Journal Article

Automatic capture verification in ICD lead systems using intracardiac ventricular evoked response and reduced coupling capacitance

J. Sperzel, H. F. Pitschner, T. Schwarz, A. König, Q. Zhu and J. Neuzner

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 5, issue 1, pages 83-89
Published in print January 2003 | ISSN: 1099-5129
Published online January 2003 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.2002.0279
Automatic capture verification in ICD lead systems using intracardiac ventricular evoked response and reduced coupling capacitance

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Aim

Intracardiac ventricular evoked-response (ER) signals detected by implanted cardioverter defibrillator (ICD) lead systems were investigated for automatic capture verification (AC).

Method

ER signals were evaluated with an external pacing system equipped with a reduced coupling capacitance (CC=2·2 #x03BC;F) in the pacing output circuit during ventricular step-down threshold testing at 0·4 ms pulse duration. Real-time pacing markers, surface ECG and intracardiac electrograms pre- and post-filtering were digitally recorded.

Results

Twenty consecutive patients, age 61±12 years, with leads from two different manufacturers were tested — 10 were implanted with acute leads (AL) and 10 with chronic leads (CL). The analysis was based on the ER amplitude during capture and on the ER-to-afterpotential ratio (SAR), with SAR>2 as the criterion for successful capture detection. ER amplitudes (median and range) were 8·1 mV (2·1–19·5 mV) for AL and 8·3 mV (3·7–14·2 mV) for CL. SAR values (median and range) were 48·0 (2·5–682·6) for AL and 13·2 (6·3–35·9) for CL, indicating that AC could successfully be applied in all patients.

Conclusions

Reducing the pacing CC allows adequate ER detection for automatic capture verification on non-selected ICD lead systems. The effect of high-voltage shock treatment on ER signal detection requires further investigation.

Keywords: ICD; ventricular autocapture; evoked response; afterpotential

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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