Durability of bipolar coaxial endocardial pacemaker leads compared with unipolar leads.
BACKGROUND
The coaxial design allows for thinner bipolar endocardial pacemaker leads, but recent reports have suggested a higher incidence of failure for this sophisticated configuration.


OBJECTIVE
To compare the long-term survival of bipolar coaxial and unipolar leads.


METHODS
Retrospective follow-up.


RESULTS
Between January 1, 1980 and June 30, 1991, 1142 bipolar coaxial leads and 1181 unipolar leads were implanted at the Cleveland Clinic. The mean follow-up was 33 +/- 32 months (range 1 to 138 months). Ten bipolar coaxial leads failed (0.88%), as did 9 unipolar leads (0.76%). At 5 years the cumulative survival was 98.6% for both types of leads; however, at 10 years the survival of bipolar coaxial leads was only 92.4% compared with 98.6% of unipolar leads (P = .03; relative risk 2.7, 95% confidence interval = 1.1 to 6.9).


CONCLUSIONS
The sophisticated design of bipolar coaxial leads could be the cause of their increased vulnerability. The benefit-to-risk ratio of this design should be prospectively reevaluated.
Helguera
M E
ME
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
Pinski
S L
SL
Maloney
J D
JD
Woscoboinik
J R
JR
Trohman
R G
RG
Morant
V A
VA
Wilkoff
B L
BL
Castle
L W
LW
D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D010138:Pacemaker, Artificial; D012189:Retrospective Studies