Near‐field impedance accurately distinguishes among pericardial, intracavitary, and anterior mediastinal position

Burkland, David; Ganapathy, Anand V.; John, Mathews; Greet, Brian; Saeed, Mohammad; Rasekh, Abdi; Razavi, Mehdi

doi:10.1111/jce.13325

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…The sensor provides visual feedback on pressure differences as the needle advances through different tissue layers. Burkland and associates 10 have introduced a similar device that relies on impedance feedback to determine the location of the needle.…”

Section: Discussionmentioning

confidence: 99%

Pericardial Access Through the Right Atrium in a Porcine Model

Kamat

Cohn

2021

Texas Heart Institute Journal

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As procedures such as epicardial ventricular ablation and left atrial appendage occlusion become more commonplace, the need grows for safer techniques to access the physiologic pericardial space. Because this space contains minimal fluid for lubrication, prevailing methods of pericardial access pose considerable periprocedural risk to cardiac structures. Therefore, we devised a novel method of pericardial access in which carbon dioxide (CO2) is insufflated through a right atrial puncture under fluoroscopic guidance, enabling clear visualization of the cardiac silhouette separating from the chest wall. We performed the procedure in 8 Landrace pigs, after which transthoracic percutaneous pericardial access was obtained by conventional means. All of the animals remained hemodynamically stable during the procedure, and none showed evidence of epicardial or coronary injury. The protective layer of CO2 in the pericardial space anterior to the heart facilitated percutaneous access in our porcine model, and the absence of complications supports the potential safety of this method.

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Section: Discussionmentioning

confidence: 99%

Pericardial Access Through the Right Atrium in a Porcine Model

Kamat

Cohn

2021

Texas Heart Institute Journal

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“…Currently, ICD implantation is performed based on conventional intraoperative criteria: the de brillation lead (DL) pacing threshold (PT) less than 1.0 V and VSA more than 5.0 mV [6]. Beyond technical aspects, several factors may in uence these measurements, including condition of the myocardial tissue surrounding the tip of the implanted lead [7][8][9]. In patients with prior myocardial infarction (MI) this may be due to scar or hibernated tissue with electrical heterogeneity in myocardium of the most frequently implanted positions, particularly an interventricular septum or apex.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with prior myocardial infarction (MI) this may be due to scar or hibernated tissue with electrical heterogeneity in myocardium of the most frequently implanted positions, particularly an interventricular septum or apex. Implantation of the DL into the area with myocardial scar may impair a proper functioning of DL, because the scar or hibernated myocardium has electrical heterogeneity and low signal amplitude [8,9]. This can lead to insu cient sensitivity of the intracardiac signal detection, pacing DL fails and as a result -an inappropriate ICD-therapy.…”

Section: Introductionmentioning

confidence: 99%

How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease

Atabekov

Баталов

Сазонова

et al. 2021

Int J Cardiovasc Imaging

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Introduction. The conventional criteria for a de brillation lead (DL) implantation don't take into account presence of scar or deep ischemia in the myocardium. This may impair a proper functioning of the DL.We sought to optimize the DL implantation placement using rest myocardial perfusion scintigraphy (MPS), which allow detecting areas of myocardial hypoperfusion (MH).Purpose. To study the in uence of MH and scarring, detected by MPS, on the DL parameters in patients with coronary artery disease (CAD).Methods. 69 patients (male -65, age 64.8±7.7 years) with CAD and indications for ICD implantation were enrolled. Two days before ICD implantation all patients underwent MPS at rest. Then patients were divided in 2 groups. In the 1 st group DL was implanted considering MPS results: to the septal position, if the most signi cant MH were detected in the apical segments, and to the apical position, if MH were in the septal segments. In the 2 nd group DL was implanted using the conventional approach without considering MPS results. Clinical 12 months follow-up was performed with ICD interrogation.Results. Patients of both groups were comparable by clinical and scintigraphic parameters. In the same time, in the 1 st group pacing threshold was lower (p<0.0001) and ventricle signal amplitude was higher (p<0.0001) comparing with the 2 nd group at all control points. Conclusion.The presence of MH detected by MPS in the area of the DL placement worsens its parameters. The results of MPS in patients with CAD can be useful for optimization of DL placement.

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“…Beyond technical aspects, several factors may influence these measurements, including properties of the myocardial tissue surrounding the lead electrodes. 1,2 Prior studies suggested an association between temporal changes in some of these parameters and clinical events, such as heart failure functional class changes or cardiac arrhythmias occurrence. [3][4][5] However, it is unknown whether their values at implant could have a clinical relevance as a systematic analysis of association between baseline measurements and clinical outcomes has never been performed.…”

Section: Introductionmentioning

confidence: 99%

“…Beyond technical aspects, several factors may influence these measurements, including properties of the myocardial tissue surrounding the lead electrodes 1,2 . Prior studies suggested an association between temporal changes in some of these parameters and clinical events, such as heart failure functional class changes or cardiac arrhythmias occurrence 3–5 .…”

Section: Introductionmentioning

confidence: 99%

Atrial signal amplitude predicts atrial high‐rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions

Zecchin

Solimene²,

D’Onofrio

et al. 2020

Journal of Arrhythmia

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Background Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual‐chamber ICD and cardiac resynchronization therapy defibrillator (CRT‐D). Methods In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all‐cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high‐rate episode lasting ≥24 hours (24 h AHRE). Results In a cohort of 2976 patients (58.1% ICD) with a median follow‐up of 25 months, event rates were 3.1/100 patient‐years for all‐cause mortality, 18.1/100 patient‐years for VA, and 9.3/100 patient‐years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high‐risk patients. However, at multivariable analysis, the adjusted‐hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 24 h AHRE than in those without (2.45 [IQR: 1.65‐3.85] vs 3.51 [IQR: 2.37‐4.67] mV, P < .01). The adjusted HR for 24 h AHRE in patients with atrial sensing >1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33‐0.83), P = .006. Conclusions Although lower baseline shock impedance was observed in patients with events, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of atrial arrhythmia.

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Near‐field impedance accurately distinguishes among pericardial, intracavitary, and anterior mediastinal position

Abstract: Impedance values are significantly different among these three anatomical compartments. Therefore, impedance can be potentially used as a means to guide percutaneous epicardial access.

Cited by 6 publications

References 15 publications

Pericardial Access Through the Right Atrium in a Porcine Model

Pericardial Access Through the Right Atrium in a Porcine Model

How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease

Atrial signal amplitude predicts atrial high‐rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions

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