© 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
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