Long-Term Performance of Bipolar Epicardial Atrial Pacing Using an Active Fixation Bipolar Endocardial Lead.
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| Title: | Long-Term Performance of Bipolar Epicardial Atrial Pacing Using an Active Fixation Bipolar Endocardial Lead. |
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| Authors: | Epstein, Michael R.1, Walsh, Edward P.1, Saul, J. Philip1, Triedman, John K.1, Mayer Jr., John E.2, Gamble, Walter J.1 |
| Source: | Pacing & Clinical Electrophysiology. May1998, Vol. 21 Issue 5, p1098-1104. 7p. |
| Subjects: | Cardiac pacing, Endocardium, Cardiac surgery, Implanted cardiovascular instruments, Cardiac pacemakers, Medical equipment |
| Abstract: | Bipolar epicardial leads are not yet widely available for atrial use. Since September 1986, we have used a bipolar active fixation endocardial lead (Cardiac Pacemakers model number's 4266, 4268, and 4269) as a bipolar epicardial atrial lead by attaching the corkscrew tip to the a trial surface and imbricating atrial tissue around the more proximal electrode. A total of 77 bipolar epicardial atrial leads have been implanted using this approach in 72 patients with congenital heart disease (ages 3 months to 38.7 years; mean 8.9 ± 8.8 years). Indications for atrial pacing included AV block (n - 46), sinus node dysfunction (n = 17), and antitachycardial pacing (n = 9). Indications for epicardial pacing included the presence of intracardiac right to left shunt (n = 33), concomitant cardiac surgery (n = 26), surgeon preference (n = 7), and lock of transvenous access to the atrial endocardium (n = 6). Follow-up (median 23 months; mean 281) ± 23.1 months; range 1-78 months) data beyond 2 month postimplantation were available far 44 leads. Atrial sensing was ≥ 2.0 mV for 26 leads (59%) with sensing possible at ≥ 0.75 mV for 42 leads (95%). Threshold data were available at 5 V for 37 leads and at 2.5 V for 36 leads with mean pulse width thresholds measuring 0.21 ± 0.33 ms and 0.34 ± 0.34 ms, respectively. Two leads failed (high capture thresholds at 5 days [n = 1], lead fracture at 42 months (n = 1): one of which was replaced. Four additional leads were replaced electively (marginal thresholds [n = 1], intermittent phrenic: nerve stimulation [n = 1], damaged during subsequent surgery [n = 1], clinically irrelevant insulation break (n = 1) concomitant with additional cardiac surgery. Until a commercially available lead is developed and released, improvisation with a bipolar active fixation endocardial lead as a bipolar epicardial atrial lead is a reasonable approach to providing bipolar atrial sensing and pacing in patients for whom endocardial pacing is contraindicated. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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