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Feasibility of Atrial autocaptureTM to Detect Atrial Evoked Response： Experience from 102 Patients Implanted with Dual-chamber Pacemakers

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Chinese Medical Journal 2017年第12期130卷 1411-1417页

作者： Hai-Long Si Qin Qin Bing-Rang Zhao Gang Chen Ya-Ru Lu Lu Kou Jing-Yu Yang Wen-Hua Lin Zi-Wen Ren Department of Cardiology Tianjin Chest Hospital Tianjin 300350 China Department of Cardiology Tianjin Cardiovascular Diseases Institute Tianjin 300350 China Department of Cardiology TEDA International Cardiovascular Hospital Tianjin 300457 China

Background： Atrial autocaptureTM （ACapTM） was a new technological development that confirmed atrial capture by analyzing evoked response （ER） with a new method - paced depolarization integral ER detection- and optimized energy output to changes in the stimulation threshold. The purpose of this study was to evaluate the clinical performance ofACapTM function. Methods： This was a prospective, observational, nonrandomized two-center study. Between November 2008 and August 2014, 102 patients were enrolled from two different institutions. Data were collected by case report forms at enrollment, hospital discharge, and in-office follow-ups scheduled at 1, 2, 3, 6, and 12 months postimplantation. Results： Ambulatory ACapTM function started to become available for 20.6% of patients at 1 day, then progressed to 30.4% at 7 days, 38.6% at 1 month, 41.6% at 2 months, 47.5% at 3 months, 53.5% at 6 months, and 63.4% at 1 year. The cause of the unsuccessful attempts to perform ACapTM threshold was ER/polarization 〈2：1. Availability for SD, BND, and HOCM indications had shown better results than AVB indication. For SD indication cases, feasibility was significantly better for SD with paroxysmal atrial fibrillation （pAF） than SD without pAF （78.4% vs. 35.0% at 1 year, n = 71, P 〈 0.001）. At each stage of the clinical follow-ups, there had been a strict correlation between ACapTM measurements and those conducted manually with P 〈 0.001 （n = 299）. Conclusions： It has been concluded that ACapTM function was safe and effective to confirm atrial threshold and reduce energy output automatically. ACapTM function is unavailable for some patients at early stages of the implantation; however, availability has been progressively increasing during follow-up.

关键词： autocapture Pacemaker Pacing Stimulation Threshold

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Pacing technology:advances in pacing threshold management

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2010年第8期11卷 634-638页

作者： Chu-pak LAU Chung-wah SIU Cardiology Division Department of MedicineQueen Mary HospitalThe University of Hong Kong

Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker ***,device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in *** addition to various hardware design to enhance device longevity,software-based solutions to minimize pacing energy and yet with good safety margin have also been *** with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic,several manufacturers have introduced different automatic threshold management *** article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.

关键词： Pacemaker Threshold management autocapture

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Impact of automatic threshold capture on pulse generator longevity

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Chinese Medical Journal 2006年第11期119卷 925-929页

作者： CHEN Ruo-han CHEN Ke-ping WANG Fang-zheng HUA Wei ZHANG Shu Centre of Arrhythmia Diagnosis and Treatment Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background The automatic, threshold tracking, pacing algorithm developed by *** Medical, verifies ventricular capture beat by beat by recognizing the evoked response following each pacemaker stimulus. This function was assumed to be not only energy saving but safe. This study estimated the extension in longevity obtained by autocapture （AC） compared with pacemakers programmed to manually optimized, nominal output. Methods Thirty-four patients who received the St. Jude Affinity series pacemaker were included in the study. The following measurements were taken： stimulation and sensing threshold, impedance of leads, evoked response and polarization signals by 3501 programmer during followup, battery current and battery impedance under different conditions. For longevity comparison, ventricular output was programmed under three different conditions：（1） AC on; （2） AC off with nominal output, and （3） AC off with pacing output set at twice the pacing threshold with a minimum of 2.0 V. Patients were divided into two groups： chronic threshold is higher or lower than 1 V. The efficacy of AC was evaluated. Results Current drain in the AC on group, AC off with optimized programming or nominal output was （14.33±2.84） mA, （16.74±2.75） mA and （18.4±2.44） mA, respectively （AC on or AC off with optimized programming vs. nominal output, P〈0.01）. Estimated longevity was significantly extended by AC on when compared with nominal setting [（103±27） months, （80±24） months, P〈0.01）. Furthermore, compared with the optimized programming, AC extends the longevity when the pacing threshold is higher than 1 V. Conclusion AC could significantly prolong pacemaker longevity; especially in the patient with high pacing threshold.

关键词： autocapture current drain longevity pulse generator

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