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Pacemaker automatic functions


Authors: J. Lipoldová;  M. Novák
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny, Brno ;  as. MUDr. Miroslav Novák, CSc.
Published in: Kardiol Rev Int Med 2006, 8(4): 174-184
Category: Editorial

Overview

Early pacemakers were single-chamber, non-programmable, fixed rate devices. First automatic function was ability to sense intrinsic electrical activity. Nowadays the concept of „smart pacemaker“ is being created. That means general diagnostics, automatic optimization of pacing and arrhythmia treatment. Huge number of automatic functions for solving different problems and possible misinterpretation of heart rhythm is known till now. Pacemaker is no longer simple pulse generator but „monitor“ of heart rhythm and haemodynamic status and detector of incoming heart decompensation in patients with heart failure etc.

Pacemaker automatic functions (providing antibradycardia pacing and cardiac resynchronization therapy) were divided systematically to: control of pacemaker proper function (appropriate pacing and sensing, control of system integrity), functions for optimizing of pacemaker parameters (change of pacing rate, change of atrioventricular delay according to preference of intrinsic conduction or pacing, prevention and management of atrial tachyarrhythmias, prevention and management of pacemaker tachycardia, management of wrong sensing and oversensing) and diagnostic functions including storing of information about pacemaker activity and heart rhythm. The list of functions and algorithms is not complete and was not meant as summary of all possible functions. The aim is to put the reader into picture of pacemaker complexity.

Keywords:
pacemaker automatic functions, automatic capture, automatic sensitivity, sensor, hysteresis, hysteresis search, repetitive hysteresis, preference of intrinsic conduction, atrioventricular hysteresis, overdrive mode, atrial tachyarrhythmia prevention, mode switch, pacemaker tachycardia, endless loop tachycardia, pacemaker diagnostics functions


Sources

1. Saoudi N, Appl U, Anselme F et al. How smart should pacemakers be? Am J Cardiol 1999; 83(5B): 180D-186D.

2. Kam R. Automatic Capture Verification in Pacemakers (Autocapture). Indian Pacing Electrophysiol J 2004; 4(2): 73-78.

3. Luria D, Gurevitz O, Bar Lev D et al. Use of automatic threshold tracking function with non-low polarization leads: risk for algorithm malfunction. Pacing Clin Electrophysiol 2004 Apr; 27(4): 453-459.

4. Lau C, Nishimura SC, Yee Raymond, Lefeuvre C et al. Intraoperative Study of Polarization and Evoked response Signals in Different Endocardial Electrode Designs. PACE 2001; 24; 1055-1060.

5. Clarke M, Liu B, Schuller H et al. Automatic Adjustment of Pacemaker Stimulation Output Correlated with Continuously Monitored Capture Thresholds: A Multicentre Study. PACE 1998; 21: 1567-1575.

6. Schubert A, Ventura R, Meinertz T. Automatic Threshold Tracking Activation Without the Intraoperative Evaluation of the Evoked Response Amplitude. AUTOCAP Investigators. PACE 2000; 23: 321-324.

7. Kam R, Tan CS, Teo WS. Initial Experience with an Autocapture Pacemaker System. Ann. Acad Med Singapore 2000; 29: 732-734.

8. Ching L, Cameron DA, Nishimura SC et al. A Cardiac Evoked Response Algorithm Providing Threshold Tracking: A North American Multicentre Study. PACE 2000; 23: 953-959.

9. Chen R, Chen K, Wang F et al. Impact of automatic threshold capture on pulse generator longevity. Chin Med J 2006; 119(11): 925-929.

10. Boriani G, Rusconi L, Biffi M et al. Role of ventricular Autocapture function in increasing longevity of DDDR pacemakers: a prospective study. Europace 2006; 8(3): 216-220.

11. Marenco JP, Greenfield RA, Massumi A et al. Use of the AutoCapture Pacing System with implantable defibrillator leads. Pacing Clin Electrophysiol. 2003; 26(1 Pt 2): 471-473.

12. Biffi M, Boriani G, Bertini M, Silvestri P et al. Pacing with capture verification in candidates for resynchronisation therapy: A feasibility study. Europace 2005; 7: 255-265.

13. Curtis AB, Vance F, Wuist SM et al. A new algorithm for minimizing polarization artifact: universally applicable in permanent pacing systems. PACE 1991; 14: 1803-1808.

