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Automatic adjustment of pacing output in the clinical setting.

Abstract：

BACKGROUND:AutoCapture (AC) is a programmable feature that enables the pacemaker to both track the capture threshold and automatically adjust the output on a beat-by-beat basis. Although AC safely and significantly reduces the current drainage, some authors have argued that the longevity benefit of such a system is overstated. This study aims to estimate the longevity extension that can be obtained, in the clinical routine, by turning the AC on in comparison to pacemakers programmed to operate at the shipped and manually optimized output. METHODS:We selected 83 consecutive patients who received implanted St Jude's Affinity pacemakers >6 months earlier. Eight patients died or were lost to follow-up and in 9 subjects the AC could not be turned on. In the remaining 66 patients, current drain and estimated longevity were compared in 3 situations: (1) AC on; (2) AC off, optimized programming (100%-150% voltage threshold); (3) AC off, shipped output (3.5 V). RESULTS:Five patients had large variations (>1 V) of the AC threshold. Current drainage was 8.0 +/- 0.9 mA in the AC group, 8.7 +/- 1.8 mA with AC off and optimized programming, and 11.3 +/- 2.3 mA at shipped output (P <.01). Estimated longevity was significantly extended (P <.01) by AC (12.1 +/- 1.0 years) when compared to shipped (8.9 +/- 1.7 years) and optimized programming (11.3 +/- 1.4 years). CONCLUSION:Reprogramming the pacemaker output significantly enhanced its estimated longevity; AC added a moderate but significant extension over manual reprogramming and was associated with increased safety in patients with large ventricular threshold variations.

journal_name

Am Heart J

journal_title

American heart journal

authors

Ribeiro AL,Rincón LG,Oliveira BG,Vinha CR,Melatto D,Torres AA,Barros VC,Levine PA

doi

10.1016/s0002-8703(03)00529-5

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

127-31

issue

1

eissn

0002-8703

issn

1097-6744

pii

aS0002870303005295

journal_volume

147

pub_type

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