Steroid Elution Improves the Stimulation Threshold in an Active-Fixation Atrial Permanent Pacing Lead

Crossley, George H.; Brinker, Jeffrey A.; Reynolds, Dwight; Spencer, William H.; Johnson, W. Ben; Hurd, H P; Tonder, Lisa; Zmijewski, Matt

doi:10.1161/01.cir.92.10.2935

Cited by 63 publications

(50 citation statements)

References 14 publications

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“…Major technological advances have been made in the last decades that have improved the development of batteries and the efficiency of pulse generators, enabling progressive miniaturisation of pacemakers and enhancing generator lifespan. However, advances in lead design have led to the most dramatic improvements in pacing system longevity, as they enable cardiac stimulation at low energy [11][12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Ribeiro¹,

Rincon²,

Oliveira³

et al. 2001

Arq. Bras. Cardiol.

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Objective -This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker Methods -Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999Electric pacing of the heart began around forty years ago and stands out as one of the major achievements in cardiac therapy in the 20th century, combining both physiologic knowledge and technologic advances in the treatment of potentially disabling and fatal bradyarrhythmias. Currently, about 400 thousands pacemakers are implanted every year world-wide 1 , and 50% of pacemaker recipients are still alive when the pulse generator lifespan is over, making them eligible for a new pulse generator. Therefore, the prolongation of the life of pulse generators has been considered desirable and cost-effective because it would postpone a second surgical intervention, eliminating the expense of new generators units 1,2 .Pacemaker longevity is defined as the interval between implantation and detection of the end of pulse generator life, which is determined by the energy consumption of the pulse generator and the deliverable capacity of its power source 3,4 . The deliverable capacity of the power source is fixed for a certain battery, but energy consumption depends on both fixed parameters and physiologic and programmable variables. Therefore, the determinants of the consuption are: programmable output parameters of the system (voltage and pulse width), the frequency and percentage of pacing, the lead impedance, and the static energy drain of the system. Although programming the pacing rate and AV interval can optimise the battery energy drain, the most important parameters that are available to optimise the longevity of a pacing system are stimulation voltage and pulse width 2 .Original settings programmed by the manufacturer are chosen to provide for a sufficient safety margin during the subacute period when stimulation thresholds typically rise. However, most leads used today enable stimulation with reduced output parameters of pacing, resulting in significant reduction in energy drain and, therefore, prolongation of pulse generator life. Thus, reprogramming a pacemaker after a subacute period, according to an obtained stimulation threshold, was a desirable practice recommended in most basic textbooks and by international guidelines 1,3-6 . However, the majority of pacemakers remain at the original programmed

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Section: Discussionmentioning

confidence: 99%

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Ribeiro¹,

Rincon²,

Oliveira³

et al. 2001

Arq. Bras. Cardiol.

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“…This effect was stable and maintained during 5-or 10-year follow-up [13,14]. Similarly benefi cial effects of steroid-eluting coating were observed in active fixation atrial pacing leads [15].…”

Section: Discussionmentioning

confidence: 54%

“…The calculated device longevity indicated, that the implantation of a steroid-eluting lead is associated with a longer battery life, therefore replacement is less often needed, which has already been suggested earlier [15].…”

mentioning

confidence: 77%

Direct comparison of steroid and non-steroid eluting small surface pacing leads: Randomized, multicenter clinical trial

Kutyifa

Zima²,

Molnár³

et al. 2013

Cardiol J

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“…[1][2][3][4] There has also been an interest in atrial and ventricular selective-site pacing 5,6) and active-fixation leads are required for secure attachment to selective sites. 7) Initially, the high pacing threshold, including pacing failure, was observed in nonsteroid active-fixation leads about 1 week after implantation, but in steroid-eluting activefixation leads, the pacing threshold remains stable over the long term.…”

mentioning

confidence: 99%

“…7) Initially, the high pacing threshold, including pacing failure, was observed in nonsteroid active-fixation leads about 1 week after implantation, but in steroid-eluting activefixation leads, the pacing threshold remains stable over the long term. 3,[8][9][10] In the acute phase of lead implantation, the pacing threshold was reported to decrease within several minutes after screw-in. 11) Nevertheless, we have experienced cases in whom the pacing threshold increased rapidly after that.…”

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confidence: 99%

Acute Changes in the Pacing Threshold After Lead Implantation

et al. 2012

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SummaryAlthough the pacing threshold of steroid-eluting active-fixation leads remains stable over the long term, it changes rapidly after screw-in. We compared the pacing threshold in the acute phase between retractable and Sweet-Tip activefixation leads. We studied 132 patients who were implanted with active-fixation leads for new pacemaker implantation or additional leads required due to disconnected/leaking leads. Pacing threshold was measured at 4 time points: before screw-in, immediately, and 5 and 10 minutes after screw-in. If the pacing threshold was > 1.5 volts (V) at 5 minutes, we changed the pacing site so that it became ≤ 1.5 V. A total of 169 retractable leads (Medtronic: 107 leads, St. Jude Medical: 62 leads) and 33 Sweet-Tip leads (Boston: 33 leads) were implanted. Eighty-nine leads were implanted in the atrium and 113 leads in the ventricle. Seventy patients were implanted with both atrial and ventricular leads. The pacing threshold of Sweet-Tip leads increased immediately after screw-in, while that of retractable leads decreased (Sweet-Tip: 0.20 ± 0.57 V, Retractable: -0.15 ± 0.53 V, P < 0.05). The pacing threshold of both types of leads decreased similarly from immediately to 5 minutes after screw-in (Sweet Tip: -0.29 ± 0.43 V, Retractable: -0.25 ± 0.36 V, P = NS). Few changes in the threshold were detected between 5 and 10 minutes. Because the pacing threshold of Sweet-Tip active-fixation leads increased immediately after screw-in and that of both type leads decreased from immediately to 5 minutes, we should measure the pacing threshold from 5 minutes after screw-in. (Int Heart J 2012; 53: 108-112)

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Steroid Elution Improves the Stimulation Threshold in an Active-Fixation Atrial Permanent Pacing Lead

Abstract: Inclusion of a steroid-eluting reservoir in an active-fixation permanent pacing lead improved stimulation thresholds in both the subacute and chronic periods and therefore should extend pulse-generator longevity.

Cited by 63 publications

References 14 publications

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Direct comparison of steroid and non-steroid eluting small surface pacing leads: Randomized, multicenter clinical trial

Acute Changes in the Pacing Threshold After Lead Implantation

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