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This editorial refers to ‘Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators’ by F.D. Murgatroyd et al ., on page 811. Automatic measurement of pacing thresholds was first introduced more than a decade ago with the purpose of ensuring ventricular capture for safety purposes and of enabling automatic adjustment of outputs to relatively low values with low safety margins, thus extending longevity of the devices and allowing for less frequent clinic visits. Over several years, the only commercially available algorithms were those operating in the right ventricle (RV). They were all based on various algorithms of detection of evoked response in the RV (while filtering the lead polarization created by the pacing pulse), with stepwise decrease in the output to the point of non-capture (= no evoked response), thus enabling automatic determination of capture threshold. Subsequently, pacing output was automatically adjusted. Threshold determination is performed periodically (typically once or several times a day) or continuously (beat to beat). Recommended safety margins varied by algorithms ranging from output multiplied by 2 of automatically determined threshold to 0.3 V above thresholds depending on the specific manufacturer and algorithm.The effect on longevity varied between additional 50 and 100% of device longevity in devices with beat-to-beat measurements and 0.3 safety margin,1 to more modest results in other algorithms.2 Importantly, the algorithm that demonstrated the most favourable effects on longevity is still limited to specific ventricular lead …

Capture management in high-power devices: an important step forward or a new gadget?