Long-term functional integrity of atrial leads

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Atrial lead effectiveness and reliability have been subjects of debate in cardiac pacing.
• Previous studies and internal data suggested variability in atrial lead performance over time.

Purpose of the Study:

• To retrospectively evaluate the long-term effectiveness and reliability of atrial leads implanted at a single center.
• To determine the frequency of atrial lead failure (pacing, sensing, or both) and the duration of proper function for specific lead models.

Main Methods:

• Retrospective analysis of 494 atrial leads (Medtronic Model 6957J and 4512) implanted over a 5-year period ending December 31, 1987.
• Assessment of lead failure rates and calculation of cumulative survival for pacing and sensing functions.

Main Results:

• Eighty-eight percent of polyurethane atrial leads maintained satisfactory function at 5 years, exceeding some previous reports.
• A total of 29 failures (6% of implants) were recorded, affecting pacing, sensing, or both.
• Cumulative atrial lead survival at 5 years was 88%, with pacing survival at 91% +/- 2.4% and sensing survival at 88% +/- 2.9%.

Conclusions:

• Atrial leads demonstrate a high degree of reliability and long-term function, with 88% functioning satisfactorily at 5 years.
• The observed reliability suggests that concerns about atrial pacing and sensing unreliability should not dictate pacemaker mode selection.
• Clinical indications should be the sole basis for choosing pacing modes, rather than apprehension regarding atrial lead performance.