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Europace 2004 6(6):561-569; doi:10.1016/j.eupc.2004.08.010
© 2004 by European Society of Cardiology
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REVIEW ARTICLE

Understanding capture detection

Willem G. de Voogta,*, Ben F. M. Vonkb, Bert A. Albersb and Florian Hintringerc

aDepartment of Cardiology, St. Lucas Andreas Ziekenhuis Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; bVitatron B.V. Meander 1051, 6825 MJ Arnhem, The Netherlands; cUniversitätsklinik Innsbruck Ansichstrasse 35, 6020 Innsbruck, Austria

Automatic capture detection systems are currently available in several cardiac pacing devices. All current systems use low-polarization electrodes and no beat to beat detection system is available for all types of electrodes. In addition the success ratio for currently available systems is not always 100%. Failure to detect capture reliably is often related to the behaviour of the electrode–tissue interface under different circumstances.

Pacemaker electrodes can be considered electrochemical cells with complicated characteristics depending on time, temperature and electrical charge. This electrochemical cell is disturbed when a charge is transferred across the electrode–tissue interface during pacing. Several measures can be taken in order to minimise this disturbance or pace polarization artefact (PPA) including the use of high active surface area electrodes and application of tri-phasic pacing pulses.

Another factor influencing detection of evoked potentials is the input circuit of the pacemaker affecting the PPA and the evoked response. Positive PPAs can be falsely interpreted as evoked potentials due to the undershoot of the second order filters applied in modern cardiac pacemakers.

This paper explains the behaviour of the interface between the electrode and the cardiac tissue in combination with the pacemaker output circuits and input amplifiers under different circumstances.

Key Words: automatic capture detection, polarization, pace polarization artefact, pacemakers, pacemaker leads, evoked response, pacing threshold

*Corresponding author. Tel.: +31 235 38 3989; fax: +31 235 490 309. E-mail address: w.g.devoogt{at}planet.nl (W.G. de Voogt).


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