Document Detail


Incidence and predictors of pacemaker dysfunction with unipolar ventricular lead configuration. Can we identify patients who benefit from bipolar electrodes?
MedLine Citation:
PMID:  11584461     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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] microJ) 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 > or = 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.
Authors:
U K Wiegand; F Bode; H Bonnemeier; R Tölg; W Peters; H A Katus
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  24     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-10-04     Completed Date:  2002-02-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1383-8     Citation Subset:  IM    
Affiliation:
Medical University of Lübeck, Department of Internal Medicine II, Lübeck, Germany. uwe.wiegand@medinf.mu-luebeck.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Electrocardiography*
Electrodes, Implanted*
Equipment Design
Equipment Failure Analysis*
Female
Humans
Male
Middle Aged
Pacemaker, Artificial*
Risk Assessment
Signal Processing, Computer-Assisted
Software

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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