de Voogt W G
Saint Lucas Andreas Hospital Amsterdam, The Netherlands.
Am J Cardiol. 1999 Mar 11;83(5B):187D-191D. doi: 10.1016/s0002-9149(98)01022-4.
Pacing leads remain the "weaker link" of the permanent pacing system. Lead failure has been an issue since the beginning of implantable pacemaker therapy. Modern electronics have brought about considerable progress in pacing technology, but lead design has been slower to evolve and problems persist. IS-1 standardization must be considered a significant advance, but some issues regarding IS-1 standardization persist and have been the cause of some compatibility problems. With respect to lead insulation, silicone has proved to offer total reliability for > 30 years. In the search for better handling characteristics, polyurethane 80A was employed for bipolar leads, but it failed to demonstrate satisfactory insulating properties. New insulation materials, such as ethylene-fluoro-ethylene (ETFE), and coated wire technology look promising, having shown 99.32% survival at 5-year follow-up. Reliability is the main objective in lead design, but leads should provide low battery consumption as well. Low coil resistance, with high electrode impedance in steroid-eluting leads, is the standard at present. Low polarization is a desirable property for 2 main reasons: (1) in conjunction with low-threshold leads, it decreases battery consumption; and (2) it allows capture detection and, therefore, safer pacing at low battery consumption. Lead tip design as well as pacing pulse configuration can influence polarization.
起搏导线仍然是永久性起搏系统的“薄弱环节”。自植入式起搏器治疗开始以来，导线故障一直是个问题。现代电子技术在起搏技术方面取得了长足进步，但导线设计的发展较为缓慢，问题依然存在。IS-1标准化堪称一项重大进展，但关于IS-1标准化的一些问题仍然存在，并导致了一些兼容性问题。就导线绝缘而言，事实证明，硅胶在30多年来一直具有完全可靠性。为了寻求更好的操作特性，聚氨酯80A被用于双极导线，但它未能展现出令人满意的绝缘性能。新型绝缘材料，如乙烯-氟乙烯（ETFE）以及涂覆导线技术看起来很有前景，在5年随访中显示出99.32%的存活率。可靠性是导线设计的主要目标，但导线还应具备低电池消耗的特性。目前的标准是，在类固醇洗脱导线中，线圈电阻低且电极阻抗高。低极化是一种理想特性，主要有两个原因：（1）与低阈值导线相结合时，它可降低电池消耗；（2）它有助于捕捉检测，从而在低电池消耗情况下实现更安全的起搏。导线尖端设计以及起搏脉冲配置都会影响极化。
