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Acute Clinical Evaluation of a Left Ventricular Automatic Threshold Determination Algorithm Based on Evoked Response Sensing
Author(s) -
KALAHASTY GAUTHAM,
GIUDICI MICHAEL,
LOBBAN JOHN,
DOSHI RAHUL,
DELANEY COLLEEN,
SHOME SHIBAJI,
GOLD MICHAEL R.,
ELLENBOGEN KENNETH
Publication year - 2012
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.1540-8159.2011.03287.x
Subject(s) - medicine , cardiac resynchronization therapy , ventricle , gold standard (test) , cardiology , algorithm , detection threshold , heart failure , ejection fraction , mathematics , real time computing , computer science
Automatic pacing threshold (AT) testing may simplify device follow‐up and improve device longevity. This study's objective was to evaluate the performance of a left ventricular (LV) evoked response sensing‐based AT algorithm, for cardiac resynchronization therapy (CRT) devices.Methods:Patients scheduled for CRT‐D/P implant were enrolled. A manual step‐down threshold test and a Left Ventricular Automatic Threshold (LVAT) test in each of four pacing vectors—LVTip→Can, LVTip→right ventricle (RV),= LVRing→Can, and LVRing→RV—were conducted. Patients were randomized to either 0.4‐ms or 1.0‐ms pacing pulse width and in the manual and LVAT test order. A blinded core lab electrophysiologist (EP) determined the threshold using the surface electrocardiogram (gold standard).Results:Data from 70 patients were analyzed. Bipolar LV leads from three major manufacturers were used. A total of 273 AT tests were performed; 12 AT tests did not result in a threshold due to improper testing conditions. Of 261 eligible tests, 234 AT tests (89.6%) returned a threshold measurement. Of the 234 tests, in 233 tests (99.5%) the algorithm‐determined threshold matched the EP‐determined threshold for that test. A total of 16,689 capture and 526 noncapture beats were collected and the accuracy for detecting capture and noncapture were 98.5% and 99.7% with a two‐sided 95% confidence level of (98.4%, 98.7%) and (99.4%, 100%), respectively. No AT threshold measurement was lower than the EP‐determined threshold.Conclusion:In this study, the results suggest that the LVAT algorithm is accurate at determining pacing thresholds in multiple pacing configurations and a wide range of LV leads in CRT‐D/P patients. (PACE 2011;1–5)