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 op...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.展开更多
Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacema...Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in 1958.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 developed.Together with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic,several manufacturers have introduced different automatic threshold management algorithm.This article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.展开更多
Background The automatic, threshold tracking, pacing algorithm developed by St.Jude Medical, verifies ventricular capture beat by beat by recognizing the evoked response following each pacemaker stimulus. This functio...Background The automatic, threshold tracking, pacing algorithm developed by St.Jude 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.展开更多
文摘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.
文摘Over the last five decades,pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features.However,device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in 1958.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 developed.Together with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic,several manufacturers have introduced different automatic threshold management algorithm.This article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.
文摘Background The automatic, threshold tracking, pacing algorithm developed by St.Jude 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.
