title: [Surgical experience with conventional pacemaker leads].
abstract: Background and objectives Due to the nonexistence of clear-cut recommendations for pacemaker lead selection, it was the objective of this retrospective observational study to define the clinical status of conventional leads. For this purpose, we compared our results with two conventional leads to modern and more expensive lead designs such as steroid-eluting and/or high impedance leads in the literature. Patients and methods Intra- and postoperative data of 231 patients who underwent implantation of 178 unipolar, carbon-coated atrial screw-in leads and 231 unipolar, tined leads with a sintered platinum lead tip in the ventricle between 1 Jan 1996 and 31 Dec 2000 were reviewed. Results Intraoperatively, we measured pacing thresholds of 0.87±0.35 V (range: 0.1-2.0V) in the atrium and 0.31±0.13 V (range: 0.1-1.1V) in the ventricle. P-wave amplitude was 3.3±1.5mV (range: 1.0-12.6mV) and R-wave amplitude 13.6±5.1mV (range: 4.2-25.0mV). Postoperatively, we found a chronic pacing threshold of ≤1.2V/1.0ms and 2.5V/0.2ms, respectively, in 97 out of 123 atrial (79%) and 136 out of 161 ventricular leads (85%) (n.s.). Chronic detection threshold measured 3.4±1.3mV in the atrium and 9.2±2.4 mV in the ventricle. Four out of 409 leads (1%) had to be reoperated due to diaphragmatic stimulation (n=1) and loss of capture (n=3). Conclusions 1) Conventional pacemaker leads show good results in the majority of cases. 2) However, modern lead concepts are reported to provide lower pacing thresholds as well as a lower current drain due to pacing. 3) Therefore, the implantation of these leads could be advantageous in younger patients and patients undergoing reoperation because of pacing threshold problems. 4) However, this requires in addition the usage of pulse generators with low internal current drain and optimized postoperative programming of output parameters. 5) Lead-related complication rates as well as the incidence of other perioperative problems should be reason enough to develop standards for pacemaker implantation.
authors.affiliation: OFA Abt. XVII - Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Rübenacher Str. 170 56072 Koblenz, Germany Tel.: +49-261/281-3701 Fax: +49-261/281-3702 E-Mail: AndreasMarkewitz@bwb.org, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Markewitz
keywords: Key words Conventional pacemaker leads; pacemaker implantation; quality standards