14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-52

Comparison of the acute and chronic electrical performance of pacing leads equipped with different steroid eluting electrodes mechanism

Daniele Cornacchia, Giosue Mascioli*, Andrea Puglisi**, Pier Vittorio Moracchini***, Marco Bernasconi****, Giancarlo Pulitano°, Daniele Bernabo°°, Danilo Cervellati°°° and ISCLP group.
Cardiology Department, Ravenna, *Val Camonica Hospital, Esine, **Fatebenefratelli Hospital, Roma, ***S. Agostino Hospital, Modena, **** San Carlo Hospital, Milano, °Policlinico M. Consolazione, Catania, °°S. Andrea Hospital, La Spezia, °°°Civile Hospital, Imola, Italy

Introduction

Pacing leads equipped with steroid elution mechanism have been shown to improve electrical performance compared with conventional leads both in the acute phase and long-term follow-up^1-3. Nowadays different steroid elution mechanisms and different steroids are available. We evaluated the acute and chronic electrical performance of 24 bipolar atrial leads (14 Capsure SP model 5524, 10 Membrane model 1420T), and 91 unipolar ventricular leads (18 Selute model 4185, 73 Capsure Z model 4033. These leads are equipped with three different steroid-eluting mechanisms.

Capsure leads use a saturated dexamethasone sodium phosphate solution placed in a silicone plug, located directly behind the platinum coated porous titanium electrode. The steroid is highly concentrated and it decreases very slowly over time. The electrode surface is 5.8 mm² for Capsure SP and 1.2 mm² for Capsure Z.

Membrane 1420T leads use the same steroid as Capsure (i.e. dexamethasone sodium phosphate) but the steroid-elution mechanism is different, the electrode is made of vitreous carbon covered by a copolymer membrane which acts as a steroid carrier. The electrode surface is 9 mm².

Selute leads use a different steroid, a mixture of dexamethasone sodium phosphate and dexamethasone acetate. The steroid plug is located rather far back within the electrode whose surface is totally porous. The electrode surface is 8 mm².

The aim of our study was to compare to what extent different elution systems can affect the electrical performances of the four leads evaluated, considering that a more or less rapid elution can interact with the chronic inflammatory reaction and, consequently, with the electrical parameters during the follow-up.

In previous studies steroid elution mechanisms completely different (silicone plug behind the tip versus silicone collar around the electrode) were compared, whereas in our case study the steroid elution is similar^4-7.