14. Sperzel J, Binner L, Boriani G et al. Evaluation of the atrial evoked response for capture detection with high-polarization leads. Pacing Clin Electrophysiol. 2005; 28(Suppl 1): 57-62.

15. Sperzel J, Milasinovic G, Smith TW et al. Automatic measurement of atrial pacing thresholds in dual-chamber pacemakers: clinical experience with atrial capture management. Heart Rhythm. 2005; 2(11): 1203-1210.

16. Biotronik GmbH & Co. KG. Lexos VR, VR-T, Lexos DR, DR-T, Lexos A+, A+/T. Technická příručka. S. 7.

17. Medtronic, Inc. EnRhytmTM P1501DR. Dvoudutinový kardiostimulátor s frekvenční odpovědí s telemetrií RapidReadTM (OAE-DDDR). Referenční příručka: S. 62.

18. Biotronik GmbH & Co. KG. Philos II. Technical Manual.:. 41.

19. Barold SS, Stroobandt RX, Sinnaeve AF. Cardiac Pacemakers Step by Step. New York: Blackwell Publishing 2004: 206-212.

20. Bonnet JL, Pioger G, Vai F. A physiological curvilinear minute ventilation vs heart rate relationship can be reproduced by a minute ventilation sensor driven pacemaker. PACE 1999; 22(6); 103.

21. Bonnet JL, Geroux L, Cazeau S. Evaluation of a dual sensor rate responsive pacing system based on a new concept. PACE 1998; 21(11); 2193-2203.

22. Occhetta E, Bortnik M, Audoglio R, Vassanelli C, INVASY Study Investigators. Closed loop stimulation in prevention of vasovagal syncope. Inotropy Controlled Pacing in Vasovagal Syncope (INVASY): a multicentre randomized, single blind, controlled study. Europace 2004; 6(6): 538-547.

23. Cron TA, Hilti P, Schächinger H, Pouskoulas CD et al. Rate Response of a Closed-Loop Stimulation Pacing System to Changing Preload and Afterload Conditions. PACE 2003; 26: 1504–1510.

24. Finch D et al. Protos CLS Emotional Response (ER) study. Biotronik Inc. 2004.

25. Puglisi A et al. Impact of Closed-Loop Stimuation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome. EHJ 2003; 24: 1952-1961.

26. Biotronik GmbH & Co. KG. Philos II. Technical Manual. s. 30.

27. Sweeney MO, Hellkamp AS, Ellenbogen KA et al; MOde Selection Trial Investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107(23): 2932-2937.

28. Wilkoff BL, Cook JR, Epstein AE et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI implantable defibrillator (DAVID) trial. JAMA 2002; 288: 3115–3123.

29. Lamas GA, Sweeney M, Leon A et al. The mode selection trial (MOST) in sinus node dysfunction: Design, rationale, and baseline characteristics of the first 1000 patients. Am Heart J 2000; 140: 541–551.

30. Lamas GA, Orav EJ, Stambler BS. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker selection in the elderly investigators. N Engl J Med 1998; 338: 1097–1104.

31. ClinicalTrials.gov. Beluga - Clinical Observations of Automatic Algorithms for Cardiac Pacing 2006. <http://www.clinicaltrial.gov/ct/show/NCT00286858;jsessionid=951BE6AE3800407B559C143971CDE1D3?order=20>

32. Savouré A, Fröhlig G, Galley D et al. A New Dual-Chamber Pacing Mode to Minimize Ventricular Pacing. PACE 2005; 28: 43.

33. Sweeney MO, Ellenbogen KA, Casavant D et al for The Marquis MVP Download Investigators. Multicenter, Prospective, Randomized Safety and Efficacy Study of a New Atrial-Based Managed Ventricular Pacing Mode (MVP) in Dual Chamber ICDs. J Cardiovasc Electrophysiol 2005; 16(8): 811-817.

34. Saksena S, Prakash A, Krol RB et al. Organized and reproducible atrial activation is present globally and regionally during phases of human atrial fibrillation [abstract]. J Am Coll Cardiol 2000; 35: 139.

35. Israel CW, Barold SS (eds). Advances in the Treatment of Atrial Tachyarrhythmias: Pacing, Cardioversion and Defibrillation. Armonk. New York: Futura Publishing Co 2002: 139-171.

36. Coumel P, Friocourt P, Mugica J et al. Long-term prevention of vagal atrial arrhythmias by atrial pacing at 90/minute: experience with 6 cases. PACE 1983; 6: 552–560.

