Superhydrophobic Coating of Pacemaker Generators- and Leads Significantly Reduces Bacterial Colonization In Vitro

All articles of this category (opens in new window) Background: Infections associated with implantable cardiac devices, such as pacemakers, remain a major clinical challenge due to bacterial adhesion and biofilm formation. These infections carry high rates of morbidity and mortality, underscoring the urgent need for effective preventive strategies. Surface modifications that inhibit bacterial colonization represent a promising approach to reducing infection risk. In this study, we generated superhydrophobic surfaces and investigated their resistance to bacterial adhesion. Methods: Superhydrophobic coatings on pacemaker generators and pacemaker leads were developed using silica nanoparticles synthesized via the Stöber method. Nanoparticles were functionalized with hexyltrimethoxysilane (Group A, n = 10), hexadecyltrimethoxysilane (Group B), or 1H,1H,2H,2H-perfluorooctyltriethoxysilane (Group C). In a separate approach, silica aerogel was used to generate a highly porous nanostructured film. Hydrophobicity was characterized by static water contact angle measurements. Bacterial adhesion was assessed using luciferase-expressing Escherichia coli and quantified by bioluminescence imaging. Results: Water contact angle analysis confirmed the successful generation of hydrophobic and superhydrophobic surfaces. Group A exhibited a mean contact angle of 150 ± 4.5 degrees, Group B 152 ± 3 degrees, and Group C 153 ± 3.7 degrees. Aerogel-based coatings demonstrated the highest hydrophobicity with a contact angle of 155 ± 2.7 degrees. Bioluminescence imaging revealed a statistically significant reduction in bacterial colonization on aerogel-coated surfaces compared with untreated controls (8.77 × 10 −6 [p/s/cm 2 /sr] vs. 4.25 × 10 −7 [p/s/cm 2 /sr], p < 0.05). Similarly, Group B and Group C demonstrated significant reductions in bacterial adhesion relative to controls (Group B: 8.28 × 10 −6 [p/s/cm 2 /sr] vs. 2.68 × 10 −8 [p/s/cm 2 /sr], p < 0.05; Group C: 9.15 × 10 −6 [p/s/cm 2 /sr] vs. 2.54 × 10 −8 [p/s/cm 2 /sr], p < 0.01). In contrast, Group A did not achieve a statistically significant reduction in bacterial adhesion. Conclusion: Superhydrophobic nanostructured coatings on pacemaker generators and leads significantly reduce bacterial colonization in vitro. Among the tested coatings, aerogel-based and fluorinated silane-modified surfaces demonstrated the strongest antibacterial effects. Further studies are warranted to assess biocompatibility and antibacterial efficacy in vivo. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany