New technology
Development of a Novel Temporary Epicardial Pacing Wire With Biodegradable Film

https://doi.org/10.1016/j.athoracsur.2006.04.040Get rights and content

Purpose

A temporary epicardial pacing wire (TEPW) has been routinely placed in patients undergoing cardiac surgery. However, its fixation or removal occasionally causes troublesome complications. The aim of this study is to develop a novel TEPW using biodegradable film to fix the electrode to the epicardium without needle stabbing.

Description

A biodegradable film was prepared with poly(L-lactide-co-ϵ-caprolactone). The film has a honeycomb-patterned structure that serves as a temporary adhesive for the myocardial surface, and the electrode was incorporated within the film. The novel TEPW was placed on the ventricular epicardium of dogs (group A, n = 5). As a control, conventional TEPW was inserted (group B, n = 6). The pacing threshold, R wave amplitude, impedance, and slew rate were measured at postoperative days 0, 1, 3, 5, 7, and 14, and complications after removal were checked.

Evaluation

All measurements in both groups were identified and differences were not observed. In addition, the novel TEPWs could be easily removed without related complications.

Conclusions

This novel TEPW is safe and feasible for postoperative management of cardiac surgeries.

Section snippets

Design of Novel Temporary Epicardial Pacing Wire

Our novel TEPW consists of four parts: (1) a patch of biodegradable film, (2) a unipolar electrode, (3) a lead covering with polyethylene, and (4) an atraumatic needle (Fig 1A–1C). The biodegradable film on the surface facing the epicardium is covered with a honeycomb-patterned structure (Fig 2). The film adheres to the epicardium, and its bondability keeps it from slipping off. This honeycomb-patterned film was prepared as previously described [9, 10]. Briefly,

Technique

All animal experimentation was performed in accordance with the “Guideline for Animal Experiments of Nagoya University,” and approved by the “Animal Experiment Advisory Committee at Nagoya University School of Medicine.”

Results

The values and the postoperative time course of the pacing threshold, sensed R wave amplitude, impedance, and slew rate are shown in Figure 3. The mean pacing threshold increased gradually in both pacing wires from POD 0 to POD 14 (0.80 ± 0.25 to 3.08 ± 0.69 V and 1.03 ± 0.34 to 3.12 ± 1.61 V, in groups A and B, respectively). The mean sensing R wave amplitude decreased in group A (25.1 ± 6.2 to 12.2 ± 7.7 mV) from POD 0 to POD 14. In contrast, the amplitude was almost fixed in group B (11.3 ±

Comment

A novel TEPW, which does not require suturing, was evaluated in this study. Given the measurements, the novel TEPW proved acceptable for ventricular temporary pacing wire after cardiac surgery, and comparable with the conventional TEPWs. However, there were several differences between the novel and the conventional TEPWs.

Among the measurements, R wave amplitudes in group A were higher than those in group B on the day of operation and POD 1. The R wave amplitude is generated as the total amount

Disclosures and Freedom of Investigation

Conventional temporary epicardial pacing wires (Medtronic 6492 heart wire [Medtronic Inc]) were purchased commercially at the regular market price in Japan. The biodegradable film with honeycomb structure and the electrode with this film were developed by our group. The patents for the film and electrode are pending (patent no. WO2004-089434 and no. 2005-124840). The authors had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the

Disclaimer

The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.

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Copyright © 2006 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.