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Biffi M, Menardi E, Narducci ML, Ammendola E, Messano L, Giofrè F, Baiocchi C, Saporito D, Lissoni F, Bertini M, Pierantozzi A, Zingarini G, Malacrida M, Ziacchi M. Manufacturer change and risk of system-related complications after implantable cardioverter defibrillator replacement. J Cardiovasc Med (Hagerstown) 2017; 18:968-975. [DOI: 10.2459/jcm.0000000000000572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Automatic atrial capture device control in real-life practice: A multicenter experience. J Arrhythm 2017; 33:139-143. [PMID: 28416982 PMCID: PMC5388052 DOI: 10.1016/j.joa.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022] Open
Abstract
Background Device-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. Methods Data 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. Results The 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). Conclusions The 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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Biffi M, Bertini M, Saporito D, Belotti G, Quartieri F, Piancastelli M, Pucci A, Boggian G, Mazzocca GF, Giorgi D, Diotallevi P, Diemberger I, Martignani C, Pancaldi S, Ziacchi M, Marcantoni L, Toselli T, Attala S, Iori M, Bottoni N, Argnani S, Tomasi C, Sassone B, Boriani G. Automatic management of atrial and ventricular stimulation in a contemporary unselected population of pacemaker recipients: the ESSENTIAL Registry. Europace 2016; 18:1551-1560. [DOI: 10.1093/europace/euw021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/20/2016] [Indexed: 11/14/2022] Open
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Hemodynamic Surveillance of Ventricular Pacing Effectiveness with the Transvalvular Impedance Sensor. Adv Med 2014; 2014:307168. [PMID: 26556408 PMCID: PMC4590946 DOI: 10.1155/2014/307168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/24/2014] [Indexed: 12/03/2022] Open
Abstract
The Transvalvular Impedance (TVI) is derived between atrial and ventricular pacing electrodes. A sharp TVI increase in systole is an ejection marker, allowing the hemodynamic surveillance of ventricular stimulation effectiveness in pacemaker patients. At routine follow-up checks, the ventricular threshold test was managed by the stimulator with the supervision of a physician, who monitored the surface ECG. When the energy scan resulted in capture loss, the TVI system must detect the failure and increase the output voltage. A TVI signal suitable to this purpose was present in 85% of the tested patients. A total of 230 capture failures, induced in 115 patients in both supine and sitting upright positions, were all promptly recognized by real-time TVI analysis (100% sensitivity). The procedure was never interrupted by the physician, as the automatic energy regulation ensured full patient's safety. The pulse energy was then set at 4 times the threshold to test the alarm specificity during daily activity (sitting, standing up, and walking). The median prevalence of false alarms was 0.336%. The study shows that TVI-based ejection assessment is a valuable approach to the verification of pacing reliability and the autoregulation of ventricular stimulation energy.
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HIIPPALA ANITA, HAPPONEN JUHAMATTI. Long-Term Performance of Beat-to-Beat Automatic Ventricular Threshold Adjustment in Infants with Congenital Atrioventricular Block. Pacing Clin Electrophysiol 2013; 36:1259-64. [DOI: 10.1111/pace.12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/03/2013] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- ANITA HIIPPALA
- Department of Pediatric Cardiology; Children's Hospital, Helsinki University Hospital and University of Helsinki; Helsinki; Finland
| | - JUHA-MATTI HAPPONEN
- Department of Pediatric Cardiology; Children's Hospital, Helsinki University Hospital and University of Helsinki; Helsinki; Finland
