Capture management efficacy in children and young adults with endocardial and unipolar epicardial systems.
OBJECTIVE
This prospective study characterized performance of the Kappa 700 Ventricular Capture Management trade mark (VCM) system for monitoring ventricular pacing threshold and adapting outputs in both endocardial and unipolar epicardial pacing systems in children and young adults. VCM bears cautionary labelling against use with epicardial leads since they have not been demonstrated appropriate for use with VCM.


RESULTS
VCM was programmed in "Monitor Only" mode. Ventricular pacemaker thresholds were measured daily using VCM for a minimum of 2 months. Potential device longevities at nominal outputs (3.5 V, 1.0 ms) and at VCM-recommended outputs were compared. Thirty patients (median age 14.4 years (1-27 years); 15 epicardial/15 endocardial) completed the study. During the daily measurements, consistent undersensed evoked response occurred in 2 patients (Medtronic epicardial leads 4965). For the other 28 patients, programming VCM in "Adaptive" mode from implant would provide an additional 6.8 months (0-19 months) of battery life.


CONCLUSIONS
Although not an IDE (Investigation Device Exemption) study, this study showed acceptable VCM performance in "Monitor Only" mode in 13/15 patients with unipolar epicardial leads. A 2-month "Monitor Only" observation period helps screen patients who might not benefit from VCM. VCM may provide substantial energy savings and extended battery life for children and young adults.
Cohen
Mitchell I
MI
Department of Pediatrics and the Division of Pediatric Cardiology at The University of Pennsylvania School of Medicine, USA. mitchell_cohen@pediatrix.com
Buck
Karen
K
Tanel
Ronn E
RE
Vetter
Victoria L
VL
Rhodes
Larry A
LA
Cox
James
J
Sheldon
Todd
T
Ruetz
Linda
L
D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D004567:Electrodes, Implanted; D004699:Endocardium; D019544:Equipment Failure Analysis; D005260:Female; D006327:Heart Block / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D011446:Prospective Studies; D015203:Reproducibility of Results