Clinical Validation of New Pacing‐Sensing Configurations for Atrial Automatic Capture Verification in Pacemakers

Butter, Christian; Hartung, Wolfgang; Kay, G. Neal; Willems, Roger; Zhang, Geng; Lang, Douglas J.; Fleck, Eckart

doi:10.1046/j.1540-8167.2001.01104.x

Cited by 14 publications

(32 citation statements)

References 2 publications

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“…All newly implanted leads were steroid‐eluting. Median follow‐up was 12 months 6–18 ; no lead dislodgement was observed. Clinical characteristics of the patients are reported in Table I.…”

Section: Resultsmentioning

confidence: 99%

“…It appears from our data that threshold measurement could be challenging in patients with%Ap > 40% and first‐degree AVB (these clinical features imply an ACR success rate ≤ 50%, and a 27% success rate for AVC). Indeed, the ACM algorithm is not based on the detection of an AER, which could prove useful in pacing‐dependent patients and in this latter challenging scenario, but is still under evaluation 8–10,14 …”

Section: Discussionmentioning

confidence: 99%

“…This is indeed suboptimal in comparison with beat‐to‐beat monitoring of stimulation, such as in ventricular pacing, but it is nonetheless safe—as the algorithm requires a dual‐chamber pacemaker—except for the risk of atrial arrhythmias or transient pacemaker syndrome in the event of loss of atrial capture. This limits the possibility of achieving atrial capture 100% of the time in a single‐chamber mode, which requires a different technologic approach 8,14 …”

Section: Discussionmentioning

confidence: 99%

“…Beat‐to‐beat verification of atrial pacing is problematic, owing to the small amplitude of atrial‐evoked response (AER), which would make an algorithm prone to underdetecting effective stimulation. The technology required to achieve atrial stimulation by capture verification has only recently been developed, 8–10 and is currently under investigation. To overcome the problem of atrial stimulation verification and meet clinical needs, an algorithm capable of measuring the atrial threshold from indirect evidence has been developed 11–13 .…”

Section: Introductionmentioning

confidence: 99%

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Atrial Threshold Variability: Implications for Automatic Atrial Stimulation Algorithms

Biffi

Spitali

Silvetti

et al. 2007

Pacing Clinical Electrophis

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The reliability of ACM is high over a long follow-up. On the basis of atrial threshold variability, a practical approach to ACM programming should be two daily atrial threshold measurements in patients with normal AV conduction and%Ap < or = 40%, or with normal sinus activity and AVB, whereas 3-4 measurements should be recommended in patients with first-degree AVB and%Ap > 40% or with recurrent atrial fibrillation and AVB. The lowest adapted stimulation output should achieve at least threshold +1 V in the first trimester after implantation, then threshold +0.5 V thereafter, in order to achieve > 99.5% effective atrial stimulation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atrial Threshold Variability: Implications for Automatic Atrial Stimulation Algorithms

Biffi

Spitali

Silvetti

et al. 2007

Pacing Clinical Electrophis

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show abstract

“…The methods used for this purpose are, substantially, the analyses of atrial potentials, evoked atrial potentials [10], and ventricular rhythm in cases of stable spontaneous AV conduction [11].…”

Section: Introductionmentioning

confidence: 99%

Automatic atrial capture device control in real‐life practice: A multicenter experience

Giammaria

Quirino

Alberio

et al. 2016

Journal of Arrhythmia

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BackgroundDevice-based fully automatic pacing capture detection is useful in clinical practice and important in the era of remote care management.The main objective of this study was to verify the effectiveness of the new ACAP Confirm® algorithm in managing atrial capture in the medium term in comparison with early post-implantation testing.MethodsData were collected from 318 patients (66% male; mean age, 73±10 years); 237 of these patients underwent device implantation and 81 box changes in 31 Italian hospitals. Atrial threshold measurements were taken manually and automatically at different pulse widths before discharge and during follow-up (7±2 months) examination.ResultsThe algorithm worked as expected in 73% of cases, considering all performed tests. The success rate was 65% and 88% pre-discharge and during follow-up examination (p<0.001), respectively, in patients who had undergone implantation. We did not detect any difference in the performance of the algorithm as a result of the type of atrial lead used. The success rate was 70% during pre-discharge testing in patients undergoing device replacement.Considering all examination types, manual and automatic measurements yielded threshold values of 1.07±0.47 V and 1.03±0.47 V at 0.2-ms pulse duration (p=0.37); 0.66±0.37 V and 0.67±0.36 V at 0.4 ms (p=0.42); and 0.5±0.28 V and 0.5±0.29 V at 1 ms (p=0.32).ConclusionsThe results show that the algorithm works before discharge, and its reliability increases over the medium term. The algorithm also proved accurate in detecting the atrial threshold automatically. The possibility of activating it does not seem to be influenced by the lead type used, but by the time from implantation.

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Future Trends in Pacemaker Technology

Gold¹,

Casavant²

2004

The Fifth Decade of Cardiac Pacing

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Clinical Validation of New Pacing‐Sensing Configurations for Atrial Automatic Capture Verification in Pacemakers

Abstract: AER can be reliably detected using independent pacing (Atip-Can) and sensing (Aring-Vtip or Aring-Indiff) electrodes. Therefore, atrial automatic capture verification by AER detection is feasible.

Cited by 14 publications

References 2 publications

Atrial Threshold Variability: Implications for Automatic Atrial Stimulation Algorithms

Atrial Threshold Variability: Implications for Automatic Atrial Stimulation Algorithms

Automatic atrial capture device control in real‐life practice: A multicenter experience

Future Trends in Pacemaker Technology

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