Transvenous Pacemaker Insertion with a Zero Dislodgement Rate

A non-retractable transvenous screw-in lead which gives both stability of placement and low acute and chronic stimulation thresholds was used in 64 patients during the period April, 1979 to June, 1981. The average threshold at implant was 0.7 volts; the current threshold average was .86 milliamps with the pulse width at the standard setting for the pacemaker employed. Chronic thresholds were usually below the lower programmable limit of the pacer as tested at 3 months. In one patient, the fact that the screw was fixed in the exposed position caused trouble. The lead became knotted in the superior vena cava and was removed by thoracotomy. Although this experience with the Osypka lead was not entirely satisfactory, newer developments with retractable leads may make the principle more acceptable.