© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
Pacing with capture verification in candidates for resynchronisation therapy: A feasibility study
aInstitute of Cardiology, University of Bologna Via Massarenti 9, 40138 Bologna, Italy; bSt. Jude Medical Italy
BACKGROUND: Devices for cardiac resynchronisation therapy (CRT) deliver energy into 3 output channels. Such a burden can significantly reduce device longevity. AutocaptureTM has been shown to improve pacemaker longevity and safety of right ventricular pacing in clinical studies. The aim of this study was to investigate the application of AutocaptureTM during biventricular pacing (BIV) to decrease the energy cost of CRT.
METHODS: During implantation of BIV devices, an acute study was performed to test the hypothesis that the evoked response (ER) elicited by each delivered stimulus is correctly detected and measured either on the right ventricular (RV) channel during BIV pacing with the left ventricular (LV) channel pacing first, or in the LV channel with the RV channel pacing first. A reliable measurement of ER is the critical requirement for the correct performance of AutocaptureTM.
RESULTS: ER amplitude in the right ventricle during BIV pacing was not significantly decreased compared with RV pacing in the VVI mode (16.36 ± 5.27 mV vs 17.09 ± 6.12 mV). ER amplitude in the left ventricle during BIV pacing was not significantly decreased compared with LV pacing in the VVI mode (12.4 ± 8.95 mV vs 12.25 ± 8.97 mV). Three patients in atrial fibrillation had a DDDR pacemaker with the LV lead connected to the atrial port, and received BIV pacing with AutocaptureTM turned on in the RV channel. AutocaptureTM performance in the long term, as assessed by the trend of RV threshold over 20 ± 8 months, showed that LV depolarisation was never sensed as an ER on the RV channel.
CONCLUSIONS: Our observations support the feasibility and safety of capture verification during BIV pacing on the ventricular channel paced secondly, which could increase the longevity of CRT devices, and decrease the costs of this new therapy for heart failure patients.
Key Words: heart failure, resynchronisation therapy, autocapture, evoked response
*Corresponding author. Tel.: +39 051 6363531; fax: +39 051 344859. E-mail address: mbiffi{at}orsola-malpighi.med.unibo.it (M. Biffi).
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