Why the study?
Do membrane covered carbon leads with or without steroid elution improve electrophysiological characteristics compared to a steroid-eluting platinum lead in patients receiving pacemakers?
Do membrane covered carbon leads with or without steroid elution improve electrophysiological characteristics compared to a steroid-eluting platinum lead in patients receiving pacemakers?
Steroid-eluting platinum leads offer advantageous stimulation characteristics over membrane-covered carbon leads, though energy consumption is not significantly reduced due to low impedance and pacemaker programming limitations.
Steroid-eluting platinum leads may be favored for lower thresholds; leaves open relevance to modern lead designs.
In a controlled study, the following four bipolar leads with passive fixation were implanted in 46 patients with the Siemens-Multilog-VVI or Sensolog-VVIR-pacemakers: membrane covered activated porous carbon with steroid elution (Siemens 1402 T, 11 patients) and without (Siemens 1403 T, 15 patients); activated carbon (Siemens 1010 T, 10 patients); and platinum with steroid elution (Medtronic Cap-Sure 5026, 10 patients). Stimulation threshold (STH) (assessed by a vario-test), impedance (IMP), and the intracardial R wave potential (IRW) (both gauged by a telemetric method) were measured 1, 5, and 10 days as well as 3 and 6 months after implantation during unipolar and bipolar stimulation, chronaxie rheobase product (CRP) and energy consumption (EC) were systematically determined. Differing insignificantly at the first day after implantation, STH is significantly lower for the 1402 T and CapSure 5026 leads at the tenth day. However, the 1402 T lead shows a significant increase of STH in the follow-up, in contrast to the other leads. The lowest chronic STH was found in the CapSure 5026 lead (CRP is significantly lower in all other leads, too). IMP is significantly lower in the CapSure 5026 lead compared to 1010 T lead. EC does not differ significantly during chronic stimulation in spite of the best possible programming of pulse amplitude and duration. No significant changes of IRW were observed. Unipolar versus bipolar stimulation shows significantly lower STH, CRP, and IMP, differences of EC and IRW were insignificant. In conclusion, the addition of steroid in membrane covered carbon leads protracts the increase of STH, but does not prevent it. The CapSure 5026 lead shows advantageous stimulation characteristics, but energy consumption is not significantly reduced because of low impedance and impossibility of programming an appropriate low output in Multilog pacemakers.
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Wiegand et al. (1996) studied this question.
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