Pacing with capture verification in candidates for resynchronisation therapy: a feasibility study.

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Cardiac resynchronisation therapy (CRT) devices use multiple output channels, increasing energy consumption and reducing longevity.
• Autocapture technology has previously improved pacemaker longevity and safety in right ventricular pacing.
• Investigating Autocapture in biventricular pacing (BIV) aims to reduce the energy demands of CRT.

Purpose of the Study:

• To assess the feasibility and safety of applying Autocapture during biventricular pacing (BIV).
• To determine if Autocapture can reduce the energy cost of CRT.
• To evaluate the accuracy of evoked response (ER) detection during BIV pacing.

Main Methods:

• An acute study during BIV device implantation tested ER detection on the ventricular channel paced second.
• The study compared ER amplitudes during BIV pacing versus single-ventricle pacing (VVI mode).
• Long-term Autocapture performance was monitored by tracking RV thresholds over 20 months.

Main Results:

• Evoked response (ER) amplitudes in both ventricles were not significantly reduced during BIV pacing compared to VVI pacing.
• Autocapture successfully verified capture on the RV channel during BIV pacing, even with LV depolarization.
• Long-term monitoring showed consistent Autocapture performance without sensing LV depolarization as an ER on the RV channel.

Conclusions:

• Capture verification using Autocapture on the secondarily paced ventricular channel during BIV pacing is feasible and safe.
• This method has the potential to increase the longevity of CRT devices.
• Implementing Autocapture in BIV pacing may lead to reduced healthcare costs for heart failure patients.