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Am J Physiol Heart Circ Physiol (October 23, 2009). doi:10.1152/ajpheart.00575.2009
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Submitted on June 29, 2009
Revised on September 18, 2009
Accepted on September 22, 2009

A Trans-Atrial Pericardial Access: Lead Placement as Proof of Concept

Ghassan S. Kassab1*, Mark C Svendsen, William Combs2, Jenny S Choy1, Edward J Berbari1, and Jose A Navia

1 Indiana University Purdue University Indianapolis
2 Medtronics

* To whom correspondence should be addressed. E-mail: gkassab{at}iupui.edu.

A safe, easy, and quick access into the pericardial space may provide a window for diagnostics and therapeutics to the heart. The objective of this study was to provide proof of concept for an engagement and access catheter that allows access to the pericardial space percutaneously. A multi-lumen catheter was developed to allow navigation and suction fixation to the right atrial appendage/wall in a normal swine model. Advancement through the multi-lumen catheter using a second catheter with a distal needle tip allows access to the pericardial space without pericardial puncture and advancement of a standard guidewire into the space. Navigation into the pericardial space was undertaken by fluoroscopy alone and was accomplished in ten swine (5 acute and 5 chronic). As a specific application of this pericardial access method, a pacing lead was implanted on the epicardial surface. Five chronic swine experiments were conducted with successful pacing engagement verified by lead impedance and pacing threshold and sensing. Lead impedance exceeded 1,000 ohms pre-engagement and dropped by an average of 200 ohms upon implant (769±498 {Omega}). Pacing thresholds at 0.4ms ranged from about 0.5 to 2.1 volts acutely (1.03±0.92 V). No cardiac effusion or tamponade was observed in any of the acute or chronic studies. The ability to engage, maintain, and retract the right atrial appendage/wall and to engage an epicardial lead was successfully demonstrated. These findings support the feasibility of safe access into the pericardial space in a normal swine model and warrant further investigations for clinical translation.







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