Early and late efficacy of three types of transvenous atrial leads

Experience with three transvenous atrial leads, representing different principles, is presented. The types were screw-in (Vitatron Helifix-12), J-lead (Intermedics Lifeline 483-01) and straight-tined (Medtronic 6961). The study comprised insertion of 86 leads (30 Helifix, 40 Lifeline, 16 Medtronic) in 76 patients. Atrial fibrillation occurred during insertion in two patients, and in two others stable electrode positioning in the right atrial appendage was not achieved. Stable position and acceptable intracardiac P-waves were obtained in all the other patients (in 5 after change to another type of lead). Atrial triggered ventricular pacing was used in 34 cases and atrial pacing was used in 38. The P-wave amplitude at insertion was significantly less with Helifix than with Lifeline or Medtronic. The stimulation thresholds (range 0.25-2.5 V) did not differ significantly between the electrodes. Dislodgement of the electrode occurred during the first week in seven cases (5 Lifeline, 2 Helifix), but no late dislodgement occurred. The mean follow-up was 14 months (range 1-31). All three atrial leads offer acceptable function with regard to electro-physiological properties and electrode stability.