstrated adequate stability of position and acceptable electric parameters without chronic pericardial inflammation in this canine model and offers a potential alternative to endocardial pacing leads.
血管内植入电极存在血管损伤和心内膜炎风险，且在左心室起搏时难以定位到理想位置。我们评估了经皮心包内电极（IPL）的急性和长期稳定性、电性能及组织病理学情况。
12只成年杂种犬接受了植入IPL的除颤器植入术。所有犬均成功且无并发症地经皮植入了IPL。最初版本的IPL - 1中有6个中的3个出现早期透视下移位，而改良后的IPL - 2未出现此情况。IPL在0.5毫秒脉宽时的平均±95%置信区间双极捕获阈值从植入时的0.69±0.14伏增加到12周时的1.50±0.34伏（P = 0.003）。与右心室心内膜电极相比，IPL的12周阈值更高（0.75±0.33伏；P = 0.001），但与冠状窦电极相比无差异（1.33±0.58伏；P = 0.994）。IPL阻抗从植入时的742±46Ω增加到12周时的1066±207Ω（P = 0.007）。12周时R波振幅为8.37±1.52毫伏。IPL起搏未引起重要的膈神经刺激。8只动物的组织病理学检查显示电极或网片与心外膜有充分粘连，未损伤下方血管。无晚期心包炎症或积液的证据。
在该犬模型中，IPL显示出足够的位置稳定性和可接受的电参数，且无慢性心包炎症，为心内膜起搏电极提供了一种潜在替代方案。
