Autocapture compatibility of different leads in the pacesetter affinity DR pacemaker

Anelli-Monti, M.; Mätchler, H.; Oberwalder, P.; Dacar, D; Knez, Igor; Bergmann, B.; Streinu, Ch.; Salaymeh, L.; Rigler, B

doi:10.1016/eupace/2.supplement_1.a35-c

Cited by 2 publications

(1 citation statement)

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“…However, in some clinical situations, e.g., in the case of PM replacement, a variety of pacing leads may be used with AC pacemakers. AC algorithm performance with non‐LP leads is less established, although recently a few small studies have demonstrated the successful application of AC with several types of non‐LP leads (“off label” use) 6‐10 . It should be noted that all of these studies performed the evaluation at a single pulse width (PW).…”

Section: Introductionmentioning

confidence: 99%

Use of Automatic Threshold Tracking Function with Non‐Low Polarization Leads:

Luria¹,

Gurevitz²,

Lev³

et al. 2004

Pacing Clinical Electrophis

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The AutoCapture (AC) function of new pacemakers (PM) from St Jude Medical (SJM) was originally recommended for use with low polarization (LP) ventricular leads only.However, recent reports have encouraged the use of the AC function with various leads, including those lacking a special LP design. The objective of this study was to analyze the reliability and safety of the AC algorithm application with different types of pacing leads. The study group comprised 30 consecutive patients with AC PMs connected to three different types of non-LP leads. Ten patients with SJM LP leads served as the control group. The study protocol included a complete AC function test using four different pulse widths (PW). The pacing threshold was independently assessed by a manual/semiautomatic check. Erratic behavior of polarization measurements with increasing PWs was demonstrated in 43% (n = 13) of the study group. Invalid polarization measurements resulted in erroneous algorithm recommendation to apply AC function in 17% (n = 5) of the study patients. Subsequent AC function activation lead to incorrect threshold determination due to missed noncapture in three patients. AC function should be applied with caution with non-LP leads. "Off label" use of these leads may cause erroneous polarization signal measurements which, in some cases, may result in incorrect pacing threshold determination, rendering a potential risk to dependent patients.

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Section: Introductionmentioning

confidence: 99%

Use of Automatic Threshold Tracking Function with Non‐Low Polarization Leads:

Luria¹,

Gurevitz²,

Lev³

et al. 2004

Pacing Clinical Electrophis

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AutocaptureTM- und Capture-ManagementTM Aktuelle Konzepte zur automatischen Reizschwellenmessung und Anpassung der Stimulationsamplitude

Anelli-Monti

Mächler

Oberwalder

et al. 2001

Herzschr Elektrophys

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Pacing threshold is not a stable value during the pacemaker's life. It is affected by many physiological, pharmacological and pathophysiological factors. A pacing system able to confirm capture and automatically adjust its output to the actual pacing threshold is highly desirable for a prolonged battery life and maximal patient safety. The Autocapture(TM) of St. Jude Medical and the Capture Management(TM) of Medtronic are currently available on the market. The key feature is the measurement of the evoked response (ER) signal by the pacemaker for capture confirmation. In case of loss of capture, the Autocapture(TM) System delivers a back up safety pulse of 4.5 Volt and 0.49 ms and starts a new threshold search. The pacemaker adapts its output to 0.3V/0.25V above the newly measured threshold. This system needs bipolar leads with low polarization for the first generation in Microny® and Regency® pacemakers; in the second generation with Affinity® and Integrity® pacemakers various bipolar leads are suitable. The Capture Management(TM) System of Medtronic, available in the Kappa® DR 700 series, performs a two point automatic threshold search once every day during rest. The output is determined by the programmed safety margin (nominal 1.5×voltage threshold). A backup pulse is only delivered during the threshold search. No special electrodes are necessary. These functions were shown to work safely and efficaciously in multicenter trials to decrease the current consumption with a prolongation of battery life up to 142%. The patients safety was increased by identifying changes of the capture threshold over time and adjusting the pacing stimulus. The conventional safety margins of 100% might not be safe for all patients. We also learned much about lead maturation and lead instability by the possibility of continuous follow-up of threshold changes in a larger group of leads in order to identify the risk group of about 10% of patients with late threshold increase and lead instability.

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Autocapture compatibility of different leads in the pacesetter affinity DR pacemaker

Cited by 2 publications

References 0 publications

Use of Automatic Threshold Tracking Function with Non‐Low Polarization Leads:

Use of Automatic Threshold Tracking Function with Non‐Low Polarization Leads:

AutocaptureTM- und Capture-ManagementTM Aktuelle Konzepte zur automatischen Reizschwellenmessung und Anpassung der Stimulationsamplitude

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