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Long‐Term Performance of Bipolar Epicardial Atrial Pacing Using an Active Fixation Bipolar Endocardial Lead
Author(s) -
EPSTEIN MICHAEL R.,
WALSH EDWARD P.,
SAUL J. PHILIP,
TRIEDMAN JOHN K.,
MAYER JOHN E.,
GAMBLE WALTER J.
Publication year - 1998
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.1540-8159.1998.tb00156.x
Subject(s) - medicine , cardiology , lead (geology) , intracardiac injection , endocardium , implant , atrial fibrillation , ablation , surgery , geomorphology , geology
Bipolar epicardial leads are not yet widely available for atrial use. Since September 1986, we have used a bipolar active fixation endocardial lead (Cardiac Pacemakers model number's 4266, 4268, and 4269) as a bipolar epicardial atrial lead by attaching the corkscrew tip to the atrial surface and imbricating atrial tissue around the more proximal electrode. A total of 77 bipolar epicardial atrial leads have been implanted using this approach in 72 patients with congenital heart disease (ages 3 months to 38.7 years; mean 8.9 ± 8.8 years). Indications for atrial pacing included AV block (n = 46), sinus node dysfunction (n = 17), and antitachycardial pacing (n = 9). Indications for epicardial pacing included the presence of an intracardiac right to left shunt (n = 33), concomitant cardiac surgery (n = 26), surgeon preference (n = 7), and lack of transvenous access to the atrial endocardium (n = 6). Follow‐up (median 23 months; mean 28.0 ± 23.1 months; range 1–78 months) data beyond 1 month postimplantation were available for 44 leads. Atrial sensing was ≥ 2.0 mV for 26 leads (59%) with sensing possible at ≥ 0.75 mV for 42 leads (95%). Threshold data were available at 5 V for 37 leads and at 2.5 V for 36 leads with mean pulse width thresholds measuring 0.21 ± 0.33 ms and 0.34 ± 0.34 ms, respectively. Two leads failed (high capture thresholds at 5 days [n = 1], lead fracture at 42 months [n = 1]); one of which was replaced. Four additional leads were replaced electively (marginal thresholds [n = 1], intermittent phrenic nerve stimulation [n = 1], damaged during subsequent surgery [n = 1], clinically irrelevant insulation break [n = 1]) concomitant with additional cardiac surgery. Until a commercially available lead is developed and released, improvisation with a bipolar active fixation endocardial lead as a bipolar epicardial atrial lead is a reasonable approach to providing bipolar atrial sensing and pacing in patients for whom endocardial pacing is contraindicated.