Schuchert A, van Langen H, Michels K, Meinertz T
Medizinische Klinik und Poliklinik Abteilung für Kardiologie Universitäts-Krankenhaus Eppendorf Hamburg.
Z Kardiol. 1996 Apr;85(4):255-9.
Steroid-eluting screw-in leads (CapSure Fix 4068, Medtronic; n = 14) were compared to the same lead as a J-shaped tined electrode (CapSure SP 4524, Medtronic; n = 27, implanted in the atrium in patients receiving dual-chamber pacemakers. Follow-up were at discharge and after 1 month. Implantation (screw-in lead: 84 +/- 18 min; tined lead: 81 +/-29 min) and fluoroscopy times (screw-in lead: 7.3 +/- 4.9 min; tined lead 9.2 +/- 7.0 min) were similar in the two groups. At implant, P-wave amplitudes were similar with 4.8 +/- 1.6 mV (screw-in lead) and 4.0 +/- 2.6 mV (tinted lead), respectively. Compared to tined leads, the screw-in leads had higher pacing thresholds at 0.5 ms pulse duration (screw-in lead: 0.74 +/- 0.32 V; tined lead: 0.55 +/- 0.15 V; p = 0.02) as well as higher impedance (screw-in lead: 566 +/- 93 ohms; tined lead: 470 +/- 99 ohms; p = 0.01). Pulse duration thresholds at 2.5 V pulse amplitude were neither different at discharge (screw-in lead: 0.07 +/- 0.04 ms; tined lead: 0.06 +/- 0.05 ms) nor after 1 month (screw-in lead: 0.09 +/- 0.04 ms; tined lead: 0.06 +/- 0.06 ms). P-wave amplitudes > or = mV were observed at discharge in 14/14 (screw-in lead) 21/27 patients (tined lead), respectively, and after 1 month in 13/14 (screw-in lead) and 22/27 (tined lead) patients, respectively. Impedance of the screw-in lead was significantly higher with 693 +/- 84 ohms at discharge and 691 +/- 79 ohms after 1 month compared to the tined lead with 520 +/- 81 and 574 +/- 62 ohms (p = 0.001). No lead dislodgment was reported during follow-up.
For the studied steroid-eluting leads active and passive fixation had neither at implantation nor during 1-month follow up any influence on P-wave amplitude. At similar pulse duration thresholds, impedance of the screw-in lead was significantly higher than for the tined lead. Higher impedance additionally reduces pacing current, if similar pacing impulses are delivered.
将类固醇洗脱旋入式电极导线（美敦力公司的CapSure Fix 4068；n = 14）与作为J形带尖电极的同一导线（美敦力公司的CapSure SP 4524；n = 27）进行比较，这些导线植入接受双腔起搏器治疗患者的心房。随访时间为出院时和1个月后。两组的植入时间（旋入式导线：84±18分钟；带尖导线：81±29分钟）和透视时间（旋入式导线：7.3±4.9分钟；带尖导线：9.2±7.0分钟）相似。植入时，P波振幅相似，旋入式导线为4.8±1.6 mV，带尖导线为4.0±2.6 mV。与带尖导线相比，旋入式导线在0.5 ms脉冲持续时间时的起搏阈值更高（旋入式导线：0.74±0.32 V；带尖导线：0.55±0.15 V；p = 0.02），阻抗也更高（旋入式导线：566±93欧姆；带尖导线：470±99欧姆；p = 0.01）。在2.5 V脉冲振幅时的脉冲持续时间阈值在出院时（旋入式导线：0.07±0.04 ms；带尖导线：0.06±0.05 ms）和1个月后（旋入式导线：0.09±0.04 ms；带尖导线：0.06±0.06 ms）均无差异。出院时，旋入式导线组14/14例患者和带尖导线组21/27例患者观察到P波振幅≥mV，1个月后，旋入式导线组13/14例患者和带尖导线组22/27例患者观察到P波振幅≥mV。旋入式导线的阻抗在出院时显著高于带尖导线，分别为693±84欧姆和520±81欧姆，1个月后为691±79欧姆和574±62欧姆（p = 0.001）。随访期间未报告导线脱位。
对于所研究的类固醇洗脱导线，主动和被动固定在植入时以及1个月随访期间对P波振幅均无影响。在相似的脉冲持续时间阈值下，旋入式导线的阻抗显著高于带尖导线。如果传递相似的起搏脉冲，更高的阻抗还会降低起搏电流。
