Incidence and Predictors of Pacemaker Dysfunction with Unipolar Ventricular Lead Configuration. Can We Identify Patients Who Benefit from Bipolar Electrodes?
WIEGAND, U.K.H., et al.: Incidence and Predictors of Pacemaker Dysfunction with Unipolar Ventricular Lead Configuration. Can We Identify Patients Who Benefit from Bipolar Electrodes? Unipolar ventricular leads were implanted in a considerable percentage of pacemaker recipients. There is little infor...
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Published in | Pacing and clinical electrophysiology Vol. 24; no. 9; pp. 1383 - 1388 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Futura Publishing, Inc
01.09.2001
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Subjects | |
Online Access | Get full text |
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Summary: | WIEGAND, U.K.H., et al.: Incidence and Predictors of Pacemaker Dysfunction with Unipolar Ventricular Lead Configuration. Can We Identify Patients Who Benefit from Bipolar Electrodes? Unipolar ventricular leads were implanted in a considerable percentage of pacemaker recipients. There is little information on incidence and risk factors for unipolar pacemaker dysfunction using modern lead designs. Included in a cross‐sectional analysis were 682 patients who fulfilled the following criteria: chronically implanted bipolar ventricular leads (> 1 year), intraoperative stimulation threshold < 1.0 V/0.5 ms, and potential amplitude > 6 mV. Incidences of chest wall stimulation (CWS) at an output of twice the amplitude threshold and of myopotential oversensing (MPO) at a sensitivity of half the sensing threshold were assessed. Energy (0.60 [0.72] vs 0.63 [0.81] μJ) and sensing thresholds (8.31 [3.18] mV vs 8.47 [3.47] mV) did not differ between uni‐ and bipolar modes. While all pacemakers worked properly during bipolar configuration, malfunctions were observed in 5.9% of patients during unipolar configuration (CWS = 1.9%, MPO = 4.2%). Patient age > 76 years (hazard ratio HR 8.2; P < 0.001), heart failure ≥ NYHA Class II (HR 3.8; P < 0.001), and an antiarrhythmic therapy with Class I or III drugs (HR 3.3; P = 0.002) were independently associated with the occurrence of unipolar pacemaker dysfunction. Use of steroid‐eluting leads reduced the probability of pacemaker dysfunction (HR 0.45; P = 0.03). Risk factors for unipolar ventricular pacemaker malfunction were higher age, heart failure, and antiarrhythmic drug therapy. Particularly in these patients, use of bipolar ventricular leads is beneficial. |
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Bibliography: | ArticleID:PACE1383 ark:/67375/WNG-8Z6JT8D8-1 istex:FCEC84CC0E2F8BA73919663314D285031867FAF9 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0147-8389 1540-8159 |
DOI: | 10.1046/j.1460-9592.2001.01383.x |