Novel approach to epicardial pacemaker implantation in patients with limited venous access

Roberto Costa, Mauricio Scanavacca, Kátia Regina Da Silva, Martino Martinelli Filho, Roger Carrillo

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Limited venous access in certain patients increases the procedural risk and complexity of conventional transvenous pacemaker implantation. Objective The purpose of this study was to determine a minimally invasive epicardial approach using pericardial reflections for dual-chamber pacemaker implantation in patients with limited venous access. Methods Between June 2006 and November 2011, 15 patients underwent epicardial pacemaker implantation. Procedures were performed through a minimally invasive subxiphoid approach and pericardial window with subsequent fluoroscopy-assisted lead placement. Mean patient age was 46.4 ± 15.3 years (9 male [(60.0%], 6 female [40.0%]). The new surgical approach was used in patients determined to have limited venous access due to multiple abandoned leads in 5 (33.3%), venous occlusion in 3 (20.0%), intravascular retention of lead fragments from prior extraction in 3 (20.0%), tricuspid valve vegetation currently under treatment in 2 (13.3%), and unrepaired intracardiac defects in 2 (13.3%). Results All procedures were successful with no perioperative complications or early deaths. Mean operating time for isolated pacemaker implantation was 231.7 ± 33.5 minutes. Lead placement on the superior aspect of right atrium, through the transverse sinus, was possible in 12 patients. In the remaining 3 patients, the atrial lead was implanted on the left atrium through the oblique sinus, the postcaval recess, or the left pulmonary vein recess. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 36.8 ± 25.1 months. Conclusion Epicardial pacemaker implantation through pericardial reflections is an effective alternative therapy for those patients requiring physiologic pacing in whom venous access is limited.

Original languageEnglish
Pages (from-to)1646-1652
Number of pages7
JournalHeart Rhythm
Volume10
Issue number11
DOIs
StatePublished - Nov 1 2013

Fingerprint

Heart Atria
Transverse Sinuses
Tricuspid Valve
Pulmonary Veins
Fluoroscopy
Complementary Therapies
Lead
Therapeutics

Keywords

  • Artificial pacemaker
  • Central venous occlusion
  • Endocarditis
  • Epicardial lead
  • Implanted electrodes
  • Pericardial reflections
  • Subxiphoid
  • Surgical procedures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Costa, R., Scanavacca, M., Da Silva, K. R., Martinelli Filho, M., & Carrillo, R. (2013). Novel approach to epicardial pacemaker implantation in patients with limited venous access. Heart Rhythm, 10(11), 1646-1652. https://doi.org/10.1016/j.hrthm.2013.08.002

Novel approach to epicardial pacemaker implantation in patients with limited venous access. / Costa, Roberto; Scanavacca, Mauricio; Da Silva, Kátia Regina; Martinelli Filho, Martino; Carrillo, Roger.

In: Heart Rhythm, Vol. 10, No. 11, 01.11.2013, p. 1646-1652.

Research output: Contribution to journalArticle

Costa, R, Scanavacca, M, Da Silva, KR, Martinelli Filho, M & Carrillo, R 2013, 'Novel approach to epicardial pacemaker implantation in patients with limited venous access', Heart Rhythm, vol. 10, no. 11, pp. 1646-1652. https://doi.org/10.1016/j.hrthm.2013.08.002
Costa R, Scanavacca M, Da Silva KR, Martinelli Filho M, Carrillo R. Novel approach to epicardial pacemaker implantation in patients with limited venous access. Heart Rhythm. 2013 Nov 1;10(11):1646-1652. https://doi.org/10.1016/j.hrthm.2013.08.002
Costa, Roberto ; Scanavacca, Mauricio ; Da Silva, Kátia Regina ; Martinelli Filho, Martino ; Carrillo, Roger. / Novel approach to epicardial pacemaker implantation in patients with limited venous access. In: Heart Rhythm. 2013 ; Vol. 10, No. 11. pp. 1646-1652.
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abstract = "Background Limited venous access in certain patients increases the procedural risk and complexity of conventional transvenous pacemaker implantation. Objective The purpose of this study was to determine a minimally invasive epicardial approach using pericardial reflections for dual-chamber pacemaker implantation in patients with limited venous access. Methods Between June 2006 and November 2011, 15 patients underwent epicardial pacemaker implantation. Procedures were performed through a minimally invasive subxiphoid approach and pericardial window with subsequent fluoroscopy-assisted lead placement. Mean patient age was 46.4 ± 15.3 years (9 male [(60.0{\%}], 6 female [40.0{\%}]). The new surgical approach was used in patients determined to have limited venous access due to multiple abandoned leads in 5 (33.3{\%}), venous occlusion in 3 (20.0{\%}), intravascular retention of lead fragments from prior extraction in 3 (20.0{\%}), tricuspid valve vegetation currently under treatment in 2 (13.3{\%}), and unrepaired intracardiac defects in 2 (13.3{\%}). Results All procedures were successful with no perioperative complications or early deaths. Mean operating time for isolated pacemaker implantation was 231.7 ± 33.5 minutes. Lead placement on the superior aspect of right atrium, through the transverse sinus, was possible in 12 patients. In the remaining 3 patients, the atrial lead was implanted on the left atrium through the oblique sinus, the postcaval recess, or the left pulmonary vein recess. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 36.8 ± 25.1 months. Conclusion Epicardial pacemaker implantation through pericardial reflections is an effective alternative therapy for those patients requiring physiologic pacing in whom venous access is limited.",
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