Automated Left Ventricular Capture Management

Crossley, George H.; Mead, Hardwin; Kleckner, Karen J.; Sheldon, Todd; Davenport, Lynn; Harsch, Manya R.; Parikh, Purvee; Ramza, Brian; Fishel, Robert S.; Bailey, J. Russell

doi:10.1111/j.1540-8159.2007.00840.x

Cited by 32 publications

(25 citation statements)

References 6 publications

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“…Moreover, the difference in PS-LV threshold shows a trend toward a decrease at follow-up (1.5 V on average) in all the pacing configurations (Table 6), a fact that makes automatic verification of stimulation even more attractive in selected patients who have a PS-LV difference Յ3.5 V. Although LV threshold shows little variability in the majority of patients, fluctuations Ն1.5 V were reported in 8% of patients. 19 Such an event could threaten PS in those patients without cathode programmability, who have a median PS-LV difference of approximately 1.5 V (Tables 5 and 6). Programming the LV pulse width at a greater duration lowered both the LV and the PS threshold voltage, so that no consistent benefit over a 0.5-ms programming (patients who could be paced by a 100% safety margin) was observed ( Table 6).…”

Section: Response To Crt and Ps Managementmentioning

confidence: 99%

Phrenic Stimulation

Biffi

Moschini

Bertini

et al. 2009

Circ: Arrhythmia and Electrophysiology

117

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Background-Phrenic stimulation (PS) may hinder left ventricular (LV) pacing. We prospectively observed its prevalence in consecutive patients with cardiac resynchronization therapy (CRT) devices. Methods and Results-In the years 2003 to 2006, 197 patients received a CRT device. PS and LV threshold measurements were carried out at implantation and at 6-month follow-up. LV reverse remodeling was assessed by echocardiography before implantation and at follow-up. LV lead placement was lateral/posterolateral in 86% of patients. Both PS and LV reverse remodeling occurred most frequently at the lateral/posterolateral LV pacing sites (PϽ0.001). PS was detected in 73 (37%) of patients and was clinically relevant in 41 (22%). The detection of PS at implantation had a poor sensitivity, as it occurred only in left lateral or sitting position in 27 patients. Ten patients (5%) underwent repeated surgery and 4 (2%) had their CRT turned off because of PS. At follow-up, we could manage PS noninvasively in 32 patients with a small PS-LV threshold difference: in 20 by cathode programmability (3 also thanks to automatic management of LV output) and in 12 (without cathode programmability) by programming the LV output as threshold ϩ1 V. Conclusions-PS may seriously hinder CRT. A bipolar LV lead and cathode programmability are mandatory to avoid PS by changing the LV pacing vector at target sites for CRT. LV stability at target sites despite PS should also be pursued by these means. The automatic adjustment of LV pacing output is complementary in patients with a small PS-LV threshold difference. (Circ Arrhythmia Electrophysiol. 2009;2:402-410.)

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Section: Response To Crt and Ps Managementmentioning

confidence: 99%

Phrenic Stimulation

Biffi

Moschini

Bertini

et al. 2009

Circ: Arrhythmia and Electrophysiology

117

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“…In our LV threshold stability analysis, we presumed the accuracy of the LVCM algorithm, but this assumption is reasonable given that previous work has demonstrated LVCM to be a highly reliable means of automatic evaluation of LV lead stimulation threshold irrespective of lead type, position (epicardial vs endocardial), or chronicity. 5 We evaluated LV thresholds only over a 2-week period rather than over the entire duration of follow-up available in the CareLink database, but prior analysis has shown that LV threshold variability is minimal even over longer follow-up of up to 21 months. 4 In our longevity increase analysis, we based our reference on current-generation battery and device parameters.…”

Section: Discussionmentioning

confidence: 99%

“…A 2-week time period was selected on the basis of previous studies demonstrating that this time period is highly correlated with long-term stability. 4,5 …”

