This is the first time researchers have purposely punctured the heart and attempted to leave something--like a catheter or pacing lead--behind. "Cardiac puncture normally is considered a major complication," Mickelsen explained. "Everyone avoids it." Perforations can lead to bleeding that basically strangles the heart so it can't pump.
But Mickelson and his colleagues found they could do it. They were able to insert a pacing lead into the pericardial space, and the puncture site healed with the lead in place.
They report on the study in the October issue of the journal Pacing and Clinical Electrophysiology.
"The method described in this paper represents a very attractive alternative for pacing lead placement," said Albert C. Lardo, director of the Image Guided Cardiotherapy Laboratory at The Johns Hopkins University School of Medicine. "Clinical and animal studies in our laboratory have shown that there is an optimal location for lead placement, but in patients with slightly abnormal coronary vein anatomy, it is often difficult or impossible to position the lead ideally. In these patients, leads must be implanted in highly invasive open chest surgery.
"This new technique allows for optimal lead placement through a minimally invasive approach," Lardo continued. "Following further testing in animals, implementation of such a method could have significant clinical implications, such as a reduction in complications, hospitalization, and recovery time compared with conventional surgical procedures."
Mickelsen inserted a catheter through the pig's jugular vein into the right side of the heart. Using x-rays to watch as he guided the catheter through the veins, he positioned the catheter just above the right atrium and threaded a long needle through the catheter. He the
Contact: Jennifer Donovan
Howard Hughes Medical Institute