Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Technology D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-108 - Multi-axes Lead And Leadless Technology - Implications For Current And Future Implantable Device Applications (ID 444)


Background: Unacceptable pacing threshold, under and over sensing issues during, after lead implantation are ongoing clinical problems in implantable devices. Leadless devices and His Pacing have brought these significant legacy limitations of single bipolar electrode concept into sharp focus. IS-4 industry standard has ushered in an era that could provide for novel innovation at lead and leadless device tips.
Objective: Multiple pacing and sensing axis combination made available by 4 electrodes at device myocardial interface were tested using proprietary prototype technology.
Methods: Seven porcine and two rabbit beating hearts on Langendorff setup were used. Ventricular capture threshold test was performed from all electrodes at the RV apex. This was repeated with retraction of lead 3mm from apex simulating lead dislodgment. Sensing via multiple bipoles available from IS-4 lead positioned at the RV apex.
Results: Pacing- Four unipolar and bipolar thresholds were obtained. The difference in pacing threshold between before and after dislodgement was found to be 0.2 mV, 95% CI (-0.5132, 0.9132), which was not significant. This indicates that the varied orientation of electrodes negate the detrimental effect of lead micro-dislodgement. Sensing- The highest bipolar sensed voltage was significantly different from the mean bipolar voltage (p<0.01) in all animals. This was tested in SR, RV pacing, LV pacing and in VF.
Conclusion: Multi axes implantable electrode technology provides the unique ability to maximize pacing and sensing capabilities. Our findings have direct implications on future applications in leadless, and His pacing.