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Automated Left Ventricular Capture Management
Author(s) -
CROSSLEY GEORGE H.,
MEAD HARDWIN,
KLECKNER KAREN,
SHELDON TODD,
DAVENPORT LYNN,
HARSCH MANYA R.,
PARIKH PURVEE,
RAMZA BRIAN,
FISHEL ROBERT,
BAILEY J. RUSSELL
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00840.x
Subject(s) - medicine , cardiac resynchronization therapy , ventricle , cardiology , confidence interval , algorithm , heart failure , ejection fraction , computer science
Background:The stimulation thresholds of left ventricular (LV) leads tend to be less reliable than conventional leads. Cardiac resynchronization therapy (CRT) requires continuous capture of both ventricles.Objective:The purpose of this study is to evaluate a novel algorithm for the automatic measurement of the stimulation threshold of LV leads in cardiac resynchronization systems.Methods:We enrolled 134 patients from 18 centers who had existing CRT‐D systems. Software capable of automatically executing LV threshold measurements was downloaded into the random access memory (RAM) of the device. The threshold was measured by pacing in the left ventricle and analyzing the interventricular conduction sensed in the right ventricle. Automatic LV threshold measurements were collected and compared with manual LV threshold tests at each follow‐up visit and using a Holter monitor system that recorded both the surface electrocardiograph (ECG) and continuous telemetry from the device.Results:The proportion of Left Ventricular Capture Management (LVCM) in‐office threshold tests within one programming step of the manual threshold test was 99.7% (306/307) with a two‐sided 95% confidence interval of (98.2%, 100.0%). The algorithm measured the threshold successfully in 96% and 97% of patients after 1 and 3 months respectively. Holter monitor analysis in a subset of patients revealed accurate performance of the algorithm.Conclusion:This study demonstrated that the LVCM algorithm is safe, accurate, and highly reliable. LVCM worked with different types of leads and different lead locations. LVCM was demonstrated to be clinically equivalent to the manual LV threshold test. LVCM offers automatic measurement, output adaptation, and trends of the LV threshold and should result in improved ability to maintain LV capture without sacrificing device longevity.