The HeartNet (Paracor Medical) was an experimental device that aimed at improving outcomes in heart failure but failed to show significant benefit in a randomized clinical trial.¹ This patient with dilated cardiomyopathy eventually required advanced heart failure therapy (left ventricular assist device as bridge to transplant).

The HeartNet device is placed via minithoracotomy into the intrapericardial space over the cardiac apex. Notice the lack of sternotomy fixation wires. Knowledge of the positioning and elastic property of this device is useful to distinguish cardiac enlargement from pericardial effusion. The former results in an enlarged cardiac silhouette with the cardiac restraint device on the outer edge, whereas the latter would result in the cardiac silhouette projecting beyond the circumference of the device.

As an aside, note should be made of the malpositioned cardiac device lead; specifically, the right atrial lead has been displaced into the right ventricle. Because the atrial lead is unable to sense or pace atrial impulses in such a configuration, the electrophysiologist must reprogram the device to VVI mode (ventricular sensing, ventricular pacing) to avoid malfunction.

Disclosure: I, Francis Deng, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.