Can the Heart be Chronically Paced with Electrodes on the Pericardial Surface?

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Title:	Can the Heart be Chronically Paced with Electrodes on the Pericardial Surface?
Authors:	Shepard, R. B.¹, A. E.Epstein², Kay, G. N.², Kirklin, J. K.¹, Slabaugh, J.¹, Renfroe, D.¹, Keith, R.¹, Pacifico, A. D.¹
Source:	Pacing & Clinical Electrophysiology. Nov1992, Vol. 15 Issue 11, p2041-2045. 5p.
Subjects:	Implanted cardiovascular instruments, Electronics in cardiology, Defibrillators, Cardiac pacing, Medical equipment, Cardiology, Medical research
Abstract:	During implantable defibrillator (ICD) operations, we measured acute and chronic transpericardial bipolar pacing thresholds through standard myocardial surface electrodes sewn on the pericardium for chronic ICD QRS rate-sensing use. We compared observations in 24 patients on day 0 with chronic measurements in seven patients at 27.4 ± 12.1 (median 31.7) months. The leads were used only for QRS rate-sensing, not for pacing, during the time between acute and chronic measurements. Acute transpericardial pacing threshold at 0.5-msec stimulus duration on day 0 was 4.5 ± 2.19 V (standard deviation), median 3.5 V, and at median time 964 days postimplantation was 3.8 ± 2.07 V, median 3.5 V. Mean acute pacing current threshold was 3.7 ± 1.90 mA, n = 23, and chronic was 2.7 ± 1.79 mA, n = 6. Acute bipolar impedance was 1,209 ± 383 ohms, median 1,138 ohms, and chronic was 1,550 ± 358 ohms, median 1,410 ohms, n = 7. Acute bipolar QRS amplitude was 12.3 ± 5.93 mV, median 12.1 mV, n = 24, and chronic was 13.5 ± 8.5 mV, median 17.2 mV, n = 7. None of the changes between the acute and chronic states was statistically significant, with the exception of bipolar impedance (P = 0.054). We concluded that: (I) transpericardial pacing threshold did not increase with time; (2) initial and chronic pacing impedances were high and current low; (3) QRS amplitudes were highly satisfactory for defibrillator rate-sensing; and (4) this approach to ICD implantation left the surgically virgin heart unscarred to make future transplantation easier, and enhanced safety when previous cardiac operations had been done. [ABSTRACT FROM AUTHOR]
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Database:	Engineering Source

Description
Abstract:	During implantable defibrillator (ICD) operations, we measured acute and chronic transpericardial bipolar pacing thresholds through standard myocardial surface electrodes sewn on the pericardium for chronic ICD QRS rate-sensing use. We compared observations in 24 patients on day 0 with chronic measurements in seven patients at 27.4 ± 12.1 (median 31.7) months. The leads were used only for QRS rate-sensing, not for pacing, during the time between acute and chronic measurements. Acute transpericardial pacing threshold at 0.5-msec stimulus duration on day 0 was 4.5 ± 2.19 V (standard deviation), median 3.5 V, and at median time 964 days postimplantation was 3.8 ± 2.07 V, median 3.5 V. Mean acute pacing current threshold was 3.7 ± 1.90 mA, n = 23, and chronic was 2.7 ± 1.79 mA, n = 6. Acute bipolar impedance was 1,209 ± 383 ohms, median 1,138 ohms, and chronic was 1,550 ± 358 ohms, median 1,410 ohms, n = 7. Acute bipolar QRS amplitude was 12.3 ± 5.93 mV, median 12.1 mV, n = 24, and chronic was 13.5 ± 8.5 mV, median 17.2 mV, n = 7. None of the changes between the acute and chronic states was statistically significant, with the exception of bipolar impedance (P = 0.054). We concluded that: (I) transpericardial pacing threshold did not increase with time; (2) initial and chronic pacing impedances were high and current low; (3) QRS amplitudes were highly satisfactory for defibrillator rate-sensing; and (4) this approach to ICD implantation left the surgically virgin heart unscarred to make future transplantation easier, and enhanced safety when previous cardiac operations had been done. [ABSTRACT FROM AUTHOR]
ISSN:	01478389
DOI:	10.1111/j.1540-8159.1992.tb03018.x