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Alings M, Vireca E, Bastian D, Wardeh AJ, Nimeth C, Tukkie R, Trinks S, Kainz W, Delaney C, Kaltofen G, Ziekenhuis A, Bloch-Thomsen PE, Cihalik C, Lawo T, Agraou B, Deutsch P, Bazin P, Guyomar Y, Bobillier M, Defaye P, Amiel A, Lazarus A, Guenoun M, Le Franc P, Oei FL, Nicastia D, Hoenen S, de Porto AE, Vontobel H, Robles de Medina R, Kainz W, Brunner P, Alzueta J, Santos JA, Navarro AB, Hie C, Kautzner J, Ammann-Kardiol P, Kaltofen G, Tukkie R, Zeindlhofer E, Nimeth C, Frommel M, Brachmann J, Gohl K, Trinks S, van der Meer P, Zenker G, Gebetsberger F, Unger T, Ruiter JH, Ramanna H, Hadj KB, Lang A, Predel D, Schnabel A, Martinek M, Cheng CW, Ward K, Jensen G, O'Nunain S, Jiang S, Terpstra WF, Budschedl E, van Doorn DJ, Marenne F, Wahlers T, Zeus T, Osswald S, Engby B, Christensen PD, Junbo G, van der Veen M. Clinical use of automatic pacemaker algorithms: results of the AUTOMATICITY registry. Europace 2011; 13:976-83. [DOI: 10.1093/europace/eur052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Glikson M, Luria D. Capture management in high-power devices: an important step forward or a new gadget? Europace 2010; 12:770-1. [DOI: 10.1093/europace/euq101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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PECORA DOMENICO, MORANDI FRANCESCA, LICCARDO MATTIA, PEPI PATRIZIA, ORAZI SERAFINO, CAICO SALVATOREIVAN, SCACCIA ALBERTO, BIZEAU OLIVEIR, CITERNE OLIVIER, RACITI GIOVANNI, GIUDICE GIOVANNIDEL. Performance of a Ventricular Automatic-Capture Algorithm in a Wide Clinical Setting. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1546-53. [DOI: 10.1111/j.1540-8159.2008.01225.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biffi M, Sperzel J, Martignani C, Branzi A, Boriani G. Evolution of pacing for bradycardia: Autocapture. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goetze S, Sperzel J, Biffi M, Sathaye A, Brooke MJ, Doelger A, Schubert B, Butter C. Clinical Evaluation of Two Different Evoked Response Sensing Methods for Automatic Capture Detection in the Left Ventricle. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:865-73. [PMID: 17584268 DOI: 10.1111/j.1540-8159.2007.00774.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This acute feasibility study compared two different automatic capture detection methodologies, the reduced coupling capacitor (RCC) and the independent pace/sense (IPS) methods, for the left ventricle (LV). METHODS LV threshold tests were performed in DDD mode, with LV-only and bi-ventricular (BiV) pacing using an external cardiac resynchronization therapy (CRT) defibrillator. Evoked response (ER) signals from LV leads were recorded using the LV(Tip) (LV(Tip)-->Can) and LV(Ring) (LV(Ring)-->Can) to empty pulse generator (Can) housing sensing vectors to evaluate the two methodologies. Pacing vector, pulse duration, atrioventricular delay, and interventricular delay were varied to assess their effects on ER. The minimum ER amplitude (ER(min)), signal-to-artifact ratio (SAR), and ER amplitude voltage dependence were evaluated. ER(min)>2 mV and SAR(min)>2 define potential automatic LV capture detection for the two methodologies. RESULTS Data collected from 43 patients (63.7 +/- 11.0 years) were analyzed, including unipolar and bipolar (14/29) LV leads. Neither ER sensing method was affected by changing the pacing vector. The LV(Tip)-->Can ER(min) was significantly decreased at the 1.0-ms pulse duration when compared to 0.4-ms (p < 0.05). During BiV pacing, LV(Tip)-->Can ER(min) increased at negative interventricular delays and decreased at positive interventricular delays relative to simultaneous pacing. LV(Tip)-->Can resulted in fewer patients with sufficient ER characteristics for capture detection, albeit only significantly at the extended pulse duration (79% vs 97%, p < 0.05) and at simultaneous and positive interventricular delays (81% vs 97%, p < 0.05). CONCLUSIONS Though LV capture detection was feasible using both investigated methods, the RCC method (LV(Tip)-->Can) sensitivity to the evaluated pacing parameters suggests the IPS method (LV(Ring)-->Can) provides a more robust performance.
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Mortensen K, Rudolph V, Willems S, Ventura R. New developments in antibradycardic devices. Expert Rev Med Devices 2007; 4:321-33. [PMID: 17488227 DOI: 10.1586/17434440.4.3.321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With increasing advances in technology, cardiac pacemakers have become highly sophisticated devices that allow diagnostic and therapeutic functions beyond conventional antibradycardic therapy. This review discusses the most promising developments in antibradycardic device therapy, such as novel diagnostic functions, telemonitoring, autoadjustment of programmed parameters, algorithms for support of intrinsic atrioventricular conduction, pacing algorithms for the prevention of atrial arrhythmias and cardiac resynchronization therapy. A short overview of the basic principles of antibradycardic device therapy is also provided.
