title: Durability of bipolar coaxial endocardial pacemaker leads compared with unipolar leads.
abstract: 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.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
authors.forename: M E
authors.initials: ME
authors.lastname: Helguera
authors.forename: S L
authors.initials: SL
authors.lastname: Pinski
authors.forename: J D
authors.initials: JD
authors.lastname: Maloney
authors.forename: J R
authors.initials: JR
authors.lastname: Woscoboinik
authors.forename: R G
authors.initials: RG
authors.lastname: Trohman
authors.forename: V A
authors.initials: VA
authors.lastname: Morant
authors.forename: B L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: L W
authors.initials: LW
authors.lastname: Castle
mesh_terms: D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D010138:Pacemaker, Artificial; D012189:Retrospective Studies