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Long‐Term Thresholds of Nonsteroidal Permanent Pacing Leads: A 5‐Year Study
Author(s) -
GUMBRIELLE THOMAS P.,
BOURKE JOHN P.,
SINKOVIC MATJAZ,
TYNAN MARGARET,
KITTPAWONG PEERAPONG,
GOLD RONALD G.
Publication year - 1996
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.1540-8159.1996.tb03366.x
Subject(s) - medicine , nonsteroidal , term (time) , cardiology , quantum mechanics , physics
The present commercial market supports many nonsteroidal endocardial pacing leads of differing construction. In order to compare the performance of these configurations, we studied the long‐term pacing properties of three representative lead types by randomized clinical trial in 99 patients undergoing a first elective VVl implant. Thirty‐one patients received sintered platinum leads, 36 activated pyrolytic carbon leads, and 32 vitreous carbon leads. All received generators capable of noninvasive threshold testing. Acute sensing parameters were R wave amplitude and ST segment elevation measured from the endocardial electrogram. Noninvasive voltage thresholds were measured at implantation, 2 days, 1, 3, and 6 months, and yearly thereafter for 5 years. There were no significant differences between leads in pacing or sensing capabilities at implantation. All three demonstrated similar increases in thresholds, peaking at 1 month, then falling to a plateau by 6 months and did not vary significantly thereafter. There were no significant differences in thresholds between leads during 5 years of follow‐up. The lowest mean threshold at 5 years was 0.93 V at 0.5 ms. This study suggests that: (1) although these lead types all perform well, none offers any particular clinical advantage over another; (2) the degree of early threshold peaking precludes immediate postimplant output reduction, but later thresholds are sufficiently low to enable reductions in pacing output; (3) safe low energy pacing requires greater attention to the lead‐generator combinations; (4) data obtained at subsequent annual follow‐up provided no additional useful clinical information to that obtained at 1 year, and (5) in the absence of other differences, cost can be the deciding factor in lead selection.