Abstract 2208: Chronic Performances of a New Lumenless Compared With Stylet-Delivered Pacing Leads in the Young With Congenital Heart
Background: United States’ approval of the model 3830 lead (Medtronic, Inc) in patients (pt) with congenital heart disease (CHD) was in 2005. The 4.1mm diameter, lumenless lead uses a flexible delivery catheter in lieu of stylets. This facilitates alternate pacing sites (APS) (septal, para-His, Bachmann) to improve paced cardiac function over usual sites (apex, appendage). However, chronic efficacy among pts with CHD is unknown compared with established leads. The purpose of this study was to evaluate performance indices (Pdex) of the 3830 lead over 5 years (y) with all other steroid-eluting leads implanted in the 5y prior at our center.
Methods: Implant and follow-up data on leads implanted by a single individual on all pts from our center, regardless of age or CHD, were reviewed. Pt were divided into those with non-3830 leads (Group 1) and 3830 leads (Group 2). Pdex included acute and chronic sensing and pacing values, impedances, implant sites and complications. Groups were compared using Fischer’s exact test, paired and non-paired t-tests, with significance at p < 0.05.
Results: A total of 119 pt (ages 5– 48y) received 171 leads. Group 1 (n=79) were leads of multiple models with active or passive fixation, polyurethane or silicone insulation, and diameters of 5– 6mm. Group 2 (n=92) is an active helix, polyurethane design. At implant, there were no differences in pt age, presence or absence of CHD, sensed P/R waves or thresholds between Groups. Implant lead impedances differed (p<0.05) between Groups (mean 747 vs 889 Ω) but all within normal values. Chronic data (Table⇓) showed no difference in sensing, pacing thresholds or impedances. There were 5 (6%) early lead dislodgements in Group 1 and 1 (1%) in Group 2. APS were achieved in Group 2 with mean 1.6 ± 1.3min fluoroscopy time (FT).
Conclusion: In spite of APS, the 3830 lead shows equal Pdex to established leads yet is smaller and readily permits APS with technical ease and limited FT, allowing more efficient chronic pacing in pt with CHD.