Automatic management of atrial and ventricular stimulation in a contemporary unselected population of pacemaker recipients: the ESSENTIAL Registry.
OBJECTIVE
We investigated the applicability of the Ventricular Capture Control (VCC) and Atrial Capture Control (ACC) algorithms for automatic management of cardiac stimulation featured by Biotronik pacemakers in a broad, unselected population of pacemaker recipients.


RESULTS
Ventricular Capture Control and Atrial Capture Control were programmed to work at a maximum adapted output voltage as 4.8 V in consecutive recipients of Biotronik pacemakers. Ambulatory threshold measurements were made 1 and 12 months after pacemaker implant/replacement in all possible pacing/sensing configurations, and were compared with manual measurements. Among 542 patients aged 80 (73-85) years, 382 had a pacemaker implant and 160 a pacemaker replacement. Ventricular Capture Control could work at long term in 97% of patients irrespectively of pacing indication, lead type, and lead service life, performance being superior with discordant pacing/sensing configurations. Atrial Capture Control could work in 93% of patients at 4.8 V maximum adapted voltage and at any pulse width, regardless of pacing indication, lead type, and service life. At 12-month follow-up, a ventricular threshold increase ≥1.5 V had occurred in 4.4% of patients uneventfully owing to VCC functioning. Projected pacemaker longevity at 1 month was strongly correlated with the 12-month estimate, and exceeded 13 years in >60% of patients.


CONCLUSIONS
These algorithms for automatic management of pacing output ensure patient safety in the event of a huge increase of pacing threshold, while enabling maximization of battery longevity. Their applicability is quite broad in an unselected pacemaker population irrespectively of lead choice and service of life.
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy mauro.biffi@aosp.bo.it.
Mauro
M
Biffi
Arcispedale S. Anna-Cona, Università di Ferrara, Ferrara, Italy.
Matteo
M
Bertini
Ospedale degli Infermi, Rimini, Italy.
Davide
D
Saporito
Ospedale Treviglio-Caravaggio, Treviglio, Italy.
Giuseppina
G
Belotti
Ospedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
Fabio
F
Quartieri
Ospedale S. Maria delle Croci, Ravenna, Italy.
Maurizio
M
Piancastelli
Ospedale di Carrara, Carrara, Italy.
Angelo
A
Pucci
Ospedale di Bentivoglio, Bentivoglio, Italy.
Giulio
G
Boggian
Ospedale Civile, Cecina, Italy.
Gian Franco
GF
Mazzocca
Ospedale San Luca, Lucca, Italy.
Davide
D
Giorgi
Clinica Città di Alessandria, Alessandria, Italy.
Paolo
P
Diotallevi
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Igor
I
Diemberger
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Cristian
C
Martignani
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Stefano
S
Pancaldi
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Matteo
M
Ziacchi
Arcispedale S. Anna-Cona, Università di Ferrara, Ferrara, Italy.
Lina
L
Marcantoni
Arcispedale S. Anna-Cona, Università di Ferrara, Ferrara, Italy.
Tiziano
T
Toselli
Ospedale degli Infermi, Rimini, Italy.
Simone
S
Attala
Ospedale Treviglio-Caravaggio, Treviglio, Italy.
Matteo
M
Iori
Ospedale Treviglio-Caravaggio, Treviglio, Italy.
Nicola
N
Bottoni
Ospedale S. Maria delle Croci, Ravenna, Italy.
Selina
S
Argnani
Ospedale S. Maria delle Croci, Ravenna, Italy.
Corrado
C
Tomasi
Ospedale di Bentivoglio, Bentivoglio, Italy.
Biagio
B
Sassone
Policlinico S. Orsola-Malpighi, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Giuseppe
G
Boriani
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D020878:Device Removal; D011211:Electric Power Supplies; D004869:Equipment Safety; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D012042:Registries; D013997:Time Factors; D016276:Ventricular Function
Automatic verification of capture; High pacing threshold; Pacemaker longevity; Safety