Comparison of mid-term clinical experience with steroid-eluting active andpassive fixation ventricular electrodes in children

Although active fixation ventricular leads seem to have advantages over pas sive fixation leads, this study compares the follow-up results of active an d passive fixation leads in children. We evaluated the implantation and fol low-up data of 41 children with active (Accufix II DEC, group 1) (n = 20) o r passive (Membrane E, group 2) (n = 21) fixation, steroid-eluting ventricu lar leads. AII but one of the patients in group 1 completed the 12-month fo llow-up. The mean follow-up period in group 2 was 10.4 +/- 2.9 months (rang e 3-12 months, median 12 months). In both groups the mean pacing threshold was measured as 0.51 +/- 0.09 V versus 0.48 +/- 0.15 V (P > 0.05) at 0.5-ms pulse width, mean R wave amplitude as 9.9 +/- 2.5 mV versus 9.4 +/- 3.2 mV (P > 0.05), and mean impedance as 557 +/- 92 Omega versus 664 +/- 160 Omega (P < 0.05), respectively, at implantation. After the first week of pacing, mean threshold Values in group I were significantly lower than those of gr oup 2 (P < 0.01 and P < 0.05, respectively). During the follow-up period, l ead impedance measurements did not show a significant difference between th e two groups. In one patient from group 1, the lead (by unscrewing) was rem oved easily because of pacemaker pocket infection. No lead dislodgement or helix deformation occurred in group 1. Nevertheless, in one patient from gr oup 2, the lead n as extracted at 4-month postimplantation because of lead displacement. We conclude that the steroid-eluting active fixation lead (Ac cufix II DEC) have advantages of easier implantation and lower acute and ch ronic stimulation thresholds compared to the passive fixation lead (Membran e E). Therefore, Accufix Il DEC is superior to Membrane E, and it is a bett er first choice in children with an implanted single chamber Ventricular pa cemaker.