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

Abstract

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.

Long‐Term RV Threshold Behavior by Automated Measurements: Safety is the Standpoint of Pacemaker Longevity!

“…1,4,5,[8][9][10][11] These two achievements ultimately meet the pivotal patients' need. 13 Evidence of AVC accuracy has been proven also in ICD patients, 8,9,19 where maximization of longevity and matching of patients' survivorship are pivotal to decrease device cost. 8,20 This is of paramount importance, mainly when expensive devices such as cardiac resynchronization therapy-defibrillators are concerned.…”

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

“…Despite several large case series demonstrating accurate and reliable performance of this algorithm in similar Medtronic devices, 3,4 this problem has not been previously reported. The lack of detection of this problem in these case series may reflect limitations similar to those described above for our patient but may also reflect the superior long-term performance of transvenous leads in older sedentary adults versus epicardial leads in younger and more active patients.…”

“…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.…”

Ventricular Fibrillation due to Automated Atrial Threshold Testing in a Patient with an Implantable Cardioverter Defibrillator

“…Most studies regarding automated threshold testing review ventricular threshold testing. This was found to be safe and improve longevity . However, not much is published about automated atrial threshold testing, especially for Biotronik devices.…”

“…This was found to be safe and improve longevity. [6][7][8][9][10][11][12] However, not much is published about automated atrial threshold testing, especially for Biotronik devices. This leaves us with little or no evidence about safety of the existing, often used algorithms.…”