Abstract
PURPOSE Permanent pacemakers implants with epicardial patch leads may give problems of high pacing threshold or threshold variability, often requiring a device programming with maximum energy output for adequate safety margin. An automatic capture algorithm, ensuring a “beat to beat” check of ventricular pacing threshold would be useful in these patients only if the signal characteristics of epicardial lead can warrant correct functioning of the system. These leads usually have lower impedance and lower sensing if compared to endocardial leads. METHODS One patient implanted with epicardial lead (Medtronic 4965) underwent pacemaker replacement and has been implanted with INSIGNIA pacemaker (GUIDANT Corp.) with automatic capture algorithm active. This algorithm is specifically designed for use with a wide range of polarization signals and with different lead types. RESULTS At 1 month follow up, daily data on ventricular threshold (T), impedance (I) and amplitude (A) were retrived from device diagnostics (T=1.3±0.3 V; I=320±10 . ; A=2.5±1.1 mV). Despite low amplitude signal and impedance, automatic capture detected correctly ventricular threshold during the whole follow up period. CONCLUSION Automatic capture algorithm may have a good opportunity of application in patients implanted with epicardial patches leads, allowing increased pacemaker lifetime and adequate pacing safety margin.
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