Document Detail


Left ventricular pacing lead insertion via the coronary sinus cardioplegia cannula: a novel method for temporary biventricular pacing during reoperative cardiac surgery.
MedLine Citation:
PMID:  20965517     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Temporary biventricular pacing to treat low output states after cardiac surgery is an active area of investigation. Reoperative cases are not studied due to adhesions, which preclude left ventricular mobilization to place epicardial pacing wires. In such patients, inserting a temporary left ventricular lead via the coronary sinus cardioplegia cannula may allow for biventricular pacing. We developed a novel technique for intraoperative left ventricular lead placement.
METHODS: Eight domestic pigs underwent median sternotomy and pericardiotomy. Temporary pacing wires were sewn to the right atrium and right ventricle. Complete heart block was induced by ethanol ablation of the atrioventricular node. A 13-French retrograde cardioplegia catheter was introduced via the right atrial free wall into the coronary sinus. A 6-French left ventricular pacing lead was inserted into the cardioplegia catheter and advanced into the coronary sinus during biventricular pacing until left ventricular capture was detected by electrocardiogram and arterial pressure monitoring. Left ventricular capture success rate and electrical performance were recorded during five placement attempts.
RESULTS: Left ventricular capture was achieved on 80% of insertion attempts. Left ventricular capture without diaphragmatic pacing was achieved in 7 pigs. Lead tip locations were mostly in lateral and posterior basal coronary vein branches. There were no arrhythmias, bleeding, or perforation associated with lead insertion.
CONCLUSIONS: Intraoperative biventricular pacing with a left ventricular pacing lead inserted via the coronary sinus cardioplegia cannula is feasible, using standard instrumentation and without requiring cardiac manipulation. This approach merits further study in patients undergoing reoperative cardiac surgery.
Authors:
Daniel Y Wang; Rabin Gerrah; Alexander Rusanov; Vinay Yalamanchi; Santos E Cabreriza; Henry M Spotnitz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-10-20
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  142     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-08-19     Revised Date:  2014-11-07    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  73-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cardiac Resynchronization Therapy / adverse effects,  methods*
Cardiac Resynchronization Therapy Devices* / adverse effects
Cardiac Surgical Procedures*
Catheters* / adverse effects
Coronary Sinus*
Electrocardiography
Feasibility Studies
Heart Arrest, Induced / adverse effects,  instrumentation*
Hemodynamics
Intraoperative Care
Pericardiectomy
Reoperation
Sternotomy
Sus scrofa
Time Factors
Ventricular Function, Left
Grant Support
ID/Acronym/Agency:
R01HL080152/HL/NHLBI NIH HHS; T32 HL007854/HL/NHLBI NIH HHS; T32 HL007854/HL/NHLBI NIH HHS
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