Device Description and Procedural Technique
We studied a novel temporary AV sequential pacing catheter (TAVSP) (Swift Sync Inc. Miami, Florida) deployed percutaneously via a transjugular approach. It consists of a plurality of pre-formed, pre-shaped, resilient insulated nitinol wires bundled together in a tubular and flexible retaining sheath. Venous access is obtained in the right internal jugular vein using standard techniques, and an 8F introducer is inserted. The catheter is delivered to the right ventricle like any other temporary ventricular pacing catheter (4). Once the sheath is retracted, the nitinol wires can spread and deploy in the right ventricle and right atrium, assuring endocardial contact. Because of nitinol’s capacity to seek a pre-shaped form (metal memory), they spread out and contact the endocardial surfaces inside the cardiac chambers. Each wire has a ball tip designed to minimize trauma to the endocardium and provide a high current density for myocardial capture. The unipolar electrodes also provided sufficient surface area to ensure adequate sensing. These are the leads of the pacing catheter. Swift Sync pacing catheter current design has three ventricular leads, one distal ( -) lead that will seat at the distal end of the right ventricle, the other two ventricular leads one (+) and one (-) spread at a 180-degree angle in the opposite direction making contact with the right ventricular endocardium at any time. The catheter has four additional atrial leads, two (+) and two (-) spreading at 90-degree angles and in opposite directions allowing right atrial wall contact at any time (Figure 1 & 2). Nitinol leads are radiopaque to allow for fluoroscopic visualization. The unique design of the catheter and the leads guarantees endocardium wall contact at any time during the cardiac cycle.