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Affiliation(s)
- Kai Mortensen
- University Heart Centre Hamburg, Department of Cardiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Sperzel J, Nowak B, Himmrich E, Zhang G, König A, Willems R, Reister C, Sathaye A, Fröhlig G. Acute performance evaluation of a new ventricular automatic capture algorithm. ACTA ACUST UNITED AC 2006; 8:65-9. [PMID: 16627412 DOI: 10.1093/europace/euj008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS This study evaluated the acute clinical performance of a new ventricular automatic capture algorithm developed to work with all lead types and pacing vectors. METHODS AND RESULTS During regular pacemaker implant or replacement, AutoThreshold and manual threshold tests were performed in ventricular unipolar (UP) and bipolar (BP, if applicable) pacing using a customized external prototype INSIGNIA pacemaker. The success rate and accuracy of two different modes (commanded and ambulatory) of the automatic capture algorithm were used to evaluate the performance. Loss-of-capture events (two consecutive non-captured beats without backup pacing) were used to assess safety. Data of 53 patients (33 DDD/20 VVI) from four medical centres were analysed. Tested leads included 43 BP and 10 UP from nine manufacturers, and seven had electrodes with low polarization. The rate of successful commanded and ambulatory AutoThreshold tests was 96 and 94%, respectively, with an average absolute threshold difference compared with manual threshold of < 0.1 V at 0.4 ms (commanded 0.07 +/- 0.07 V and ambulatory 0.08 +/- 0.07 V). There was no significant difference in performance between UP/BP pacing, polarization, and lead type. No loss-of-capture event was observed. CONCLUSION When successful, the ventricular automatic capture algorithm accurately determined pacing thresholds in either a UP or BP pacing configuration among all leads tested.
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Affiliation(s)
- Johannes Sperzel
- Kerckhoff-Klinik GmbH, Department of Cardiology and Electrophysiology Benekestrasse 2-8, D-61231 Bad Nauheim, Germany.
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Yaacoby E, Akselrod S, Eldar M, Glikson M. Algorithm for ventricular capture verification based on the mechanical evoked response. Med Biol Eng Comput 2005; 43:511-5. [PMID: 16255434 DOI: 10.1007/bf02344733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Automatic pacemaker capture verification is important for maintaining safety and low energy consumption in pacemaker patients. A new algorithm was developed, based on impedance measurement between pacing electrode poles, which reflects the distribution of the conducting medium between the poles and changes with effective contraction. Data acquired during pacemaker implant in 17 subjects were analysed, with intracardiac impedance recorded while pacing was performed in the ventricle at varying energies, resulting in multiple-captured and non-captured beats. The impedance signals of all captured/non-captured beats were analysed using three different algorithms, based on the morphology of the impedance signal. The algorithm decision for each beat was compared with an actual capture or non-capture, as determined from the simultaneous recording of surface ECG. Two of the three algorithms (Z1 and Zn) were based on impedance values, and one (Z'n) was based on the first derivative of the impedance. Z1 was based on a single sample, whereas Z'n and Z'n were based on several samples in each beat. The total accuracy for each was Z1: 43%, Zn: 87%, Z'n: 92%. It was concluded that impedance-based capture verification is feasible, that a multiple rather than single sample approach for signal classification is both feasible and superior, and that first derivative analysis with multiple samples (Z'n) provides the best results.
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Affiliation(s)
- E Yaacoby
- Department of Physics, Tel-Aviv University, Tel Aviv, Israel
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Liberman L, Hordof AJ, Hsu DS, Pass RH. Failure of automatic capture verification in an epicardial pacemaker system. J Interv Card Electrophysiol 2005; 13:235-7. [PMID: 16177851 DOI: 10.1007/s10840-005-2973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 06/14/2005] [Indexed: 10/25/2022]
Abstract
Epicardial pacing is frequently used in pediatric patients with congenital heart disease. Automatic threshold determination has been reported to be safe in epicardial lead systems. We report a case of falsely low ventricular thresholds determined by automatic capture verification in a patient with complete loss of capture due to a lead fracture.
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Affiliation(s)
- Leonardo Liberman
- Division of Pediatric Cardiology, New York Presbyterian Hospital, Columbia University, New York, 10032 NY, USA.
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