A. Bolz et al., LOW POLARIZATION PACING LEAD FOR DETECTING THE VENTRICULAR-EVOKED RESPONSE, Medical progress through technology, 19(3), 1993, pp. 129-137
The cardiac response to a pacing pulse is potentially useful for rate
adaptive pacemakers and threshold tracking systems. However, until now
capture recognition of the ventricular-evoked response by the use of
a single electrode for stimulation as well as detection was limited by
the electrode polarization. Electronic measures against the stimulus
polarization artifact have not been successful due to the variability
of the after potential or the requirement of additional battery power.
Following the idea of Lewin, Myers and Parsonnet [1], who introduced
the idea of a non-polarizable porous electrode for physiological stimu
lation, titanium nitride (TiN) and iridium (Ir) coatings with fractal
surface structure have been developed with high electro-chemical activ
e surface areas and Helmholtz double-layer capacities of up to 50.000
mu F/cm(2), thus reducing the polarization artifact significantly. Two
types of endocardial leads (10 with a fractal TiN coating and 5 with
a fractal Ir coating) were implanted in the apex of the right ventricl
e and the polarization artifact, as well as the evoked response, was m
easured. Both types of pacing leads show a 90% reduction in the polari
zation artifact in comparison to conventional leads. If an autoshort o
f approximately 20 to 50 ms is applied after the pacing pulse, the pol
arization artifact of these leads is negligible, thus enabling reliabl
e detection of at least the repolarization phase of the ventricular-ev
oked response, which is fully sufficient: for capture recognition. Add
itionally, due to their low polarization losses, TiN- or Ir-coated ele
ctrodes with fractal surface structure have a unique stimulation and d
etection performance.