Section: Methodsmentioning

confidence: 99%

Effect of Smaller Left Ventricular Capture Threshold Safety Margins to Improve Device Longevity in Recipients of Cardiac Resynchronization-Defibrillation Therapy

Steinhaus

Waks

Collins

et al. 2015

The American Journal of Cardiology

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Device longevity in cardiac resynchronization therapy (CRT) is affected by the pacing capture threshold (PCT) and programmed pacing amplitude of the left ventricular (LV) pacing lead. The aims of this study were to evaluate the stability of LV pacing thresholds in a nationwide sample of CRT defibrillator recipients and to determine potential longevity improvements associated with a decrease in the LV safety margin while maintaining effective delivery of CRT. CRT defibrillator patients in the Medtronic CareLink database were eligible for inclusion. LV PCT stability was evaluated using ≥2 measurements over a 14-day period. Separately, a random sample of 7,250 patients with programmed right atrial and right ventricular amplitudes ≤2.5 V, LV thresholds ≤ 2.5 V, and LV pacing ≥90% were evaluated to estimate theoretical battery longevity improvement using LV safety margins of 0.5 and 1.5 V. Threshold stability analysis in 43,256 patients demonstrated LV PCT stability of <0.5 V in 77% of patients and <1 V in 95%. Device longevity analysis showed that the use of a 0.5-V safety margin increased average battery longevity by 0.62 years (95% confidence interval 0.61 to 0.63) compared with a safety margin of 1.5 V. Patients with LV PCTs >1 V had the greatest increases in battery life (mean increase 0.86 years, 95% confidence interval 0.85 to 0.87). In conclusion, nearly all CRT defibrillator patients had LV PCT stability <1.0 V. Decreasing the LV safety margin from 1.5 to 0.5 V provided consistent delivery of CRT for most patients and significantly improved battery longevity.

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“…1,6–7 As the number of patients with implantable cardiac devices continues to increase with current patient demographics, the need to reduce the follow-up burden increases.…”

Section: Introductionmentioning

confidence: 99%

“…A secondary objective was to evaluate the automated RA and RV CM features in high-power devices. The LV CM algorithm has already been validated in a previous CRT-D study 1 and therefore was not validated in the current clinical study.…”

Section: Introductionmentioning

confidence: 99%

Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators

et al. 2010

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AimsThe Secura™ ICD and Consulta™ CRT-D are the first defibrillators to have automatic right atrial (RA), right ventricular (RV), and left ventricular (LV) capture management (CM). Complete CM was evaluated in an implantable cardioverter defibrillator (ICD) population.Methods and resultsTwo prospective clinical studies were conducted in 28 centres in Europe and Israel. Automatic CM data were compared with manual threshold measurements, the CM applicability was determined, and adjustments to pacing outputs were analysed. In total, 160 patients [age 64.6 ± 10.4 years, 77% male, 80 ICD and 80 cardiac resynchronization therapy defibrillator (CRT-D)] were included. The differences between automatic and manual measurements were ≤0.25 V in 97% (RA CM) and 96% (RV CM) and were all within the safety margin. Fully automatic CM measurements were available within 1 week prior to the 3-month visit in 90% (RA), 99% (RV), and 97% (LV) of the patients. Results indicated increased output (threshold >2.5 V) due to raised RA threshold in seven (4.4%), high RV threshold in nine (5.6%), and high LV threshold in three patients (3.8%). All high threshold detections and all automatic modulations of pacing output were adjudicated appropriate.ConclusionComplete CM adjusts pacing output appropriately, permitting a reduction in office visits while it may maximize device longevity.The study was registered at ClinicalTrials.gov identifiers: NCT00526227 and NCT00526162.

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Automated Left Ventricular Capture Management

Cited by 32 publications

References 6 publications

Phrenic Stimulation

Phrenic Stimulation

Effect of Smaller Left Ventricular Capture Threshold Safety Margins to Improve Device Longevity in Recipients of Cardiac Resynchronization-Defibrillation Therapy

Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators

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