Do Steroid‐Eluting Electrodes Really Have Better Performance Than Other State‐of‐the‐Art Designs?

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Abstract
A multicenter study evaluated the performance of atrial and ventricular unipolar leads with porous steroid‐eluting and platinized grooved electrodes. A total of 563 leads were implanted in 451 patients. These included 311 ventricular and 97 atrial steroid‐eluting electrodes; and 112 ventricular and 43 atrial leads with platinized electrodes. Mean follow‐up was ± 1 year. At implant there were no significant differences in threshold parameters in either chamber. Chronically, however, the steroid eluting lead consistently had significantly lower pacing thresholds in both chambers. For example, after 360 days implant, steroid‐eluting electrodes had 0.23 ± 0.10 msec ventricular thresholds at 0.8 V compared to 0.45 ± 0.3 msec in the platinized group (P < 0.0001). In the atrium, the steroid‐eluting lead's 6‐month thresholds at 0.8 V were 0.15 ± 0.06 msec compared to 0.9 ± 0.8 msec for the platinized electrode (P < 0.01). The chronic ventricular QRS amplitudes were significantly greater for the steroideluting electrode (P < 0.0005). There were no significant differences in atrial sensing and no incidence of atrial undersensing in the study. The low and consistent thresholds of the steroid‐eluting electrodes would have permitted pacing in the ventricle at ± 2.5 V without compromising safety factor in 99.4% of the patients. The other 0.6% required 5 V temporarily. In the atrium, 100% of the patients could have been paced safely at reduced output. In spite of this, 63% of the implanters lacked the confidence to use reduced outputs.