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Precipitous exit block with epicardial steroid-eluting leads
S D Beder1, K S Kuehl, R A Hopkins
1Georgetown University Medical Center, Washington, D.C., USA.
Pacing and Clinical Electrophysiology : PACE
|February 10, 1998
Summary
Steroid-eluting ventricular pacing leads showed varying long-term performance. High early pacing thresholds predict future exit block risk, especially with the 10295A lead, necessitating vigilant monitoring.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Steroid-eluting epicardial pacing leads are used for ventricular pacing.
- Assessing long-term performance and identifying predictors of lead failure is crucial.
Purpose of the Study:
- To evaluate the long-term outcomes of steroid-eluting ventricular epicardial pacing leads (Medtronic 10295A and 10295B/4965).
- To identify early predictors of late pacing threshold increases and exit block.
Main Methods:
- Retrospective analysis of 16 steroid-eluting ventricular epicardial pacing leads implanted in 12 patients.
- Review of Medtronic clinical study database for early pacing thresholds (4 weeks post-implant).
- Correlation of early thresholds with long-term lead performance and exit block.
Main Results:
- Lead fracture occurred in 1 of 12 patients.
- 8 of 11 patients had stable, low long-term pacing thresholds.
- 3 patients experienced precipitous threshold increases, indicating exit block.
- A 4-week post-implant pacing threshold ≥ 0.12 ms (5 V) predicted a 27.3% risk of exit block for the 10295A lead and 7.5% for the 4965 lead.
Conclusions:
- The Medtronic 4965 steroid-eluting epicardial lead demonstrates better long-term stability than the 10295A lead.
- Early identification of high pacing thresholds (≥ 0.12 ms at 4 weeks) is vital for predicting exit block.
- Frequent threshold testing is recommended for patients with the 4965 lead and elevated early thresholds to detect late increases.