Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study.

Autor:	Sholevar DP; Our Lady of Lourdes Medical Center, Camden, New Jersey. Electronic address: Sholevar1@comcast.net., Tung S; Royal Columbian Hospital, New Westminster, British Columbia, Canada., Kuriachan V; Foothills Hospital Cardiac Arrhythmia Clinic, Calgary, Alberta, Canada., Leong-Sit P; London Health Sciences Centre, London, Ontario, Canada., Roukoz H; University of Minnesota Medical Center Fairview, Minneapolis, Minnesota., Engel G; Sequoia Hospital, Redwood City, California., Kutalek SP; Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, Pennsylvania., Akula D; Our Lady of Lourdes Medical Center, Camden, New Jersey., Thompson AE; Medtronic plc, Mounds View, Minnesota., Christie MGT; Medtronic plc, Mounds View, Minnesota., Ostanniy M; Medtronic plc, Mounds View, Minnesota., Molin F; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2018 Apr; Vol. 15 (4), pp. 536-542. Date of Electronic Publication: 2017 Dec 02.
DOI:	10.1016/j.hrthm.2017.11.030
Abstrakt:	Background: Subcutaneous implantable cardioverter-defibrillators provide an alternative to transvenous defibrillation but require higher shock outputs and offer no antitachycardia pacing. The Substernal Pacing Acute Clinical Evaluation (SPACE) study evaluated the feasibility of pacing from an extravascular substernal location. Objectives: The primary purpose of the SPACE study was to characterize pacing from the substernal space. Secondary objectives included evaluating extracardiac stimulation and recording electrograms. Methods: The SPACE study prospectively evaluated the feasibility of pacing with a commercially available electrophysiology catheter acutely implanted in the substernal space via minimally invasive subxiphoid access. Pacing data were collected in ≥7 vectors using constant current stimulation up to 20 mA and pulse width up to 10 ms. Results: Catheter placement was successful in all 26 patients who underwent the procedure, with a mean placement time of 11.7 ± 10.1 minutes. Eighteen patients (69%) had successful ventricular capture in ≥1 tested vector. The mean pacing threshold at a pulse width of 10 ms was 7.3 ± 4.2 mA across all vectors (5.8 ± 4.4 V). Failed capture was generally associated with suboptimal catheter placement or presumed air ingression. A low level of extracardiac stimulation was observed in 1 patient. The mean R-wave amplitude ranged from 2.98 to 4.11 mV in the unipolar configuration and from 0.83 to 3.95 mV in the bipolar configuration. Conclusion: The data from the SPACE study demonstrate that pacing is feasible from the extravascular substernal location. A substernal electrode configuration has the potential to provide pacing in a future extravascular device without need for intracardiac hardware placement. (Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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