Automatic Atrial Threshold Measurement and Adjustment in Pediatric Patients

Abstract

ACM measures atrial thresholds reliably in pediatric patients with both endocardial and epicardial leads, allowing its use in both. Constant high intrinsic atrial rate may prevent automatic threshold measurement in young children.

A Cautionary Tale on Atrial Capture Management, Biventricular Pacing, and Recurrent Asystole

“…Over recent decades, device manufacturers have developed several approaches to minimize battery drain by facilitating lower paced outputs in a reliable and safe manner. 1,2,[4][5][6] Automated capture management algorithms require precise engineering to confirm pacing-induced myocardial depolarization, either by discerning evoked responses from polarization afterpotentials in ventricular leads or by evaluating AV conduction Figure 1: Inpatient telemetry recording of a 25-year-old male patient with complex postoperative CHD and CAVB following dual-chamber biventricular pacemaker showing appropriate DDD pacemaker function followed abruptly by 11 seconds of ventricular asystole and then slow ventricular escape beats. During asystole, note the slightly faster atrial rates with mildly variable P-wave morphologies and no clear atrial pacing spikes (see text for explanation).…”

“…Capture management algorithms have been developed for permanent pacemakers, cardiac resynchronization therapy (CRT) devices, and cardioverter-defibrillators to enhance battery longevity and device performance. [1][2][3][4][5][6] Although generally safe, significant complications have been reported in patients who are pacemakerdependent. 7,8 Patients with postoperative congenital heart disease (CHD) often require epicardial rather than transvenous pacing leads, 9 and CRT systems are now being implanted more frequently in these individuals.…”