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Capture Management™ in transvenously paced patients with congenital heart disease

Anatomische Reizschwellenerkennung mit Capture Management™ bei transvenös stimulierten Patienten mit angeborenem Herzfehler

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Summary

Automatic testing of the ventricular pacing threshold and adjustment of the pacing output are desirable properties of modern pacemakers designed to save energy, prolong battery lifetime and enhance pacing safety. The Medtronic Capture Management™ algorithm fulfills these criteria independently of lead polarity and lead polarization amplitude. Our initial experience in 38 paced patients with congenital heart disease with transvenous leads is reported. The age at pacemakerimplantation was 11.59 (2.72–63.7) years, follow-up after lead implantation was 1.49 (0.01–9.39) years and threshold voltage 0.5 (0.25–2.0) V at a pulse width of 0.4 (0.21–1.0) ms. The default limits of Capture Management™ were left unchanged initially and adjusted individually during follow-up. A correct adaptive Capture Management™ function was observed in all patients. Due to a high pacing threshold late deactivation was necessary in 1 patient.

Conclusion

In the complex and inhomogenous patient group with congenital heart disease the Capture Management™ algorithm allows safe adjustment of the pacing energy according to the actual pacing threshold using transvenous leads.

Zusammenfassung

Algorithmen zur automatischen Bestimmung der ventrikulären Reizschwelle mit konsekutiver Anpassung der Stimulationsenergie sind wünschenswerte Eigenschaften moderner Herzschrittmacher, um Energie zu sparen, die Batterielaufzeit zu verlängern und die Stimulationssicherheit zu erhöhen. Der Medtronic Capture Management™ Algorithmus erfüllt diese Kriterien unabhängig von der Polarität und dem Polarisationssignal der Elektroden. Es wird über unsere initiale Erfahrung bei 38 transvenös stimulierten Patienten mit einem angeborenen Herzfehler berichtet. Das Alter bei Schrittmacherimplantation betrug 11,59 (2,72–63,7) Jahre, das Follow-up nach Elektrodenimplantation war 1,49 (0,01–9,39) Jahre und die Reizschwelle wurde mit 0,5 (0,25–2,0) V bei einer Impulsbreite von 0,4 (0,21–1,0) ms bestimmt. Die einwandfreie adaptive Capture-Management™-Funktion konnte bei allen Patienten nachgewiesen werden. Wegen einer hohen Reizschwelle musste der Agorithmus nur bei einem Patienten spät deaktiviert werden.

Schlussfolgerung

Bei transvenös stimulierten Patienten mit angeborenem Herzfehler kann der Capture-Management™-Algorithmus die tägliche Überwachung der ventrikulären Reizschwelle mit konsekutiver Anpassung der Stimulationsenergie sicherstellen und dadurch die Stimulationssicherheit für diese komplexe und inhomogene Patientengruppe verbessern.

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Authors and Affiliations

  1. Dept. of Congenital Heart Defects/Pediatric Cardiology, Klinikum Links der Weser, Senator Weßling Str. 1, 28277, Bremen, Germany

    J.-H. Nürnberg

  2. German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    S. Ovroutski,  M. Yigitbasi,  M. Emeis,  B. Peters &  P. E. Lange

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  1. J.-H. Nürnberg
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  2. S. Ovroutski
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  3. M. Yigitbasi
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  4. M. Emeis
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  5. B. Peters
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  6. P. E. Lange
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Correspondence to J.-H. Nürnberg.

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Nürnberg, JH., Ovroutski, S., Yigitbasi, M. et al. Capture Management™ in transvenously paced patients with congenital heart disease. Z Herz- Thorax- Gefäßchir 19, 25–31 (2005). https://doi.org/10.1007/s00398-005-0484-2

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  • DOI: https://doi.org/10.1007/s00398-005-0484-2

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