Subxiphoid epicardial pacing lead implantation using a miniature crawling robotic device

Abstract

Background: We have developed a miniature crawling robot (HeartLander) that navigates on the epicardium. We tested the epicardial pacing lead implantation with the fifth generation prototype of the HeartLander using a beating porcine heart accessed through a closed chest subxiphoid approach. Methods: Heart- Lander consists of two articulated modules that adhere to the epicardium using suction and achieve inchworm-like locomotion. The device was inserted into the pericardial space through a subxiphoid approach. Visualization was achieved with an onboard camera and a fluoroscopy. Left ventricular epicardial pacing lead placement was performed through the working port of the robot. The blood pressure and electrocardiogram were monitored. The heart was excised and examined after the test. Results: The HeartLander walked on the surface of the heart from the apex to the targeted posterior wall. After being screwed down into the myocardium, the epicardial lead was released from the Heart- Lander body. The successful placement of the lead was confirmed by fluoroscopy and actual electrical pacing tests (threshold: 0.5mV/0.5ms). The on-board camera provided adequate visualization of intrapericardial landmarks. No adverse hemodynamic or electrophysiologic events were noted during the trial. A histological study of the excised heart verified that no epicardial damage was caused by the locomotion. Conclusions: The HeartLander prototype demonstrated successful epicardial pacemaker lead placement on a beating porcine heart through a closed chest subxiphoid approach. This approach may be useful for epicardial left ventricular lead implantation for cardiac resynchronization therapy.