title: Effect of short pulse width programming in AutoCapture devices.
abstract: Pacing chronaxie can increase over time. The impact of a short pulse duration on threshold (THR) variations, frequency of noncapture episodes, and overall patient safety has not been fully studied. AutoCapture (AC) pacemakers are capable of memorizing THR trends and loss of capture (LOC) episodes. The study included 20 recipients of AC pacemakers (mean age = 76 +/- 9 years, 15 men) followed for 6 months. They were randomly assigned to pulse durations of 0.2 versus 1.0 ms at 1 month, and crossed over to the alternate programming at 3 months. Evoked response (ER) and AC tests were performed at follow-up. At 0.2 ms and 1.0 ms, the mean number of LOC/day was 2.37 +/- 5.81 and 0.91 +/- 0.49, respectively (ns). LOC trends between follow-up were significantly different with 0.2 versus 1.0 ms pulse duration (P < 0.01). AC THR at 1.0 ms was significantly lower (0.44 +/- 0.77) than at 2.0 ms (0.97 +/- 0.26, P < 0.05). No patient reported symptoms related to LOC during the study. Pulse duration programmed near the strength-duration curve is associated with greater variations in THR and LOC. AC responds to these changes by delivering 4.5 V pulses and keeping the capture THR at low, though safe values.
authors.affiliation: McGuire VAMC, Richmond, Virginia 23249, USA. laichow@yahoo.com
authors.forename: Lai Chow
authors.initials: LC
authors.lastname: Kok
authors.forename: George P
authors.initials: GP
authors.lastname: Hanna
authors.forename: Sheldon
authors.initials: S
authors.lastname: Brownstein
authors.forename: Michael
authors.initials: M
authors.lastname: Kim
authors.forename: Paul A
authors.initials: PA
authors.lastname: Levine
authors.forename: Pugazhendhi
authors.initials: P
authors.lastname: Vijayaraman
authors.forename: Andre
authors.initials: A
authors.lastname: Go
authors.forename: Zaffer A
authors.initials: ZA
authors.lastname: Syed
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors