Low Threshold Endocardial Electrodes for Permanent Cardiac Pacing

Three different electrodes, i.e. conventional large and small surface endocardial electrodes and a new large contact area-small active surface electrode, have been compared with respect to their stimulation thresholds for cardiac pacing in 94 patients with 96 electrodes. Both capacitor discharge and constant current pulses were used for the measurements. The average 2 msec impulse threshold for the 47 mm(2) electrode reached its maximum on the 14th postoperative day and was 3.6+/-1.4 V and 4.4+/-1.8 mA. One month after insertion, the threshold was 3.2+/-1.4 V and 3.9+/-1.7 mA. Corresponding values after one month for the 6 mm(2) electrode were 2.0+/-1.0 V and 1.7+/-0.9 mA and for the new electrode 1.7+/-0.9 V and 1.4+/-0.8 mA. Thresholds increased by about 20% when the impulse duration was diminished from 2 to 0.5 msec. The new large area-small active surface electrode offers advantages of significantly smaller increases in stimulation thresholds during the first month after insertion and good attachment to the endocardium.