Intrapericardial drug delivery: pharmacologic properties and long-term safety in swine.
BACKGROUND
Intrapericardial drug delivery is a promising new technique, but the pharmacologic properties of various agents delivered via this route are not known. Furthermore, the long-term safety of intrapericardial catheters has not been previously examined.


METHODS
Using a pericardial access device, a catheter connected to a drug-delivery system was implanted in five pigs. Plasma levels and electrocardiographic measurements were obtained after intravenous and intrapericardial administration of digoxin and procainamide. Histological examination was performed after the device had been implanted for a total of 6 months.


RESULTS
The QTc interval did not change significantly after digoxin or procainamide intravenous administration. QTc decreased by 47+/-23 ms (p=0.046) 8 h after digoxin intrapericardial administration and increased by 128+/-60 ms (p=0.002) 1 h after procainamide intrapericardial administration. The QRS duration did not change significantly after intravenous administration of either agent, but it increased by 17+/-9 ms (p=0.004) 1 h and by 15+/-4 ms (p=0.01) 8 h after procainamide intrapericardial administration. After intravenous procainamide the RR interval decreased, but it did not change significantly after intrapericardial administration of either agent. Histology showed moderate inflammatory infiltration and fibrosis adjacent to the catheter.


CONCLUSIONS
Intrapericardial delivery of digitalis and procainamide produces unique electrophysiological properties. In contrast to satisfactory success of the implantation technique, long-term dwell of the catheter in the pericardium induces moderate, albeit probably clinically significant, fibrosis.
Kolettis
Theofilos M
TM
Department of Cardiology, University of Ioannina, 1 University Avenue, 45 110 Ioannina, Greece.
Kazakos
Nikolaos
N
Katsouras
Christos S
CS
Niokou
Dimitra
D
Pappa
Lamprini
L
Koulouras
Vassilios
V
Stefanou
Panagiotis
P
Seferiadis
Constantinos
C
Malamou-Mitsi
Vassiliki
V
Michalis
Lampros K
LK
Marselos
Marios
M
Sideris
Dimitrios A
DA
D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D004071:Digitalis Glycosides / Q000008:administration & dosage*; D006329:Heart Conduction System / Q000187:drug effects; D008297:Male; D011342:Procainamide / Q000008:administration & dosage*; D013552:Swine
D000889:Anti-Arrhythmia Agents; D004071:Digitalis Glycosides; D011342:Procainamide