<b>Automatic Adjustment of Pacemaker Stimulation Output Correlated with Continuously Monitored Capture Thresholds:</b> A Multicenter Study

Clarke, Malcolm; Liu, Bo; Schüller, Hans; Binner, L.; Kennergren, Charles; Guerola, Modesto; Weinmann, Peter Erwin; Ohm, Ole‐Jørgen

doi:10.1111/j.1540-8159.1998.tb00244.x

Cited by 109 publications

(108 citation statements)

References 4 publications

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“…They allow for the output to be automatically adjusted based on automatic evaluations of pacing threshold, making the most of optimised output 18 . When AutoCapture TM function (or a similar mechanism) be available in all models, manual output reprogramming will no longer be necessary.…”

Section: Discussionmentioning

confidence: 99%

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Ribeiro¹,

Rincon²,

Oliveira³

et al. 2001

Arq. Bras. Cardiol.

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Objective -This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker Methods -Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999Electric pacing of the heart began around forty years ago and stands out as one of the major achievements in cardiac therapy in the 20th century, combining both physiologic knowledge and technologic advances in the treatment of potentially disabling and fatal bradyarrhythmias. Currently, about 400 thousands pacemakers are implanted every year world-wide 1 , and 50% of pacemaker recipients are still alive when the pulse generator lifespan is over, making them eligible for a new pulse generator. Therefore, the prolongation of the life of pulse generators has been considered desirable and cost-effective because it would postpone a second surgical intervention, eliminating the expense of new generators units 1,2 .Pacemaker longevity is defined as the interval between implantation and detection of the end of pulse generator life, which is determined by the energy consumption of the pulse generator and the deliverable capacity of its power source 3,4 . The deliverable capacity of the power source is fixed for a certain battery, but energy consumption depends on both fixed parameters and physiologic and programmable variables. Therefore, the determinants of the consuption are: programmable output parameters of the system (voltage and pulse width), the frequency and percentage of pacing, the lead impedance, and the static energy drain of the system. Although programming the pacing rate and AV interval can optimise the battery energy drain, the most important parameters that are available to optimise the longevity of a pacing system are stimulation voltage and pulse width 2 .Original settings programmed by the manufacturer are chosen to provide for a sufficient safety margin during the subacute period when stimulation thresholds typically rise. However, most leads used today enable stimulation with reduced output parameters of pacing, resulting in significant reduction in energy drain and, therefore, prolongation of pulse generator life. Thus, reprogramming a pacemaker after a subacute period, according to an obtained stimulation threshold, was a desirable practice recommended in most basic textbooks and by international guidelines 1,3-6 . However, the majority of pacemakers remain at the original programmed

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Section: Discussionmentioning

confidence: 99%

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

Ribeiro¹,

Rincon²,

Oliveira³

et al. 2001

Arq. Bras. Cardiol.

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“…Evoked responses (ER, mV) and polarization signals (PS, mV) were measured after the pocket was closed. Pacing thresholds by Autocapture (AC thrd, V) and Vario (Vario thrd, V), battery current (mA), and battery impedance (kW) were also repeated during predischarge and 1, 6,12,18, 24, 30, 40, 50, and 60 months after discharge. According to the ER and PS values an Autocapture algorithm could be activated in 49 patients (88%).…”

Section: Discussionmentioning

confidence: 99%

“…6) For capture verification, a satisfactory ER amplitude has to be measured after pacing pulse. The changes in the stimulation threshold after pacemaker implantation are similar to those of ER values.…”

Section: Discussionmentioning

confidence: 99%

“…Study design and patient population: This was a retrospective study performed at the Siyami Ersek Cardiovascular and Thoracic Surgery Center with enrollment Vol 43 No 6 between May 1996 and May 2001. Sixty consecutive patients implanted with a permanent pacemaker using an Autocapture algorithm (Regency SR+, St. Jude Medical, n: 44; Microny, St. Jude Medical, n: 16) were included in the study.…”

Section: Methodsmentioning

confidence: 99%

“…3,[6][7][8][9][10][11][12] However, long-term follow-up studies examining the safety and effectiveness of the algorithm are also necessary. The aim of this study was to evaluate the five-year performance of the Autocapture algorithm implemented in VVIR pacing systems in 60 consecutive patients.…”

Section: In the 1970s Mugica And Preston Proposed A Threshold-trackimentioning

confidence: 99%

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Long-term Follow-up of Pacemakers with an Autocapture Pacing System.

et al. 2002

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SUMMARYThe aim of this study was to evaluate the safety and performance of the Autocapture pacing system during a 5-year follow-up period.The study was conducted retrospectively between May 1996 and May 2001. Sixty consecutive patients who had undergone VVI pacemaker implantation using an Autocapture program with leads 1402T (n: 31) and 1452T (n: 29) were included in the study. Intraoperative measurements including a ventricular stimulation threshold test, sensing of intrinsic R wave (mV), and lead impedance (W) were done by a standard pacing system analyzer. Evoked responses (ER, mV) and polarization signals (PS, mV) were measured after the pocket was closed. Pacing thresholds by Autocapture (AC thrd, V) and Vario (Vario thrd, V), battery current (mA), and battery impedance (kW) were also repeated during predischarge and 1, 6,12,18, 24, 30, 40, 50, and 60 months after discharge. According to the ER and PS values an Autocapture algorithm could be activated in 49 patients (88%). The Autocapture algorithm remained active during the follow-up in all of these patients. In patients with inappropriate ER and PS values (11 patients, 12%), pacemakers were programmed to a VVIR pacing mode and Autocapture algorithm was inactivated. ER and PS values did not reach appropriate values to activate the Autocapture algorithm in any of these patients in consecutive follow-ups. Twenty-four-hour Holter monitoring could be conducted in 32 patients (53%). In all recordings, when the loss of capture occurred, it was confirmed that back-up pacing continued. When the first measurements recorded during implantation were compared to approximately the 5 th year measurements; ER (9.2 mV vs 9.6 mV), PS signal (1.13±0.30 mV vs 1.15±0.72 mV), AC thrd (0.4 V vs 1.2 V), Vario thrd (0.7 V vs 1.3 V), and lead impedance (502 ohm vs 620 ohm) were not changed significantly. Battery impedance increased 1 kOhm between 30-40 months of the implantation. Seven deaths occurred during follow-up. Three patients had fatal myocardial infarction, one died due to a non-cardiac event, and the remaining three died due to progressive heart failure. Conclusion: ER, R wave amplitude, and PS, which are the main parameters for the continuation of Autocapture function, did not change significantly during long-term follow-up. High output back up pacing provided additional safety for sudden rises in threshold. The Autocapture pacing algorithm was

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