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Discussion

The T-bar lead proposed here for use in percutaneous fetal pacing might offer important technical advantages over leads used in conventional open surgical procedures. During the observed period of fetal pacing, our lead provided stable fixation with acceptable performance, as demonstrated by the low acute thresholds. Indeed, we believe that this is the first documentation of voltage strength-duration curves for the acute myocardial stimulation threshold of a human fetus that survived 36 hours after intrauterine pacemaker implantation. Moreover, this technique has the potential to minimize surgical trauma to both the fetus and the mother.

The cardiac tamponade observed in this case could have resulted from the 3 failed attempts at lead placement. We believe that use of fetoscopy in conjunction with ultrasonographic guidance would allow for a more controlled procedure in which the new lead could be more easily placed. 2 In addition, the development of improved materials, such as a thinner needle (20 gauge) and a bipolar pacing wire, could facilitate puncture of the fetal myocardium, thus decreasing the chances of such a complication.