Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators.
OBJECTIVE
The Secura ICD and Consulta CRT-D are the first defibrillators to have automatic right atrial (RA), right ventricular (RV), and left ventricular (LV) capture management (CM). Complete CM was evaluated in an implantable cardioverter defibrillator (ICD) population.


RESULTS
Two prospective clinical studies were conducted in 28 centres in Europe and Israel. Automatic CM data were compared with manual threshold measurements, the CM applicability was determined, and adjustments to pacing outputs were analysed. In total, 160 patients [age 64.6 +/- 10.4 years, 77% male, 80 ICD and 80 cardiac resynchronization therapy defibrillator (CRT-D)] were included. The differences between automatic and manual measurements were </=0.25 V in 97% (RA CM) and 96% (RV CM) and were all within the safety margin. Fully automatic CM measurements were available within 1 week prior to the 3-month visit in 90% (RA), 99% (RV), and 97% (LV) of the patients. Results indicated increased output (threshold >2.5 V) due to raised RA threshold in seven (4.4%), high RV threshold in nine (5.6%), and high LV threshold in three patients (3.8%). All high threshold detections and all automatic modulations of pacing output were adjudicated appropriate.


CONCLUSIONS
Complete CM adjusts pacing output appropriately, permitting a reduction in office visits while it may maximize device longevity. The study was registered at ClinicalTrials.gov identifiers: NCT00526227 and NCT00526162.
Kings College Hospital, Cardiac Catheter Suite, Level 1, Denmark Hill, SE5 9RS London, UK. francis@sinusrhythm.com
Francis D
FD
Murgatroyd
Erhard
E
Helmling
Bernd
B
Lemke
Bernd
B
Eber
Christian
C
Mewis
Judith
J
van der Meer-Hensgens
Yanping
Y
Chang
Vladimir
V
Khalameizer
Amos
A
Katz
D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D011211:Electric Power Supplies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006329:Heart Conduction System / Q000502:physiology*; D006339:Heart Rate; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome