Extension of Generator Longevity by Use of High Impedance Ventricular Leads

Scherer, M.; Ezziddin, Khaled; Klesius, Armin; Skupin, M; Helms, Stephan; Moritz, A; Olbrich, Hans-Georg

doi:10.1046/j.1460-9592.2001.00206.x

Cited by 24 publications

(16 citation statements)

References 15 publications

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“…The electrode surface area is inversely related to the pacing impedance, and high impedance pacing leads with small surface electrodes have recently been shown to extend the estimated generator longevity without compromising overall system performance. 13,[17][18][19] The use of a defibrillation lead with a small electrode tip surface for high impedance pacing might, therefore, enhance ICD longevity in selected patients. However, due to the critical role of the defibrillation lead for appropriate device function and for the patient's life, its overall performance should be carefully assessed.…”

Section: Dft and Hv Impedancementioning

confidence: 99%

“…At the same time, pacing thresholds were not different in the two lead models. Considering the existing experience with high impedance pacing leads, 13,[17][18][19] it thus seems likely that defibrillation leads with a small electrode tip surface will decrease energy consumption and prolong device longevity, especially in ICD patients with a high percentage of ventricular pacing.…”

Section: Dft and Hv Impedancementioning

confidence: 99%

“…In pacemaker patients, high impedance pacing appears to prolong device longevity without compromising system performance. 13 Selected ICD patients might benefit from reduced energy consumption during pacing, 7 but the general performance of a defibrillation lead with a small electrode tip surface has not yet been evaluated.…”

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confidence: 99%

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1‐Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study

Vollmann

Stevens

Zenker

et al. 2002

Pacing Clinical Electrophis

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A small electrode surface reduces pacing current drain and can extend generator longevity. The study evaluated the performance of a tined, quadripolar defibrillation lead (model 6944) that has a small-surfaced, steroid-eluting electrode tip for high impedance pacing. In a prospective, controlled study, 34 patients with conventional ICD indications were randomized one to one to receive the high impedance model 6944 or a tined defibrillation lead with a conventional sized, steroid-eluting electrode tip model 6942. Lead performance was evaluated at implant, prior to hospital discharge, and 1, 3, 6, and 12 months thereafter. Baseline characteristics did not differ significantly between patients implanted with lead model 6942 (n = 16) or model 6944 (n = 17). One patient randomized to receive the model 6942 was excluded from the study and was implanted with an active-fixation lead after stable lead positioning was neither possible with the 6942 nor with the 6944 electrode. No other lead related adverse events were observed. At implant, there were no significant differences between pacing thresholds, sensing performance, defibrillation impedances, and defibrillation thresholds in both groups, but pacing impedance of the model 6944 (988.6 +/- 217.7 omega) was approximately twice as high as high as in the model 6942 (431.7 +/- 83.7 omega; P < 0.0001). This difference remained highly significant throughout the observation period of 12 months, while R wave amplitudes and pacing thresholds remained equal in both lead models. The use of a tined defibrillation lead with a small, steroid-eluting electrode tip appears safe and results in a high pacing impedance without compromising system performance.

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Section: Dft and Hv Impedancementioning

confidence: 99%

Section: Dft and Hv Impedancementioning

confidence: 99%

See 1 more Smart Citation

1‐Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study

Vollmann

Stevens

Zenker

et al. 2002

Pacing Clinical Electrophis

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“…For instance, for the CapSure model 5024 Z 3 = R т ≈ 0.6 kΩ [8], for model TIR 60 UP Z 3 = R т ≈ 0.5 kΩ [9], and for model Е 1450 Т Z 2 ≈ 0.6 kΩ [10]. The values of imped ance Z 3 and Z 4 in vivo and in vitro are comparable.…”

Section: A Dubrovskiimentioning

confidence: 99%

A Model of Impedance of Cardiac Pacemaker Electrodes

Dubrovskii

2010

Biomed Eng

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Cardiac electrostimulation uses an implanted pace maker passed through a cardioelectrode. The contact of the electrode with cardiac tissue gives rise to a electric double layer (Fig. 1a). The electric double layer contains capacitance C p , resistance R p , and cardiac tissue resist ance R т representing electrode polarization [1]. The chain is characterized by impedance Z . 1 A telemetric unit of the pacemaker monitors electrode insulation damage, and this also provides electrode service live prognosis.The electrode is connected to the pacemaker output via dividing capacitor C d . Voltage pulse U(t) induces a decrease in the electrode current I(t) due to the capacitor C d charge and polarization capacitance C р (Fig. 1, b and c). The charge Q = ∫I(t)dt decreases within pulse time t p . This increases the required pulse amplitude U and decreases service life. The value of capacitance C d determines energy loses [2]. The losses in C р can be compensated by appro priate electrode material and coating technology [3].Results of clinical testing of electrodes are reported in the literature [4,5]. New domestic pacemaker models provide impedance monitoring [6]. The goal of this work was to construct a model of impedance for cardiac pace maker electrodes in vitro and in vivo.Pacemaker manuals contain a mathematical (calcu lation) and a metrological (experimental) definition of impedance. Voltage pulse trailing front δ U is measured in the pacemaker telemetric unit [7] (Fig. 1b). Impedance Z is calculated assuming Z contains only an active compo nent. Some pacemaker models suggest that δ U decay is linear:Other pacemaker models suggest that δ U decay is exponential:In some cases the impedance is determined from current I(0) from a time of a few microseconds using volt age pulse U(0):Impedance measurement in 67 patients using three models of impedance meter and five models of pacemak er telemetric unit were reported in [7]. The Z value varia tion was 18 34% and detection error ε ex was ≈20%. This error was due to physiological in vivo factor, parameters of C d capacitor, Eqs. (1) (3), and electrode contact polarizaThe impedance of the electrode of pacemaker telemetry units was measured to diagnose damage to the conduc tor and/or isolation of the electrode, as well as to predict the service life of an implanted pacemaker. However, different pacemaker models use different methods for measuring the impedance. The procedure of physical and mathematical modeling allows in vivo impedance to be compared with in vitro impedance values. A physical model was determined using active resistance and polarization capacitance and resistance. The mathematical model of the impedance was determined using Orcad Capture by comparing different definitions of impedance. It is shown that for electrodes without excessive polarization the difference between the methods of measuring impedance pacemaker telemetry units did not exceed the declared measurement error of 20%. A method for measuring and calculating the impedance in vitro is suggested. Th...

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“…Contributions to the solution of this conflict have been made from hardware and software improvements. Batteries with higher energy density, steroid‐eluting electrodes, and high impedance, low threshold leads have been developed 1–5 . It has been shown that all these advancement 5 in hardware significantly extend pacemaker longevity if the device is programmed accordingly 1–7 …”

Section: Introductionmentioning

confidence: 99%

Effect of Modern Pacing Algorithms on Generator Longevity:

Gelvan

Crystal

Dokumaci

et al. 2003

Pacing Clinical Electrophis

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Pulse generator (PG) longevity is of major importance to the quality of care of pacemaker patients. A series of automatic algorithms affect PG longevity. This study investigated the individual and combined effects of three algorithms incorporated in the Medtronic Kappa 700 pacemaker series: Capture Management periodically measures the stimulation threshold and adjusts the PG output, Sinus Preference allows the sinus rate to prevail in a specified range below the sensor rate, and Search AV allows an extension of the AV interval if spontaneous conduction is observed. The effects of Capture Management, Sinus Preference, and Search AV on device longevity were studied in 21 consecutive patients treated in the VDD and DDDR modes. Patients were followed for 1 year. The data were analyzed using an equation provided by the manufacturer. Capture Management was activated in 20 patients. For 11 PGs at the basic settings, longevity was extended by 5.2%, whereas reprogrammed PGs had no gain. Sinus Preference was active in four DDDR patients, who gained 12.0 +/- 5.3%atrial sensing from it, with a resultant longevity gain of1.4 +/- 0.45 months(NS). Search AV was active in 19 patients and 8 responders gained 7.8 +/- 4.4 months PG longevity. The overall longevity in this study was 106.3 +/- 8.4 months with all features as programmed, whereas the longevity without Capture Management and Search AV algorithms would be 98.2 +/- 4.9 months, saving 8.1 +/- 5.8 months(range 0-18) of battery life. Thus, two algorithms: Capture Management and Search AV, have clinical relevance in the extension of PG longevity.

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Extension of Generator Longevity by Use of High Impedance Ventricular Leads

Cited by 24 publications

References 15 publications

1‐Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study

1‐Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study

A Model of Impedance of Cardiac Pacemaker Electrodes

Effect of Modern Pacing Algorithms on Generator Longevity:

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