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Long‐Term Performance of Epimyocardial Pacing Leads in Adults: Comparison with Endocardial Leads
Author(s) -
HELGUERA MARCELO E.,
MALONEY JAMES D.,
WOSCOBOINIK JAVIER R.,
TROHMAN RICHARD G.,
MCCARTHY PATRICK M.,
MORANT VICTOR A.,
WILKOFF BRUCE L.,
CASTLE LON W.,
PINSKI SERGIO L.
Publication year - 1993
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1993.tb01603.x
Subject(s) - medicine , cardiology , confidence interval , lead (geology) , cardiac pacing , implantable cardioverter defibrillator , endocardium , geomorphology , geology
The long‐term performance of epimyocardiaJ pacing leads in children is well established, but few studies have analyzed the performance in adults. This issue has clinical relevance in view of the increased use of epimyocardial leads with implantable cardioverter defibrillator and antitachycardia pacing systems. We analyzed 93 epimyocardial pacing “systems” (121 leads: 65 unipolar, 28 bipolar) in adult patients (age 57 ± 16 years), implanted since January 1980. Two different models were studied: Medtronic 4951 “Stab–on” (n = 35) and Medtronic 6917/6917A “Screw‐in” (n = 58). A control group was created by randomly matching each epimyocardial system with two endocardial leads, according to age and year of implant. Epimyocardial and endocardial leads were followed‐up for 44 ± 35 and 43 ± 35 months, respectively (P = NS). Freedom from failure for epimyocardial leads was 0.91 (95% Confidence Interval [95% CI] = 0.82 to 0.96) at 5 years, and 0.91 f95% CI = 0.69 to 0.98) at 10 years. No difference was found between the two analyzed models. Freedom from failure for endocardial leads was 0.97 (95% CI = 0.93 to 0.99) and 0.90 (95% CI = 0.61 to 0.97) at 5 and 10 years, respectively. Epimyocardial Jeads had a significantly poorer short‐term survival than endocardiaJ leads, secondarily to earlier “technique related” failures (P = 0.03; relative riskc 3.0; Wilcoxon test). However, overall long‐term performance was similar to endocardial leads. Epimyocardial pacing leads, meticulously implanted and tested, have a long‐term performance similar to endocardial pacing leads.