title: Clinical validation of new pacing-sensing configurations for atrial automatic capture verification in pacemakers.
abstract: BACKGROUND
  This study evaluated an atrial automatic capture verification scheme based on atrial evoked response (AER). Atrial pacing was between Atip and Can (Atip-Can) using different coupling capacitances (CCs). Independent pairs of sensing electrodes between Aring and Vtip (Aring-Vtip) or between Aring and a separate indifferent electrode (Aring-Indiff) were used to reduce pacing-induced afterpotentials.
  
  
  RESULTS
  A custom-made external pacing system was used to perform automatic step-up and step-down pacing (0.1 to 7.1 V at 0.5 msec, step size of 0.1 V) using different CCs (2 or 15 microF). Intracardiac signals from Aring-Indiff and Aring-Vtip were independently recorded and analyzed both in real time and off-line to detect AER. Every paced beat also was visually inspected and compared with surface ECG to verify the captures. With the intracardiac signals properly filtered, AER detection was based on the signal within a window of 12 to 65 msec after the stimulus. Data from 27 patients (4 chronic and 23 acute implantations; age 65.6+/-13.9 years) were analyzed. Bipolar atrial lead measurements using a standard pacing system analyzer were as follows (mean +/- SD): impedance 695+/-227 ohms, P wave amplitude 4.2+/-2.3 mV, slew rate 1.1+/-0.9 V/sec, and pacing threshold at 0.5 msec 1.0+/-0.5 V. The results with CC = 2 microF showed that of 9,500 atrial paced beats, correct capture verification rates were 99.8% (Aring-Indiff) and 99.4% (Aring-Vtip). Similar results were achieved with CC = 15 microF (99.7% and 99.5%, respectively).
  
  
  CONCLUSIONS
  AER can be reliably detected using independent pacing (Atip-Can) and sensing (Aring-Vtip or Aring-Indiff) electrodes. Therefore, atrial automatic capture verification by AER detection is feasible.
authors.affiliation: Department of Cardiology, German Heart Institute Berlin & Charité. christain.butter@charite.de
authors.forename: C
authors.initials: C
authors.lastname: Butter
authors.forename: W M
authors.initials: WM
authors.lastname: Hartung
authors.forename: G N
authors.initials: GN
authors.lastname: Kay
authors.forename: R
authors.initials: R
authors.lastname: Willems
authors.forename: G
authors.initials: G
authors.lastname: Zhang
authors.forename: D J
authors.initials: DJ
authors.lastname: Lang
authors.forename: E
authors.initials: E
authors.lastname: Fleck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D004566:Electrodes; D022062:Electrophysiologic Techniques, Cardiac; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012684:Sensory Thresholds / Q000502:physiology*