Active-fixation pacemaker leads enable pacing at various sites, have a low dislodgment rate, and are easier to extract than passive-fixation leads, though are usually not routinely implanted in the ventricle because of their higher pacing threshold. The long-term pacing threshold associated with an active-fixation steroid-eluting lead was prospectively measured in 18 women and 20 men. At a mean follow-up of 14 months (range 3-25 months), pacing threshold increased from 0.71 +/- 0.29 V to 0.96 +/- 0.28 V (P = 0.01) between implant and the first month of follow-up, then remained stable over time, consistently allowing the long-term programming of the ventricular output at 2.5 V, while lead impedance remained stable (from 647 +/- 161 omega at implant to 666 +/- 122 omega at last follow-up). If the long-term performance of this type of lead is confirmed, the routine implantation of ventricular steroid-eluting active-fixation leads should be considered since lead extraction has become a major concern.