title: Left heart pacing lead implantation using subxiphoid videopericardioscopy.
abstract: BACKGROUND
  Recent clinical data support the utility of left heart pacing. The transvenous approach for left heart pacing lead implantation is imperfect. A direct epicardial approach may have advantages, but heretofore its utility has been limited because of the requirement for thoracotomy. We sought to examine the feasibility of a method for epicardial lead implantation that did not require thoracotomy.
  
  
  RESULTS
  In five large swine, percutaneous access to the epicardium was achieved with subxiphoid videopericardioscopy, using a device that marries endoscopy with a port through which pacing leads could be introduced. In each animal, standard, active fixation pacing leads were implanted onto the left atrium and ventricle. The atrial lead was implanted at the base of the appendage. The ventricular lead was implanted on the anterior, lateral, and inferior walls. Continuous direct visualization of the epicardium provided guidance for lead localization and fixation, including avoidance of complications such as trauma to epicardial coronary vessels. Capture thresholds were uniformly low. Postmortem examination demonstrated anatomically accurate, uncomplicated lead fixation.
  
  
  CONCLUSIONS
  Using subxiphoid videopericardioscopy, uncomplicated, anatomically accurate left heart epicardial pacing lead implantation can be achieved without thoracotomy.
authors.affiliation: Center for Minimally Invasive Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Zenati
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bonanomi
authors.forename: Albert  K
authors.initials: A
authors.lastname: Chin
authors.forename: David
authors.initials: D
authors.lastname: Schwartzman
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial; D004567:Electrodes, Implanted; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D008297:Male; D010496:Pericardium / Q000601:surgery; D025321:Surgery, Computer-Assisted; D013552:Swine; D013690:Television; D014989:Xiphoid Bone