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Lower chronic stimulation threshold in the carbon-tip than in the platinum-tip endocardial electrode: a randomized
L Thuesen1, P J Jensen, H Vejby-Christensen
1University Department of Cardiology, Skejby Hospital, Denmark.
Insights
Vitreous carbon pacemaker electrodes showed a lower chronic stimulation threshold compared to platinum-tip electrodes. This suggests carbon-tip electrodes may offer better long-term performance for pacemaker patients.
Area of Science:
- Cardiology
- Biomaterials Science
- Medical Device Engineering
Background:
- Pacemaker implantation requires reliable endocardial electrodes for effective cardiac pacing.
- Electrode tip material influences chronic stimulation thresholds and long-term pacing performance.
- Vitreous carbon and platinum are common tip materials with distinct electrical properties.
Purpose of the Study:
- To compare the chronic stimulation threshold of vitreous carbon-tip and platinum-tip endocardial pacemaker electrodes.
- To evaluate the long-term efficacy and performance of these two electrode types in patients undergoing VVI pacemaker treatment.
Main Methods:
- Randomized trial involving 79 patients receiving VVI pacemaker treatment.
- Patients were implanted with either Siemens-Elema 412 S (carbon-tip) or 415 S (platinum-tip) endocardial electrodes.
- Pacing thresholds were measured using the vario technique at implantation, 3 months, and 15 months post-implantation.
Main Results:
- No significant differences in stimulation thresholds were observed at implantation or 3 months between carbon-tip and platinum-tip electrodes.
- At 15 months, the chronic stimulation threshold was significantly lower for carbon-tip electrodes (1.12 +/- 0.33 V) compared to platinum-tip electrodes (1.37 +/- 0.38 V, P = 0.003).
- After 1 year, 88% of patients with carbon-tip electrodes met criteria for reducing pacemaker output, versus 66% with platinum-tip electrodes (P = 0.04).
Conclusions:
- Vitreous carbon-tip pacemaker electrodes demonstrate a lower chronic stimulation threshold compared to platinum-tip electrodes.
- Carbon-tip electrodes may facilitate greater reduction in pacemaker output over time, indicating potentially improved long-term pacing efficiency.
- The findings suggest vitreous carbon is a favorable material for endocardial pacemaker electrodes, offering potential advantages in chronic performance.
Abstract:
Seventy-nine patients admitted for VVI pacemaker treatment were randomly given a Siemens-Elema 412 S endocardial electrode (tip material vitreous carbon, tip area 12 mm2) (41 patients) or a Siemens-Elema 415 S endocardial electrode (tip material platinum, tip area 12 mm2) (38 patients). The groups did not differ in age, sex, magnitude of intracardiac signal or indication for pacemaker treatment. Pacing threshold was measured by the vario technique at 3 and 15 months after the implantation. In the group of carbon-tip electrodes and in the group of platinum-tip electrodes stimulation thresholds at implantation were 0.49 +/- 0.10 V and 0.54 +/- 0.14 V (ns), at months 31.40 +/- 0.45 V and 1.57 +/- 0.53 V (ns), and at months 15 1.12 +/- 0.33 V and 1.37 +/- 0.38 V (P = 0.003), respectively. After 1 year, 88% of the patients in the carbon-tip group and 66% (P = 0.04) in the platinum-tip group fulfilled our criteria for reducing pacemaker output from 5.0 V to 2.5 V. In comparable platinum-tip and carbon-tip pacing electrodes, the chronic stimulation threshold was lower in the carbon-tip than in the platinum-tip electrode.