title: The monolithic fetal pacemaker: prototype lead design for closed thorax deployment.
abstract: Prenatal sudden cardiac death and hydrops fetalis are often due to complete heart block. However, no pacing modality exists for intrauterine application for fetal bradycardia. A prototype lead for a novel fetal pacemaker has been developed and used in a direct pacing model. It has been demonstrated that the lead can be safely and successfully deployed using a hypochondriac and transdiaphragmatic or subxiphoid approach. Pacing with ventricular capture was evident with the widening of QRS duration from 50.2 +/- 9.8 to 95.1 +/- 12.8 ms (P = 0.0001). Further studies by echocardiogram revealed an increase in the pulse with pacing, confirming pacing. This study documents proof-of-concept for closed thorax over-the-wire deployment of a novel lead design applicable to fetal pacing. By combining the lead design with microcircuitry and a small power source, it is possible to create a monolithic fetal pacemaker system capable of being deployed in utero.
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Dell'Orfano
authors.forename: Howard A
authors.initials: HA
authors.lastname: Chou
authors.forename: Daegyun
authors.initials: D
authors.lastname: Park
authors.forename: Humair
authors.initials: H
authors.lastname: Mirza
authors.forename: Tomasz
authors.initials: T
authors.lastname: Stys
authors.forename: Vicki
authors.initials: V
authors.lastname: Mahan
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Zavitz
authors.forename: Boris M
authors.initials: BM
authors.lastname: Petrikovsky
authors.forename: Marc
authors.initials: M
authors.lastname: Ovadia
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D004867:Equipment Design; D006327:Heart Block / Q000150:complications / Q000628:therapy*; D015160:Hydrops Fetalis / Q000209:etiology / Q000628:therapy*; D010138:Pacemaker, Artificial; D011295:Prenatal Care; D051381:Rats; D017207:Rats, Sprague-Dawley