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Automatic atrial threshold measurement and adjustment in pediatric patients
Anita Hiippala1, Gerald A Serwer, Eva Clausson
1Pediatric Cardiology, Hospital for Children and Adolescents, Helsinki University Hospital, Helsinki, Finland.
Pacing and Clinical Electrophysiology : PACE
|December 4, 2009
Summary
Atrial Capture Management (ACM) reliably measures pacemaker atrial thresholds in pediatric patients, including those with epicardial leads. High intrinsic atrial rates may occasionally prevent automatic threshold measurement.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Modern pacemakers utilize automatic threshold measurement and output adjustment as default settings.
- Assessing Atrial Capture Management (ACM) functionality is crucial for optimizing pacemaker performance in pediatric populations.
Purpose of the Study:
- To evaluate the accuracy and reliability of Medtronic's Atrial Capture Management (ACM) system in pediatric patients.
- To compare ACM-derived atrial thresholds with manually determined values.
Main Methods:
- A cohort of 40 pediatric patients (median age 9.8 years) with various congenital heart defects and pacing indications were enrolled.
- Both endocardial and epicardial atrial leads were included, with 45% of patients having epicardial leads.
- Atrial thresholds were measured manually and compared with those obtained via ACM.
Main Results:
- ACM measurements demonstrated expected variation in 93% of patients (37/40).
- Mean atrial thresholds showed no significant difference between manual and ACM measurements (0.69 V vs. 0.68 V, P = 0.52).
- No atrial arrhythmias were observed as a complication of ACM measurements.
Conclusions:
- Atrial Capture Management (ACM) provides reliable atrial threshold measurements in pediatric patients, irrespective of lead type (endocardial or epicardial).
- ACM can be safely implemented in pediatric pacemaker management.
- High intrinsic atrial rates can interfere with ACM's ability to measure thresholds in some young patients.
