Evaluation of a novel ventricular support device with defibrillation capabilities in canine and porcine animal models.
BACKGROUND
Sudden death is prevalent in heart failure patients. We tested an implantable ventricular support device consisting of a wireform harness with one or two pairs of integrated defibrillation electrode coils.


RESULTS
The device was implanted into six pigs (36-44 kg) through a subxiphoid incision. Peak voltage (V) defibrillation thresholds (DFT) were determined for five test configurations compared with a control transvenous lead (RV to CanPect). Defibrillator can location (abdominal or pectoral) and common coil separation on the implant (0 degrees or 60 degrees ) were studied.(.) The DFT for RV60 to LV60 + CanPect was significantly less than control (348 +/- 57 vs 473 +/- 27 V, P < 0.05). The DFTs for other vectors were similar to control except for RV0 to LV0 + CanAbd (608 +/- 159 V). The device was implanted into 12 adult dogs for 42, 90, or 180 days with DFT and pathological examination performed at the terminal study. Cardiac pressures were determined at baseline, after implantation, and at the terminal study. The DFT was also determined in a separate group of four dogs at 42 days following implantation of the support device with one pair of defibrillation electrodes. The DFTs at implant and explant in dogs with one pair (8 +/- 1.5 Joules [J] and 6 +/- 1.9 J) or two pairs (8 +/- 3.4 J and 7 +/- 1.9 J) of defibrillation electrodes were not significantly different from each other but significantly less than control measured at the terminal study (18 +/- 3.4 J). Left-sided pressures were significantly decreased at explant but within expected normal ranges. Right-sided pressures were not different except for RV systolic. Histopathology indicated mild to moderate epicardial inflammation and fibrosis, consistent with a foreign body healing response.


CONCLUSIONS
This defibrillation-enabled ventricular support system maintained mechanical functionality for up to 6 months while inducing typical chronic healing responses. The DFT was equal to or lower than a standard transvenous vector.
Killingsworth
Cheryl R
CR
Cardiac Rhythm Management Laboratory, Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, AL 35294-0019, USA. crk@crml.uab.edu
Rippy
Marian K
MK
Virmani
Renu
R
Rollins
Dennis L
DL
McGiffin
David C
DC
Ideker
Raymond E
RE
D000818:Animals; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D004195:Disease Models, Animal; D004285:Dogs; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D006353:Heart-Assist Devices; D019736:Prostheses and Implants; D013552:Swine; D018511:Systems Integration; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000517:prevention & control* / Q000534:rehabilitation