title: Minimally invasive resynchronization pacemaker: a pediatric animal model.
abstract: OBJECTIVE
  We developed a minimally invasive epicardial pacemaker implantation method for infants and congenital heart disease patients for whom a transvenous approach is contraindicated. The piglet is an ideal model for technical development.
  
  
  METHODS
  In 5 piglets we introduced a needle through subxiphoid approach under thoracoscopic guidance, inserting a wire into the pericardial space. Pacing leads were affixed to the left ventricular free wall and left atrial appendage. After verifying functionality with atrial and ventricular pacing and sensing, animals were euthanized. Pacemaker monitoring occurred daily for 4 days in the fifth animal.
  
  
  RESULTS
  Through minimally invasive pericardial access, we directly visualized and fixated pacing leads to the left ventricle and left atrial appendage, successfully pacing atrium and ventricle. Epicardial structures were visualized. One piglet had contralateral pneumothorax, which resolved with needle decompression. No other adverse events occurred.
  
  
  CONCLUSIONS
  Minimally invasive epicardial pacemaker implantation in an infant model is feasible and effective. This innovation may be of value for pacing and resynchronization in infants and congenital heart disease patients. Survival studies with permanent generator implantation are under way.
authors.affiliation: Children's National Medical Center, Washington, DC.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Jordan
authors.forename: Kyle
authors.initials: K
authors.lastname: Wu
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ishibashi
authors.forename: Axel
authors.initials: A
authors.lastname: Krieger
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Kane
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Charles I
authors.initials: CI
authors.lastname: Berul
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D004195:Disease Models, Animal; D004562:Electrocardiography; D004867:Equipment Design; D005240:Feasibility Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010496:Pericardium / Q000601:surgery*; D010865:Pilot Projects; D013552:Swine
keywords: 24