Durability of bipolar coaxial endocardial pacemaker leads compared with unipolar leads
Marcelo E. Helguera, MD
Sergio L. Pinski, MD
James D. Maloney, MD
Javier R. Woscoboinik, MD
Richard G. Trohman, MD
Victor A. Morant, MD
Bruce L. Wilkoff, MD
Lon W. Castle, MDAddress reprint requests to L.W.C., Department of Cardiology, F15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
The coaxial design allows for thinner bipolar endocardial pacemaker leads, but recent reports have suggested a higher incidence of failure for this sophisticated configuration.OBJECTIVE
To compare the long-term survival of bipolar coaxial and unipolar leads.METHODS
Between January 1, 1980 and June 30, 1991, 1142 bipolar coaxial leads and 1181 unipolar leads were implanted at the Cleveland Clinic. The mean follow-up was 33 ± 32 months (range 1 to 138 months). Ten bipolar coaxial leads failed (0.88%), as did 9 unipolar leads (0.76%). At 5 years the cumulative survival was 98.6% for both types of leads; however, at 10 years the survival of bipolar coaxial leads was only 92.4% compared with 98.6% of unipolar leads (P = .03; relative risk 2.7, 95% confidence interval = 1.1 to 6.9).CONCLUSIONS
The sophisticated design of bipolar coaxial leads could be the cause of their increased vulnerability. The benefit-to-risk ratio of this design should be prospectively reevaluated.