Steroid-eluting electrodes prevent chronic pacing threshold rise in the atrial chamber after oral propafenone administration

The aim of the study was to evaluate chronic atrial pacing threshold increase after oral propafenone therapy. Fifty patients affected by advanced AV block and sick sinus syndrome were studied at least 6 months after pacemaker implantation, before and after oral propafenone therapy (450-900 mg/day based on body weight). The patients were subdivided into three groups as to the type of electrode implanted, all three unipolar: group I (20 patients) Medtronic CapSure 4003, group II (13 patients) Medtronic Target Tip 4011, group III (17 patients) Medtronic 4057 screw-in leads. In all cases, Medtronic unipolar pacemakers were implanted with the same noninvasive autothreshold measurement method. Propafenone and 5-OH-propafenone blood levels were measured 3-5 hours after drug administration. The packing autothreshold was measured at 0.8, 1.6, and 2.5 V by reducing the pulse width. After propafenone, groups II and III showed a statistically significant threshold rise (P ranging from < 0.01 to 0.05), whereas no significant difference was found in group I. Propafenone and 5-OH-propafenone blood vessels did not show any significant difference among the three groups. Strength-duration curves were drawn for the three groups before and after propafenone: at baseline the curves shifted to the left with the steep part above the knee, clearly favoring CapSure over the other two groups. After propafenone, the curves shifted to the right, with the flat par progressively more evident in groups II and III. In the atrial chamber, steroid-eluting leads prevented threshold increase after propafenone therapy, in contrast with a significant threshold rise with conventional porous and screw-in leads.