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Left ventricle automatic pacing threshold management in CRT systems: A comprehensive review
Author(s) -
Zoppo Franco,
Gagno Giulia
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14630
Subject(s) - medicine , cardiac resynchronization therapy , ventricle , subthreshold conduction , ventricular pacing , cardiology , implant , cardiac pacing , refractory (planetary science) , heart failure , ejection fraction , voltage , surgery , electrical engineering , transistor , engineering , physics , astrobiology
Modern cardiac resynchronization therapy (CRT) device‐based threshold detection enables capture management and voltage output adjusting to combine consistent left ventricular (LV) pacing with acceptable battery drainage. The current technologies available for LV capture automatic confirmation in most cases require the evoked response, as well as “LV pace to right ventricular sense” algorithms. The LV pacing percentage counter may overestimate the CRT delivery which may be reduced due to pacing inhibition (by sensed LV activation) or inadequate capture due to subthreshold current or pacing into refractory tissue. Moreover, the LV threshold at implant and its behavior over time (as a marker of electrical viability) and the ineffective CRT issues (subthreshold stimulation or concealed loss of capture) are discussed. The purpose of the present review is to explore these new challenges regarding LV pacing automatic management.