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Apex Pacing Simulator

Team Members:
  • Demetri Monovoukas
  • Matthew Nojoomi
  • Shravya Srigiri
  • Scott Stanley
  • Krishnamohan Lalukota, MBBS, MRCP
  • Arpan Chaudhuri, MBBS, MD
  • Abhijeet Shelke, MBBS, MD, DNB
  • Ronald Berger, MD, PhD
  • Harikrishna Tandri, MBBS, MD
  • Youseph Yazdi, PhD, MBA
  • Soumyadipta Acharya, MBBS, PhD
  • Aditya Polsani, MS
  • Naresh Pagidimarry, MS
  • Wade Demmer, Medtronic
  • Yong Cho, Medtronic
  • Erin Reisfeld, Medtronic
  • Pankti Shah, Medtronic
  • Thomas Lulic, Medtronic


The 2015-2016 CBID-Medtronic team represents the third year of a global health collaboration initiative between Johns Hopkins and Medtronic. The overall goal of the project is to identify and address the most significant barriers preventing pacemaker adoption in India, particularly in the more underdeveloped regions. After multiple visits to the field, the team identified that secondary-care facilities in India lack adequate treatment capabilities for emergent bradycardic patients. The standard of care for these emergency patients involves the implantation of a temporary pacemaker until they are effectively stabilized or receive a permanent pacemaker. However, because secondary-care facilities in India typically do not have catheterization labs, implanting cardiologists, or other necessary resources, they are unable to perform temporary pacemaker procedures. Due to the relevance of temporary pacing in the overall patient care pathway, the team has chosen to focus on increasing access to temporary pacing at the secondary-care level in order to increase the overall number of patients who go on to receive permanent pacemakers.

The team’s proposed solution is a pacemaker lead navigation simulator, to help increase the confidence and competency of blind lead navigation at secondary care facilities. The simulator consists of an anatomically accurate model of the heart vasculature that provides electrical signal feedback as an indication of lead position in order to educate and familiarize physicians with the lead navigation procedure. As the user advances a lead through the simulator, the electrogram (EGM) signal corresponding to the location of the lead tip is displayed on a monitor that represents the ECG machine used during the actual procedure. The lead navigation simulator not only allows for less experienced physicians, such as emergency and critical care doctors, to gain experience performing lead navigation, but it also encourages the practice of ECG-guided navigation, a reliable and proven technique used in the US. The simulator directly addresses the lead navigation barrier by increasing physician confidence and helping achieve proper lead placement, which ultimately minimizes associated complications.

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