Journal article
Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study
Heart rhythm, v 15(4), pp 536-542
Apr 2018
PMID: 29197657
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Subcutaneous implantable cardioverter-defibrillators provide an alternative to transvenous defibrillation but require higher shock outputs and offer no antitachycardia pacing. The Substernal Pacing Acute Clinical Evaluation (SPACE) study evaluated the feasibility of pacing from an extravascular substernal location.
The primary purpose of the SPACE study was to characterize pacing from the substernal space. Secondary objectives included evaluating extracardiac stimulation and recording electrograms.
The SPACE study prospectively evaluated the feasibility of pacing with a commercially available electrophysiology catheter acutely implanted in the substernal space via minimally invasive subxiphoid access. Pacing data were collected in ≥7 vectors using constant current stimulation up to 20 mA and pulse width up to 10 ms.
Catheter placement was successful in all 26 patients who underwent the procedure, with a mean placement time of 11.7 ± 10.1 minutes. Eighteen patients (69%) had successful ventricular capture in ≥1 tested vector. The mean pacing threshold at a pulse width of 10 ms was 7.3 ± 4.2 mA across all vectors (5.8 ± 4.4 V). Failed capture was generally associated with suboptimal catheter placement or presumed air ingression. A low level of extracardiac stimulation was observed in 1 patient. The mean R-wave amplitude ranged from 2.98 to 4.11 mV in the unipolar configuration and from 0.83 to 3.95 mV in the bipolar configuration.
The data from the SPACE study demonstrate that pacing is feasible from the extravascular substernal location. A substernal electrode configuration has the potential to provide pacing in a future extravascular device without need for intracardiac hardware placement.
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Details
- Title
- Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study
- Creators
- Darius P. Sholevar - Our Lady of Lourdes Medical CenterStanley Tung - Royal Columbian HospitalVikas Kuriachan - Foothills Hospital Cardiac Arrhythmia Clinic, Calgary, Alberta, CanadaPeter Leong-Sit - London Health Sciences CentreHenri Roukoz - University of Minnesota Medical CenterGregory Engel - Sequoia HospitalSteven P. Kutalek - Hahnemann University HospitalDevender Akula - Our Lady of Lourdes Medical CenterAmy E. Thompson - Medtronic plc, Mounds View, MinnesotaMelissa G.T. Christie - Medtronic plc, Mounds View, MinnesotaMarina Ostanniy - Medtronic plc, Mounds View, MinnesotaFranck Molin - Institut universitaire de cardiologie et de pneumologie de QuébecSPACE Study Investigators
- Publication Details
- Heart rhythm, v 15(4), pp 536-542
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000428820300011
- Scopus ID
- 2-s2.0-85044172639
- Other Identifier
- 991019340425904721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems