Autocapture Enhancements: Unipolar and Bipolar Lead Compatibility and Bipolar Pacing Capability on Bipolar Leads
| Autor: | Yves Vandekerckhove, M Berkhof, Euljoon Park, Johannes Sperzel, John W. Poore, Nils Holmström, Hansjürgen Bondke, John C. Messenger, Ludwig Binner, Jöerg Scheiner, Gene A. Bornzin |
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| Rok vydání: | 2003 |
| Předmět: |
Male
Stimulus amplitude Pacemaker Artificial business.industry Threshold test Cardiac Pacing Artificial General Medicine Electrocardiography mental disorders Electrode cardiovascular system Humans Medicine Calibration algorithm Female Cardiology and Cardiovascular Medicine business Intracardiac Electrogram Bipolar lead Aged Biomedical engineering Voltage |
| Zdroj: | Pacing and Clinical Electrophysiology. 26:221-224 |
| ISSN: | 1540-8159 0147-8389 |
| DOI: | 10.1046/j.1460-9592.2003.00020.x |
| Popis: | Beat-by-beat Autocapture maximizes device longevity by minimizing stimulus amplitude while assuring patient safety. Currently, Autocapture permits use of only bipolar leads. The authors have devised a detection method that operates with unipolar and bipolar leads and covers all pacing and sensing combinations (but bipolar pace and sense simultaneously). This new detection method for unipolar sensing uses the integral of the negative portion of the unipolar evoked response as a robust capture detection feature. When using bipolar leads, the method provides the flexibility of bipolar or unipolar pacing. In this study, unipolar ventricular intracardiac electrograms (EGMs) were recorded in 71 patients, 73.7 +/- 9.9 years of age; 9 with high polarization, 62 with low polarization. High polarization had polished platinum or activated carbon electrodes. Low polarization had TiN, platinized platinum, or IrOx electrodes. The intracardiac EGMs were recorded 544 +/- 796 days after implant. The pacemakers performed an automatic capture threshold test while the intracardiac EGM signals were recorded in a programmer. These digitized signals were saved for off-line analysis. The unipolar evoked response was calculated at up to six (depending on capture threshold) pacing voltages and the polarization integral at 4.5 V and at loss of capture. An automatic calibration algorithm determined if the signal-to-noise ratio was adequate for Autocapture operation. Autocapture was possible with 60 of 62 of the low polarizations, and with 6 of 9 of the high polarizations. The average values form the data collected were: average unipolar evoked response--4.1 +/- 2.1 mV, average peak negative voltage--10.0 +/- 3.7 mV, average polarization 0.3 +/- 0.34 mV, and average signal-to-noise ratio (unipolar evoked response/ polarization) 38 +/- 71. In all cases the algorithm correctly determined the appropriateness of using Autocapture with the electrodes tested and the unipolar evoked response threshold to be used. |
| Databáze: | OpenAIRE |
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