Influence Of Inter Electrode Atrial Lead Distance On Acapconfirm™ Viability

Introduction: The AcapConfirm™ feature available with the Zephyr pacemaker family (St. Jude Medical) is designed for monitoring patient's atrial capture threshold periodically, and automatically adjusting the atrial pulse amplitude. Previous studies showed a relative low proportion of patients at three months follow-up with recommended automatic atrial capture after the AcapConfirm™ viability test. The purpose of the present study is to evaluate the effect of inter electrode distance on the viability of the AcapConfirm™ algorithm. Methods and Results: 132 patients (66 woman and 86 men; 71, 08 ± 8, 04 years old) were enrolled into this prospective evaluation. Sixty six bipolar leads (models 1882 (54p) and LPA1200M (12p)) with an inter electrode distance of 10 mm (Group A) were compared with sixty six bipolar leads (model 1999) with an inter electrode distance of 1,1mm (Group B). Set-up test AcapConfirm viability and manual step-down atrial threshold test as well as automatic threshold testing by AcapConfirm™ were performed at 3 months after implantation. A positive viability of the AcapConfirm™ algorithm was much lower in Group B (37, 9%; 95% confidence interval, 10, 3% - 65, 4%) versus thirty two patients (48, 5%; 95% confidence interval, 20, 9% - 76%) in Group A. However, the difference was not statistically significant (χ2=1, 51; p=0, 33). The most frequent reason to reject the AcapConfirm activation was a too small evoked response to polarization ratio (N9).At 3 months, threshold results from the AcapConfirm™ positive test were: 0, 53 ± 0, 13 V in Group B versus 0, 67 ± 0, 18 V in Group A (p< 0, 01). The differences between automatic and manual measurements were ≤0.25V in all patients. Conclusion: We observed that a short inter electrode distance (1,1mm) is more likely correlated with a lower frequency of AcapConfirm™ viability and threshold that a standard inter electrode distance (10mm). A small evoked response to polarization ratio was the most common cause of a negative test of AcapConfirm™ viability.