Robotic Pacemaker Lead Placement

Biventricular Pacemaker

Biventricular pacemakers work by activating the right and left ventricles at the same time.

Studies have shown that patients with severely reduced heart function and an abnormally slow electrical system can benefit from a special type of pacemaker called a biventricular pacemaker. The concept is that instead of activating part of the heart muscle with electricity and then having it travel through the heart in an uncoordinated fashion, this special type of pacemaker allows the heart to beat in a more coordinated fashion.

The delay in ventricular contraction can definitely impair heart function. To fix this, something called “cardiac resynchronization therapy” or CRT is required in the form of a biventricular pacemaker. Usually these can be placed percutaneous (through the skin) using the veins of the heart to place the left ventricular lead in the correct place. However, in a small subset of patients, this is not possible often due to unusual anatomy. This is where the robot has a role.

Biventricular pacemaker

We can place a pacemaker lead precisely in the correct location on the left ventricle. This is then attached to a pacemaker generator (placed under the skin through a small incision). Usually a lead can be placed in the right ventricle using catheters alone.

The robotic placement of the left ventricular lead requires general anesthesia (you go to sleep), 3 small (8mm) pencil-sized ports in the left chest and a small incision for the generator just under the left collarbone. The procedure takes around 30 minutes in most cases. The heart beats normally during the procedure and no heart lung machine or “stopping of the heart” is required.

Epicardial pacemaker lead

Epicardial pacemaker lead. The robot is used to attach this to the heart.

The real value of this approach is that it puts the left ventricular lead where it needs to be. Often when surgeons place such leads with open surgery, they are not easily placed in this location and can be in a position that is not optimal.

With a catheter delivering a lead into the right ventricle and the robotic (under control by the surgeon) delivering a second lead onto the left ventricle, the heart is optimally stimulated to beat in a coordinated more natural fashion and function can improve.

robotic left ventricular pacemaker leads

This depicts robotically placed left ventricular pacemaker leads

T. Sloane Guy, MD

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