Wish M, Swartz J, Cohen A, Cohen R, Fletcher R
Department of Medicine, VA Medical Center, Washington, DC.
Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1887-90. doi: 10.1111/j.1540-8159.1990.tb06910.x.
There is little data directly comparing steroid-tipped permanent pacemaker leads to otherwise state-of-the-art porous platinum leads. Eighteen patients receiving unipolar generators capable of low voltage outputs were randomized at the time of implant to receive either steroid-tipped leads or porous platinum leads. All leads were unipolar, tined, passive fixation, and placed in the right ventricular apex or atrial appendage. This study is single center. At implant, threshold pulse width was determined at 3 voltages (2.5, 1.5, and 0.8 V). Follow-up thresholds were determined at weeks 1, 2, 3, and 4, and at 3 and 6 months. There was no difference in implant thresholds or amplitudes for sensing. By 2 weeks postimplant, lower thresholds were noted for the steroid leads, and this discrepancy grew more significant with time. There was no significant postimplant rise in threshold for steroid-tipped leads. At 6 months, the average threshold pulse width for ventricular steroid leads at 0.8 V was 0.3 +/- 0.1 msec. In contrast, five patients with standard leads did not capture at maximum pulse width at 0.8 V (P less than 0.0001). There was no significant difference in the amplitude of the chronic atrial electrogram. This study shows steroid-tipped leads to offer a significant advantage in reducing thresholds early postimplant and chronically.
几乎没有数据直接比较带类固醇的永久性起搏器导线与其他最先进的多孔铂导线。18名接受能够输出低电压的单极发生器的患者在植入时被随机分配接受带类固醇的导线或多孔铂导线。所有导线均为单极、有倒刺、被动固定，并放置在右心室心尖或心耳。本研究为单中心研究。在植入时，在3个电压（2.5V、1.5V和0.8V）下测定阈值脉冲宽度。在第1、2、3和4周以及3和6个月时测定随访阈值。植入阈值或感知幅度没有差异。植入后2周，类固醇导线的阈值较低，并且随着时间的推移这种差异变得更加显著。带类固醇的导线植入后阈值没有显著升高。6个月时，心室类固醇导线在0.8V时的平均阈值脉冲宽度为0.3±0.1毫秒。相比之下，5名使用标准导线的患者在0.8V的最大脉冲宽度下未能夺获（P小于0.0001）。慢性心房电图的幅度没有显著差异。本研究表明，带类固醇的导线在植入后早期和长期降低阈值方面具有显著优势。
