Pacing technology: advances in pacing threshold management

Abstract

Over the last five decades, pacemaker therapy has undergone remarkable technological advances with increasing sophistication of pacemaker features. However, device longevity has remained one of the major issues in pacemaker design ever since the first endocardial pacing lead implantation in 1958. In addition to various hardware design to enhance device longevity, software-based solutions to minimize pacing energy and yet with good safety margin have also been developed. Together with desire and need of fully automatic pacing system in increasingly busy pacemaker clinic, several manufacturers have introduced different automatic threshold management algorithm. This article summarizes the current state-of-the-art management in pacing threshold in the modern pacemakers.

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References

  1. Clarke, M., Liu, B., Schüller, H., Binner, L., Kennergren, C., Guerola, M., Weinmann, P., Ohm, O.J., 1998. Automatic adjustment of pacemaker stimulation output correlated with continuously monitored capture thresholds: a multicenter study. European Microny Study Group. Pacing and Clinical Electrophysiology, 21(8):1567–1575. [doi:10.1111/j.1540-8159.1998.tb00244.x]

    CAS  Article  PubMed  Google Scholar 

  2. Curtis, A.B., Vance, F., Miller, K., 1991. Automatic reduction of stimulus polarization artifact for accurate evaluation of ventricular evoked responses. Pacing and Clinical Electrophysiology, 14(4 Pt 1):529–537. [doi:10.1111/j.1540-8159.1991.tb02825.x]

    CAS  Article  PubMed  Google Scholar 

  3. Gelvan, D., Crystal, E., Dokumaci, B., Goldshmid, Y., Ovsyshcher, I.E., 2003. Effect of modern pacing algorithms on generator longevity: a predictive analysis. Pacing and Clinical Electrophysiology, 26(9):1796–1802. [doi:10.1046/j.1460-9592.2003.t01-1-00272.x]

    Article  PubMed  Google Scholar 

  4. Guilleman, D., Bussillet, H., Scanu, P., Raguin, D., Aisenfarb, J.C., Bienvenu, P., Meunier, J.F., Canot, N., 1999. Output adjustment with the DDD pacemaker with automatic capture-control algorithm. Progress in Biomedical Research, 4:291–294.

    Google Scholar 

  5. Israel, C.W., Gascon, D., Nowak, B., Campanale, G., Pascotto, P., Hartung, W., Lellouche, D., Pulsar/Selute Picotip VDD Study Group, 2000. Diagnostic value of stored electrograms in single-lead VDD systems. Pacing and Clinical Electrophysiology, 23(11 Pt 2):1801–1803.

    CAS  PubMed  Google Scholar 

  6. Lau, C.P., Siu, C.W., 2010. Pacing Technology and Its Indications: Advances in Threshold Management, Automatic Mode Switching, and Sensors. In: Saksena, S., Camm, A.J., Boyden, P.A., Dorian, P., Goldschlager, N. (Eds.), Electrophysiological Disorders of the Heart. Elsevier/Churchill Livingstone, Philadelphia, USA.

    Google Scholar 

  7. Leung, S.K., Lau, C.P., Lam, C.T., Tse, H.F., Tang, M.O., Chung, F., Ayers, G., 1998. Programmed atrial sensitivity: a critical determinant in atrial fibrillation detection and optimal automatic mode switching. Pacing and Clinical Electrophysiology, 21(11 Pt 2):2214–2219. [doi:10.1111/j.1540-8159.1998.tb01155.x]

    CAS  Article  PubMed  Google Scholar 

  8. Love, C.J., Wilkoff, B.L., Hoggs, K.S., 1997. Incidence of mode switch in a general pacemaker population. Pacing and Clinical Electrophysiology, 20:1137.

    Google Scholar 

  9. Maisel, W.H., 2006. Pacemaker and ICD generator reliability: meta-analysis of device registries. The Journal of the American Medical Association, 295(16):1929–1934. [doi: 10.1001/jama.295.16.1929]

    CAS  Article  Google Scholar 

  10. Medtronic AT500 Technical Manual. Medtronic, Minn., USA. Novak, M., Kamaryt, P., Haeuser, T., Mach, P., 1999. Simplifying pacemaker follow-up using automatic threshold determination in ventricle. Progress in Biomedical Research, 4:287–290.

    Google Scholar 

  11. Ohm, O.J., Danilovic, D., 1997. Improvements in pacemaker energy consumption and functional capability: four decades of progress. Pacing and Clinical Electrophysiology, 20(1 Pt 1):2–9. [doi:10.1111/j.1540-8159.1997.tb04805.x]

    CAS  Article  PubMed  Google Scholar 

  12. Provenier, F., Germonpre, E., de Wagter, X., 2000. Improved differentiation of the ventricular evoked response from polarization by modification of the pacemaker impulse. Pacing and Clinical Electrophysiology, 23(12):2073–2077. [doi:10.1111/j.1540-8159.2000.tb00779.x]

    CAS  Article  PubMed  Google Scholar 

  13. Savelieva, I., Camm, A.J., 2000. Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. Journal of Interventional Cardiac Electrophysiology, 4(2):369–382. [doi:10.1023/A:1009823001707]

    CAS  Article  PubMed  Google Scholar 

  14. Schaldach, M., Hubmann, M., Weikl, A., Hardt, R., 1990. Sputter-deposited TiN electrode coatings for superior sensing and pacing performance. Pacing and Clinical Electrophysiology, 13(12 Pt 2):1891–1895. [doi:10.1111/j.1540-8159.1990.tb06911.x]

    CAS  Article  PubMed  Google Scholar 

  15. Schuchert, A., Ventura, R., Meinertz, T., 2000. Automatic threshold tracking activation without the intraoperative evaluation of the evoked response amplitude. AUTOCAP Investigators. Pacing and Clinical Electrophysiology, 23(3):321–324. [doi:10.1111/j.1540-8159.2000.tb06756.x]

    CAS  Article  PubMed  Google Scholar 

  16. Seidl, K., Meisel, E., Vanagt, E., Ottenhoff, F., Hess, M., Hauer, B., Zahn, R., Senges, J., 1998. Is the atrial high rate episode diagnostic feature reliable in detecting paroxysmal episodes of atrial tachyarrhythmias? Pacing and Clinical Electrophysiology, 21(4 Pt 1):694–700. [doi: 10.1111/j.1540-8159.1998.tb00125.x]

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Chu-pak Lau.

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Lau, Cp., Siu, Cw. Pacing technology: advances in pacing threshold management. J. Zhejiang Univ. Sci. B 11, 634–638 (2010). https://doi.org/10.1631/jzus.B1001016

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Key words

  • Pacemaker
  • Threshold management
  • Autocapture

CLC number

  • R54