Case report: Feasibility of thoracoscopic epicardial pacing in two dogs: Clinical and surgical features, and outcome

Abstract

Summary This article reports the feasibility of thoracoscopic epicardial pacing in two dogs with permanent bradyarrhythmia requiring pacemaker therapy. Both dogs presented with third degree atrioventricular block. Pre-operative examinations revealed no contraindication to pacemaker therapy. A three-port subxiphoid thoracoscopic approach was used. Pericardectomy was performed to access the epicardium. A sutureless unipolar epicardial pacing lead was placed. The lead was introduced through a 15 mm cannula positioned in the 6th left intercostal space and implanted within the epicardium. The pacemaker generator pocket was created between latissimus dorsi and intercostal muscles. Lead implantation was achieved after one attempt for dog 1, and three for dog 2. Surgical times were respectively 26 and 44 minutes. Pacemaker therapy was effective after surgery for both dogs. Complications included Twiddler's syndrome in the first dog and a seroma in the second. The above technique was compared to the transdiaphragmatic approach in a limited cadaveric study on two dogs to establish the precise location of the epicardial leads for each technique. It demonstrated that thoracoscopic approach paced the right ventricle, while transdiaphragmatic technique paced the left ventricle.