Europace Advance Access originally published online on February 10, 2006
Europace 2006 8(3):216-220; doi:10.1093/europace/euj027
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PACING
Role of ventricular autocapture function in increasing longevity of DDDR pacemakers: a prospective study
1 Institute of CardiologyUniversity of BolognaAzienda Ospedaliera Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138 Bologna Italy ; 2 Ospedale CeccariniRiccione Italy ; 3 Ospedale PiemonteMessina Italy ; 4 Ospedale Grande degli InfermiViterbo Italy ; 5 Ospedale GravinaCaltagirone Italy ; 6 Ospedale. CisanelloPisaItaly ; 7 Ospedale CareggiFirenze Italy ; 8 Ospedale S. PaoloSavona Italy ; 9 Ospedale Santa CoronaPietra Ligure Italy ; 10 Ospedale di Sanremo Italy ; 11 Clinica PederzoliPeschiera del Garda Italy
Aims Autocapture is an algorithm for automatic adaptation of ventricular output to capture threshold. The aim of this prospective study was to estimate the effects of ventricular Autocapture algorithm on DDD–DDDR pacemaker longevity.
Methods and results Eighty-three patients implanted with a DDD–DDDR pacemaker (Affinity or Entity; St Jude Medical, USA) were enrolled and the Autocapture function was activated pre-discharge. Ventricular pulse duration was randomly programmed at 0.3 or 0.4 ms, with a cross-over at 8–12 weeks and again at 13–14 months. Diagnostic data were retrieved from device memory and by calculating battery current drain from long-term threshold recordings; device longevity was estimated at the following settings: Autocapture with a pulse duration of 0.3 and 0.4 ms, respectively, standard output (3.5 V, 0.4 ms) and conventional low output programming (2.5 V, 0.4 ms). According to a series of assumptions, Autocapture was associated with a 55–60% increase in estimated device longevity compared with standard output programming and a 6–7% increase in longevity compared with low output programming. No significant differences were found between Autocapture programmed with a pulse duration of 0.3 or 0.4 ms. In projections to a 10-year follow-up, use of the Autocapture function resulted in a 42% reduction in pacing-related estimated costs compared with standard output programming at 3.5 V, 0.4 ms.
Conclusion Pacing with constant adaptation of ventricular output in dual-chamber devices has the potential to increase generator longevity and to reduce sizeably pacing-related costs compared with standard programming.
Key Words: Autocapture, Cardiac pacing, Cost-effectiveness, Stimulation threshold
* Corresponding author. Tel: +39 051 6363531; fax +39 051 344859. E-mail address: cardio1{at}almadns.unibo.it
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