From the Editor

I recently read “Actual Pacemaker Longevity: The Benefit of Stimulation by Automatic Capture Verification” (ACV) in the July 2010 issue of PACE.1 The manuscript reveals that control patients’ pacemakers were left at out-of-the-box 3.5-V atrial and ventricular outputs. In our center and many others, leaving pulse generators at manufacturer’s settings is neither standard nor recommended practice. For example, we have used leads with steroid-eluting iridium-oxide electrodes for over 15 years, and at the time of subsequent pulse generator replacement 6to >10year postimplant, voltage thresholds for both atrial and ventricular capture have typically been ≤0.6 V at pulse widths of 0.4 ms. Although occasionally indicated, very few of our over 1,000 patients are programmed to higher than 2.5-V outputs, and settings of ≤2.0 V (as low as 1.5 V in nondependent