The effects of local steroid-elution on high-performance pacing leads

Pacing leads without the elution of dexamethasone from the electrode tip usually have an unpredictable increase of pacing threshold within the first few months after implantation. During follow-up, pacing thresholds remained significantly above the level at the time of implantation. The specific clinical effect of local steroid elution is to attenuate the increase of pacing threshold during lead maturation and to maintain low pacing thresholds during follow-up. With pacing thresholds less than 2.5V at 0.5ms pulse duration in more than 95%, patients with steroid-eluting leads rarely have a significant pacing threshold increase compared to patients with non-steroid leads. Steroid elution made the implantation of pacing leads with a small surface of 1.2mm(2) feasible. An advantage of these leads is a higher pacing impedance with values above 1000 ohms, in addition to constant pacing thresholds, which additionally reduces the pacing current. Steroid-elution also avoids in screw-in leads the postoperative threshold peaking, and long-term pacing thresholds were lower compared to non-steroid controls. The local steroid elution itself has no effect on pacing impedance or P/R-wave sensing.