37. Attuel P, Pellerin D, Mugica J et al. DDD pacing: an effective treatment modality for recurrent atrial arrhythmias. PACE 1988; 11: 1647–1654.

38. Carlson M, Ip J, Messenger J, Beau S et al. A New Pacemaker Algorithm for the Treatment of Atrial Fibrillation. Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol 2003; 42: 627–633.

39. Lee MA, Weachter R, Pollak S et al. The Effect of Atrial Pacing Therapies on Atrial Tachyarrhythmia Burden and Frequency. J Am Coll Cardiol 2003; 41:1926 –1932.

40. Camm AJ. AF therapy study: Preventive pacing for paroxysmal atrial fibrillation. (Abstract) Pacing Clin Electrophysiol 2002; 25: 125.

41. Lau C, Leung S, Tse HF, Barold S. Automatic mode switching of implantable pacemakers: I. Principles of instrumentation, clinical, and hemodynamic considerations. Pacing Clin Electrophysiol 2002; 25: 967-985.

42. Dulk K, Dijkman B, Wellens HJJ. Dual Chamber Pacemakers In Patients With Paroxysmal Atrial Fibrillation. HeartWeb 1996; 2(1): Article 96110041.

43. Passman RS, Weinberg KM, Freher M et al. Accuracy of Mode Switch Algorithms for Detection of Atrial Tachyarrhythmias. J Cardiovasc Electrophysiol 2004; 15(7): 773-777.

44. Pitney MR, Max CD, Davis MJ. Undesirable mode switching with a dual camber rate responsive pacemaker. PACE 1993; 16: 729-737.

45. Limousin M, Bonnet JL and the investigators of the multicenter study. A new algorithm to solve endless loop tachyardia in DDD pacing: A multi-center study in 91 patient. PACE 1990; 13: 1711-1718.

46. Fontaine JW, Maloney JD, Castle LW et al. Noninvasive assessment of ventriculoatrial conduction and early experience with the tachycardia termination algorithm in pacemaker-mediated tachycardia. PACE 1986; 9: 212.

47. Duncan JL, Clark MF. Prevention and termination of pacemaker-mediated tachycardia in a new DDD pacing system (Siemens-Pacesetter Model 2010T). PACE 1988; 11: 1679.

48. Cameron DA et al. Initial Cliical Experience with a New Automatic PMT Detection and Termination Algorithm to Discriminate Between Pacemaker Mediated Tachycardia Due to Ventriculo-atrial Conducrion and Normal Sinus Tachycardia. HeartWeb 1996; 2(1): Article 96110035.

49. Biotronik GmbH & Co. KG. Philos II. Technical Manual.:. 60.

50. Biotronik GmbH & Co. KG. Philos II. Technical Manual.:. 54.

51. Biotronik GmbH & Co. KG. Philos II. Technical Manual.:. 38.

52. Irnich W. Interference in pacemakers. PACE 1984; 7: 1021.

53. Cardiac Rhythm Management. Guidant pacemaker noise rejection feature to prevent inappropriate pacing inhibition due to cross-chamber sensing. Guidant Corp 2003; 33.

54. Nowak B. Taking Advantage of Sophisticated Pacemaker Diagnostics. Am J Cardiol 1999; 83: 172D-179D.

55. Charles R, Rauscha F, Waucquez JL et al. Storage of intracardiac electrograms in pacing systems: a new tool in arrhythmia diagnosis. Arch Mal Coeur 1998; 91: 230.

56. Nowak B, Middeldorf T, Housworth CM et al. Holter recordings with continuous marker annotations: a new tool in pacemaker diagnostics. PACE 1996; 19: 1791-1795.

57. Abraham WT, Foreman B, Fishel R et al. Fluid Accumulation Status Trial (FAST). Heart Rhythm 2005; (Suppl 2): S65. Abstract AB33-4.

58. Studie Mona Lisa (MONitoring of Arrhythmias and HRV in Patients With Heart Failure Treated With the CRT Pacemaker Renewal TR2) 2004. <http://www.clinicaltrials.gov/ct/show/NCT00180531>

59. Schuchert A, Brunekreeft W on behalf of T-STAR investigators. T-STAR interim results: Therapy Advisor for optimising the pacemaker AF therapy. Europace Supplements 2005; 7: 106.

60. Guidant Corp. Contak Renewal TR2 CRT-P. Models H145/H140. System Guide. Guidant 2003: 3/18-3/20.

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