Actual pacemaker longevity: the benefit of stimulation by automatic capture verification

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Pacemaker longevity is crucial for patient well-being and healthcare economics.
• Fixed-output pacing (FOP) may not adapt to changing pacing needs, potentially impacting device longevity.

Purpose of the Study:

• To compare the long-term impact of automatic capture pacing (ACP) versus FOP on pacemaker longevity.
• To assess the safety and efficacy of ACP in a real-world clinical setting over a 9-year period.

Main Methods:

• A prospective observational study of 300 patients with VDDR/DDDR pacemakers, comparing 61 patients on ACP with 239 on FOP.
• Data collected included pacing parameters, heart rate, and patient outcomes over a median follow-up of 9 years.
• Patients were excluded if they died, were lost to follow-up, or developed permanent atrial fibrillation before pacemaker replacement.

Main Results:

• Pacemaker replacement occurred significantly less often in the ACP group (1/34) compared to the FOP group (60/92; P < 0.001).
• Automatic capture pacing was the sole independent predictor of pacemaker longevity (hazard ratio = 0.03, P < 0.001).
• No adverse clinical events related to increased right ventricular (RV) thresholds were observed in the ACP group, versus two in the FOP group.

Conclusions:

• Automatic verification of stimulation is a reliable long-term strategy, offering superior safety and significantly increasing pacemaker longevity compared to FOP.
• ACP can improve patient quality of life and reduce pacing therapy costs.
• ACP is a foundational technology for remote patient monitoring and automated device follow-up.