Recent advances in electrode surface designs have eliminated tradition
al threshold differences between endo- and epicardial pacing leads. Si
nce the epicardial approach offers the potential of direct left ventri
cular pacing and the transvenous approach may not be feasible or warra
nted in all instances, more advanced leads are being designed to optim
ize epicardial pacing capabilities. This study was conducted to evalua
te a bipolar epimyocardial lead. Six immature canines (age 3 months) w
ere instrumented. The lead (Medtronic model 10389) is a single-pass, '
'in-line'' bipolar electrode with low current drain and high impedance
, with an intramyocardial steroid-eluting cathode and nonsteroid epica
rdial anode. Twelve ventricular leads were implanted (two per animal)
and the animals followed for 6 months with weekly analysis of pacing a
nd sensing capabilities. Results at explant were compared with implant
values and showed no significant differences between sensed R waves o
r in R wave slew rates in unipolar or bipolar modes. Explant lead impe
dances remained high in both modes: bipolar, 1658 +/- 331; and unipola
r, 1327 +/- 308 Ohm (P < 0.05). Chronic voltage (V) threshold at 0.5 m
s showed no significant change from implant values during the study: u
nipolar, 0.3 +/- 0.06 versus 1.0 +/- 0.8; and bipolar, 0.4 +/- 0.06 ve
rsus 1.6 +/- 1.2. Histologic review showed negligible fibrous reaction
at the electrode-tissue interface. This study introduces a high imped
ance, low threshold, ''in-line'' bipolar pacing lead design capable of
stable chronic pacing with implant facilitated by a single suture tec
hnique.