Chronic steroid-eluting lead performance: a comparison of atrial and ventricular pacing

Abstract

It is generally believed that atrial pacing leads have higher stimulation thresholds and long-term complication rates than ventricular leads, and this is one of the factors limiting the use of dual chamber pacing. A study was undertaken to compare atrial and ventricular bipolar tined steroid-eluting leads in two designs: the Medtronic CapSure SP and the Telectronics Encor Dec. There were 123 pairs of leads: 81 CapSure SP and 42 Encor Dec. Bipolar atrial and ventricular stimulation thresholds, electrograms, and pacing impedance were measured using the Telectronics META DDDR pulse generator immediately postimplantation, and at 1, 3, and 6 months for all leads and at 12, 18, and 24 months for the CapSure SP. The only major lead complication was a 2% atrial lead dislodgment rate. All leads demonstrated low stimulation thresholds, with the CapSure SP leads having lower values than comparable Encor Dec leads. All leads had a mean range of 0.53-0.89 V at all testing periods with P < 0.05 for atrial leads only. There were no differences in electrogram size between manufacturers and no instances of atrial and ventricular undersensing. Pacing impedance was about 100 omega higher for the Encor Dec leads (P < 0.05, atrial leads only), suggesting that these leads will result in lower pacing energy losses provided the pulse generators are at identical settings. More than 90% of patients could be paced chronically in the atrium and ventricle at 2.5 V, but for chronic 1.6-V pacing, the CapSure SP leads were superior. In conclusion, atrial and ventricular steroid-eluting leads of both manufacturers gave excellent stimulation threshold results allowing low energy dual chamber pacing.