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Performance Evaluation of a Right Atrial Automatic Capture Verification Algorithm using Two Different Sensing Configurations
Author(s) -
SPERZEL JOHANNES,
GOETZE STEPHAN,
KENNERGREN CHARLES,
BIFFI MAURO,
BROOKE M. JASON,
VIRECA ELISA,
SAHA SUNIPA,
SCHUBERT BERND,
BUTTER CHRISTIAN
Publication year - 2009
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.1540-8159.2009.02330.x
Subject(s) - medicine , implantable cardioverter defibrillator , ring (chemistry) , electrode , cardiac resynchronization therapy , artifact (error) , cardiology , algorithm , biomedical engineering , heart failure , mathematics , artificial intelligence , ejection fraction , computer science , physics , chemistry , organic chemistry , quantum mechanics
Background: This acute data collection study evaluated the performance of a right atrial (RA) automatic capture verification (ACV) algorithm based on evoked response sensing from two electrode configurations during independent unipolar pacing.Methods: RA automatic threshold tests were conducted. Evoked response signals were simultaneously recorded between the RA Ring electrode and an empty pacemaker housing electrode (RA Ring →Can) and the electrically isolated Indifferent header electrode (RA Ring →Ind). The atrial evoked response (AER) and the performance of the ACV algorithm were evaluated off‐line using each sensing configuration. An accurate threshold measurement was defined as within 0.2 V of the unipolar threshold measured manually. Threshold tests were designed to fail for small AER (< 0.35 mV) or insufficient signal‐to‐artifact ratio (SAR < 2). Manual threshold measurements were obtained during RA unipolar and bipolar pacing and compared across device indications.Results: Data were collected from 38 patients with RA bipolar leads from four manufacturers. AER signals were analyzed from 34 patients who were indicated for a pacemaker (five), implantable cardioverter‐defibrillator (11), or cardiac resynchronization therapy pacemaker (six) or defibrillator (12). The minimum AER amplitude was larger (P < 0.0001) when recorded from RA Ring →Can (1.6 ± 0.9 mV) than from RA Ring →Ind (1.3 ± 0.8 mV). The algorithm successfully measured the pacing threshold in 96.8% and 91.0% of tests for RA Ring →Can and RA Ring →Ind, respectively. No statistical difference between the unipolar and bipolar pacing threshold was observed.Conclusions: The RA Ring →Can AER sensing configuration may provide a means of implementing an independent pacing/sensing method for ACV in the RA. RA bipolar pacing therapy based on measured RA unipolar pacing thresholds may be feasible.