© 2003 by European Society of Cardiology
Automatic capture verification in ICD lead systems using intracardiac ventricular evoked response and reduced coupling capacitance
1Kerckhoff-Klinik, Department of Cardiology and Electrophysiology Benekestrasse 2-8, 61231, Bad Nauheim, Germany; 2Department of Heart Surgery Benekestrasse 2-8, 61231, Bad Nauheim, Germany; 3Guidant Europe NV/SA, Research Department Park Lane, Culliganlaan 2B, 1831, Diegem, Belgium; 4Guidant, Research and Development Mailstop E 211, 4100 Hamline Avenue North, 55112-5798, St Paul, MN, U.S.A.
AIM: Intracardiac ventricular evoked-response (ER) signals detected by implanted cardioverter defibrillator (ICD) lead systems were investigated for automatic capture verification (AC).
METHOD: ER signals were evaluated with an external pacing system equipped with a reduced coupling capacitance (CC=2·2 #x03BC;F) in the pacing output circuit during ventricular step-down threshold testing at 0·4 ms pulse duration. Real-time pacing markers, surface ECG and intracardiac electrograms pre- and post-filtering were digitally recorded.
RESULTS: Twenty consecutive patients, age 61±12 years, with leads from two different manufacturers were tested — 10 were implanted with acute leads (AL) and 10 with chronic leads (CL). The analysis was based on the ER amplitude during capture and on the ER-to-afterpotential ratio (SAR), with SAR>2 as the criterion for successful capture detection. ER amplitudes (median and range) were 8·1 mV (2·1–19·5 mV) for AL and 8·3 mV (3·7–14·2 mV) for CL. SAR values (median and range) were 48·0 (2·5–682·6) for AL and 13·2 (6·3–35·9) for CL, indicating that AC could successfully be applied in all patients.
CONCLUSIONS: Reducing the pacing CC allows adequate ER detection for automatic capture verification on non-selected ICD lead systems. The effect of high-voltage shock treatment on ER signal detection requires further investigation.
Key Words: ICD, ventricular autocapture, evoked response, afterpotential
Correspondence: Dr med. Johannes Sperzel, Kerckhoff-Klink, Department of Cardiology and Electrophysiology, Benekestraße 2-8, 61231 Bad-Nauheim, Germany. Tel.: +49 6032 9960; Fax: +49 6032 996 2236; E-mail:Johannes.Sperzel{at}kerckhoff.med.uni-giessen.de
[1] Trappe H-J, Achtelik M, Pfitzner P, et al. Single-chamber versus dual-chamber implantable cardioverter defibrillators: indications and clinical results. Am J Cardiol 1999; 83: 8D–16D.[CrossRef][Web of Science][Medline]
[2] Danilovic D, Stroebel J, Ohm OJ, et al. Stimulation thresholds during activities of daily living. Pacing Clin Electrophysiol 1996; 19: 659–669.
[3] Alt E, Kriegler E, Fituhi P, et al. Feasibility of using intracardiac impedance measurements for capture detection. Pacing Clin Electrophysiol 1992; 15: 1873–1879.[Medline]
[4] Feld GK, Love CJ, Camerlo J, et al. A new pacemaker algorithm for continuous capture verification and automatic threshold determination: elimination of pacemaker afterpotential utilizing a triphasic charge balancing system. Pacing Clin Electrophysiol 1992; 15: 171–178.[Medline]
[5] Danilovic D, Ohm OJ, Stroebel J, et al. An algorithm for automatic measurement of stimulation thresholds: Clinical performance and preliminary results. Pacing Clin Electrophysiol 1998; 21: 1058–1068.[Medline]
[6] Kadhiresan VA, Olive A, Gornick C, et al. Automatic capture verification by charge-neutral sensing. Pacing Clin Electrophysiol 1999; 22: 73–78.[Medline]
[7] Lau C, Cameron DA, Nishimura SC, et al. A cardiac evoked response algorithm providing threshold tracking: A North American multicenter study. Pacing Clin Electrophysiol 2000; 23: 953–959.[CrossRef][Medline]
[8] Butter C, Hartung WM, Kay GN, et al. Clinical validation of new pacing-sensing configurations for atrial automatic cap-ture verification in pacemakers. J Cardiovasc Electrophysiol 2001; 12: 1104–1108.[Medline]
[9] Lau C, Nishimura SC, Yee R, et al. Intraoperative study of polarization and evoked response signals in different endocardial electrode designs. Pacing Clin Electrophysiol 2001; 24: 1055–1060.[Medline]
[10] Zhu Q and Lang DJ. Effect of pacemaker output coupling capacitor on intracardiac evoked response sensing. Proceedings of the 20th Annual International Conference of IEEE Engineering in Medicine and Biology Society 1998; Hong Kong Vol. 20:No. 1.
[11] Sperzel J, Neuzner J, Schwarz T, et al. Reduction of Pacing Output Coupling Capacitance for Sensing the Evoked Response. Pacing Clin Electrophysiol 2001; 24: pp. 1377–1382.[Medline]
[12] Cleveland WS. Visualizing Data. Summit 1993; New Jersey Hobart Press pp. 25–26.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Sperzel, B. Nowak, E. Himmrich, G. Zhang, A. König, R. Willems, C. Reister, A. Sathaye, and G. Fröhlig Acute performance evaluation of a new ventricular automatic capture algorithm. Europace, January 1, 2006; 8(1): 65 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Biffi, G. Boriani, M. Bertini, P. Silvestri, C. Martignani, and A. Branzi Pacing with capture verification in candidates for resynchronisation therapy: A feasibility study Europace, January 1, 2005; 7(3): 255 - 265. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||