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Transvenous Access to the Pericardial Space: An Approach to Epicardial Lead Implantation for Cardiac Resynchronization Therapy
Journal article   Open access   Peer reviewed

Transvenous Access to the Pericardial Space: An Approach to Epicardial Lead Implantation for Cardiac Resynchronization Therapy

STEVEN R. Mickelsen, HIROSHI Ashikaga, RANIL Desilva, AMISH N. Raval, ELLIOT Mcveigh and FRED Kusumoto
Pacing and clinical electrophysiology, Vol.28(10), pp.1018-1024
Received May 24, 2005; revised July 8, 2005; accepted July 25, 2005.
10/2005
DOI: 10.1111/j.1540-8159.2005.00236.x
PMCID: PMC2396320
PMID: 16221257
url
https://www.ncbi.nlm.nih.gov/pmc/articles/2396320View
Open Access

Abstract

Background: Percutaneous access to the pericardial space (PS) may be useful for a number of therapeutic modalities including implantation of epicardial pacing leads. We have developed a catheter-based transvenous method to access the PS for implanting chronic medical devices. Methods: In eight pigs, a transseptal Mullins sheath and Brockenbrough needle were introduced into the right atrium (RA) from the jugular vein under fluoroscopic guidance. The PS was entered through a controlled puncture of the terminal anterior superior vena cava (SVC) (n = 7) or right atrial appendage (n = 1). A guidewire was advanced through the transseptal sheath, which was then removed leaving the wire in PS. The guidewire was used to direct both passive and active fixation pacing leads into the PS. Pacing was attempted and lead position was confirmed by cine fluoroscopy. Animals were sacrificed acutely and at 2 and 6 weeks. Results: All animals survived the procedure. Pericardial effusion (PE) during the procedure was hemodynamically significant in four of the eight animals. At necropsy, lead exit sites appeared to heal without complication at 2 and 6 weeks. Volume of pericardial fluid was 10.8 ± 6.2 mL and appeared normal in four of the six chronic animals. Moderate fibrinous deposition was observed in two animals, which had exhibited significant over-procedural PE. Conclusions: Access to the PS via a transvenous approach is feasible. Pacing leads can be negotiated into this region. The puncture site heals with the lead in place. Further development should focus on eliminating PE and performing this technique in appropriate heart failure models.
 epicardial pacing pericardial resynchronization technique transvenous

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