New temporary pacing lead for use after cardiac operations.

A newly designed temporary pacemaker lead (Medtronic Model 6400), which has a solid defined electrode surface area of 7.5 mm2, was compared with a multifilamental stainless steel electrode in common use (Davis & Geck, DG). Thirty-nine patients had both types of electrodes inserted intramyocardially in the right ventricle. A DG electrode fastened to the pericardium served as a reference lead. In addition to the standard Medtronic 7.5 mm2 electrode (n = 11), specially made Medtronic electrodes with areas of 5 mm2 (n = 10), 10 mm2 (n = 10), or 7.5 mm2 with platinum-iridium tips (n = 8) were studied. Measurements of myocardial stimulation threshold and resistance were made in both electrodes throughout the postoperative period. The patients' electrograms were recorded on magnetic tape for computer analysis of amplitudes and slew rates. The Medtronic 7.5 mm2 electrodes showed overall better results than 5 and 10 mm2 leads. Maximum stimulation threshold on the Medtronic 7.5 mm2 electrodes was medium 3.4 mA versus 10 mA on DG electrodes (p less than 0.001). The tissue resistance on Medtronic 7.5 mm2 was almost double than on the Davis & Geck electrodes (median 311 ohms versus 164 ohms on the day of minimum resistance, p less than 0.001). There were no significant differences in electrogram amplitudes between the two electrode types studied (5.52 versus 4.68 mV, p greater than 0.1), but the slew rates were significantly higher on the Medtronic (0.56 versus 0.37 V/sec; p less than 0.01). The new lead is an important innovation in temporary pacemaker lead design compared to the commonly used multifilamental leads.