Minimally invasive implantable fetal micropacemaker: mechanical testing and technical refinements

Zhou, Li; Vest, Adriana Nicholson; Peck, R.A.; Sredl, Jonathan P.; Huang, Xuechen; Bar‐Cohen, Yaniv; Silka, Michael J.; Pruetz, Jay D.; Chmait, Ramen H.; Loeb, Gerald E.

doi:10.1007/s11517-016-1470-4

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…EXIT may be a viable alternative for the late preterm CAVB fetus too small for extracorporeal membrane oxygenation or the premature fetus with CAVB and structural heart disease. As techniques for in utero pacemakers improve [8] , rescue fetal pacing followed by EXIT to temporary pacing may finally offer hope to the most fragile CAVB patients before birth.…”

Section: Discussionmentioning

confidence: 99%

Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia

Cuneo¹,

Mitchell²,

Marwan

et al. 2017

Fetal Diagn Ther

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Fetuses with anti-SSA-mediated complete atrioventricular block (CAVB) are at high risk for perinatal death if they present at <20 weeks of gestation and develop ventricular rates of <55 beats per minute (bpm), cardiac dysfunction, or hydrops [Izmirly et al.: Circulation 2011;124:1927-1935; Jaeggi et al.: J Am Coll Cardiol 2002;39:130-137; Eliasson et al.: Circulation 2011;124:1919-1926]. After our experience with two such fetuses who died with pulseless electrical activity despite being paced within 30 min of birth, we performed an ex utero intrapartum treatment procedure to ventricular pacing on a 36-week CAVB fetus with cardiac dysfunction, mild hydrops, and a ventricular rate of 46 bpm. While still on placental bypass, temporary epicardial ventricular pacing leads were successfully placed; the infant was delivered and made a successful transition to postnatal life. This approach can improve the 11-fold increase in mortality for the preterm fetus with long-standing CAVB, severe bradycardia, and heart failure.

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Section: Discussionmentioning

confidence: 99%

Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia

Cuneo¹,

Mitchell²,

Marwan

et al. 2017

Fetal Diagn Ther

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“…A new micro pacing device, which is wireless, leadless and percutaneously implantable, has been used in animal models and may have human applications in due course. 33 An algorithm for the management of fetal bradyarrhythmias is presented in Figure 11.…”

Section: Management Of Complete Heart Blockmentioning

confidence: 99%

“…Some reports 31,32 have shown it is possible to pace the fetal cardiac ventricle, but attempts to do this have been complicated by difficulties with lead placement and lead dislodgement. A new micro pacing device, which is wireless, leadless and percutaneously implantable, has been used in animal models and may have human applications in due course 33 …”

Section: Bradycardiasmentioning

confidence: 99%

The diagnosis and management of fetal cardiac arrhythmias

Stott

Pandya

Attilakos

et al. 2022

The Obstetric & Gynaecologis

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Fetal cardiac arrhythmias are relatively common and account for up to 20% of referrals to fetal cardiologists. Arrhythmias may occur because of structural abnormalities of the fetal heart, or because of abnormal functioning of the cardiac conduction system in an otherwise structurally normal heart. Arrhythmias may be diagnosed using ultrasound and M-mode and Doppler echocardiography. Transplacental therapy for tachyarrhythmias has been one of the success stories of fetal cardiology, and good outcomes can be expected in the absence of hydrops. Congenital heart block is most commonly caused by the transplacental passage of anti-Ro and anti-La antibodies and transplacental therapy is less successful in managing this. Learning objectivesTo enable clinicians to provide better counselling for patients about the prognosis of fetal arrhythmias. To learn how to diagnose fetal arrhythmias and know when to refer to a specialist centre if the diagnosis is suspected. To understand the treatment options available and the evidencebased antenatal care schedule.

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“…While the utility of these leadless pacemakers has been demonstrated in adults, they are 5-7 times larger than the fetal micropacemaker and use a lead configuration that cannot be extrapolated to the fetus (Tjong & Reddy, 2017). The fetal micropacemaker is held in a sheath and implanted through a surgical trocar via subxiphoid epicardial approach (Figure 4, Zhou et al 2016). The micropacemaker was first validated in adult rabbits hearts (Loeb et al, 2013) and then optimized through trials in pregnant ewes with successful capture in the final four sheep fetuses (Bar-Cohen et al, 2015).…”

Section: Novel Fetal Pacing Therapiesmentioning

confidence: 99%

Prenatal diagnosis and management of congenital complete heart block

Pruetz

Miller

Loeb

et al. 2019

Birth Defects Research

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Congenital complete heart block (CCHB) is a life‐threatening medical condition in the unborn fetus with insufficiently validated prenatal interventions. Maternal administration of medications aimed at decreasing the immune response in the fetus and beta‐agonists intended to increase fetal cardiac output have shown only marginal benefits. Anti‐inflammatory therapies cannot reverse CCHB, but may decrease myocarditis and improve heart function. Advances in prenatal diagnosis and use of strict surveillance protocols for delivery timing have demonstrated small improvements in morbidity and mortality. Ambulatory surveillance programs and wearable fetal heart rate monitors may afford early identification of evolving fetal heart block allowing for emergent treatment. There is also preliminary data suggesting a roll for prevention of CCHB with hydroxychloroquine, but the efficacy and safety is still being studied. To date, intrauterine fetal pacing has not been successful due to the high‐risk invasive placement techniques and potential problems with lead dislodgement. The development of a fully implantable micropacemaker via a minimally invasive approach has the potential to pace fetal patients with CCHB and thus delay delivery and allow fetal hydrops to resolve. The challenge remains to establish accepted prenatal interventions capable of successfully managing CCHB in utero until postnatal pacemaker placement is successfully achieved.

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Minimally invasive implantable fetal micropacemaker: mechanical testing and technical refinements

Cited by 8 publications

References 39 publications

Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia

Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia

The diagnosis and management of fetal cardiac arrhythmias

Prenatal diagnosis and management of congenital complete heart block

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