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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]
Copyright of Pacing & Clinical Electrophysiology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: 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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  Data: <i>Copyright of Pacing & Clinical Electrophysiology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/j.1540-8159.1992.tb03018.x
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      – SubjectFull: Implanted cardiovascular instruments
        Type: general
      – SubjectFull: Electronics in cardiology
        Type: general
      – SubjectFull: Defibrillators
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      – SubjectFull: Cardiac pacing
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      – SubjectFull: Medical equipment
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      – SubjectFull: Cardiology
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              Text: Nov1992
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