Clark Bradley C, Opfermann Justin D, Davis Tanya D, Krieger Axel, Berul Charles I
Division of Cardiology, Children's National Health System, Washington, DC, USA.
Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
J Cardiovasc Electrophysiol. 2017 Sep;28(9):1098-1104. doi: 10.1111/jce.13263. Epub 2017 Jun 23.
Our group has demonstrated the feasibility of percutaneous pericardial ICD lead placement in a piglet model utilizing direct visualization from a lateral thoracoscopic approach. Development of a novel delivery tool that incorporates visualization allows for the procedure to be performed with a 1 cm subxiphoid incision.
A 1 cm incision is made in the subxiphoid area and a novel self-anchoring delivery tool is inserted. A rigid thoracoscope and needle are inserted into two crossed working channels of the tool. After needle visualization, pericardial needle access, followed by sheath access is obtained. A modified side-biting ICD lead is inserted and fixated to the ventricular epicardial surface. The lead is connected to an ICD generator and lead testing followed by defibrillation threshold testing (DFT) is performed. Single-incision ICD lead placement was performed in 6 piglets without acute complications. Median time from subxiphoid incision to DFT testing was 64 minutes; median time from thoracoscope insertion to lead fixation was 16.5 minutes (range 9-30). All had adequate ventricular sensing and pacing at implant and underwent successful defibrillation (range 3-5 J). Survival period ranged from 1 to 16 weeks. Two piglets had survival periods of 12 and 16 weeks with mean weight gain of 7 kg; both had successful repeat DFT at 10 J. All survival animals had stable lead impedances and R-wave amplitudes throughout the survival period.
Percutaneous pericardial placement of an ICD lead using our novel access tool can be safely performed through a 1 cm incision without complications.
我们的团队已在仔猪模型中证明了经皮心包植入式心律转复除颤器（ICD）导线放置的可行性，该操作采用侧胸壁电视胸腔镜直视方法。开发一种结合可视化功能的新型输送工具，可通过剑突下1厘米切口进行该手术。
在剑突下区域做一个1厘米的切口，插入一种新型的自锚定输送工具。将一个硬质胸腔镜和穿刺针插入该工具的两个交叉工作通道。在穿刺针可视化后，进入心包穿刺，随后进入鞘管。插入一根改良的侧咬式ICD导线并固定于心室外膜表面。将导线连接到ICD发生器，进行导线测试，随后进行除颤阈值测试（DFT）。在6只仔猪中进行了单切口ICD导线植入，无急性并发症。从剑突下切口到DFT测试的中位时间为64分钟；从胸腔镜插入到导线固定的中位时间为16.5分钟（范围9 - 30分钟）。所有仔猪在植入时均有足够的心室感知和起搏功能，并成功进行了除颤（能量范围3 - 5焦耳）。生存期为1至16周。两只仔猪生存期分别为12周和16周，平均体重增加7千克；两者在10焦耳时均成功进行了重复DFT测试。所有存活动物在生存期内导线阻抗和R波振幅均稳定。
使用我们的新型进入工具经皮心包植入ICD导线可通过1厘米切口安全进行，无并发症。
