Compatibility of automatic threshold tracking pacemakers with previously implanted pacing leads in children.

Abstract

The Autocapture function controls and optimizes the amplitude of the pacing pulse and saves energy. The manufacturer recommends using a special low polarization, low threshold bipolar Pacesetter lead for the Autocapture function. The purpose of this study was to evaluate the compatibility of Autocapture with previously implanted pacing leads. The study included 15 patients (mean age 13.6 +/- 3.4 years) who needed pulse generator replacement and received the VVIR pacemaker Regency SR+ or the DDDR pacemakers Affinity DR or Integrity DR with the Autocapture function. The new pulse generators connected to previously implanted ventricular leads. At the time of implantation the pacing threshold was 1.0 +/- 0.35 V at 0.5 ms, the lead impedance was 580 +/- 80 omega, and the spontaneous R wave amplitude was 7.89 +/- 4.89 mV. The polarization signal (PS) was 3.8 +/- 3.04 mV, and evoked response (ER) was 8.15 +/- 4.57 mV at the predischarge testing. Follow-up telemetry was done at months 1, 3, 6, 12, and 18. The follow-up duration was 9.4 +/- 5 months (range 1-18 months). If the results of PS and ER measurements were acceptable for autocapture, it turned on at the 1-month visit. In six (40%) patients the results were found acceptable for autocapture function. Age, lead impedance, pacing threshold, intrinsic R wave measurement, lead age, fixation mechanism, and ER measurements were not statistically different in Autocapture suitable and not suitable groups. The main reason not to activate Autocapture had been increased PS. Any significant fluctuations were not observed in pacing threshold, lead impedance, ER, and PS during follow-up. In conclusion, previously implanted pacing leads may be compatible with the Autocapture function.