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Stable electrical performance of high efficiency pacing leads having small surface, steroid-eluting pacing electrodes
P Deshmukh1, D Casavant, K Anderson
1Cardiology Division, Robert Packer Hospital, Sayre, Pennsylvania 18840, USA.
Pacing and Clinical Electrophysiology : PACE
|December 22, 1999
Summary
New small electrode steroid-eluting pacing leads show high pacing efficiency with low rates of microdislodgment. Electrical stability was generally maintained, with minimal impact on capture, suggesting successful design for cardiac pacing.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Steroid-eluting pacing leads with small electrodes offer improved pacing efficiency.
- Concerns exist regarding the electrical stability of these small electrode designs.
- High impedance pacing electrodes present unique design challenges.
Purpose of the Study:
- To evaluate the clinical performance of a new steroid-eluting pacing lead with small, high impedance electrodes.
- To assess rates of microdislodgment and electrical instability.
- To determine the long-term electrical performance of these novel pacing leads.
Main Methods:
- Implantation of Medtronic Model 5034 ventricular and Model 5534 atrial leads in 167 patients by a single physician.
- Follow-up for a minimum of 9 months post-implantation.
- Monitoring for microdislodgment (sudden pacing threshold increase with radiographic stability) and electrical instability.
Main Results:
- A low microdislodgment rate of 2.3% (6/263 leads) was observed.
- Electrical instability occurred in 2.4% (4/167) of ventricular leads, with only two sustained events, neither causing loss of capture.
- Atrial leads showed a 2.1% (2/96) rate of transient, non-invasive intervention-requiring threshold rise.
Conclusions:
- Small electrode steroid-eluting pacing electrodes can achieve low microdislodgment rates and stable electrical performance.
- Careful lead positioning and securing techniques are crucial for successful implantation.
- Lead stiffness and mass characteristics are critical factors for high impedance lead design success.
