Schuchert A, Ventura R, Meinertz T
Medical Clinic, Department of Cardiology, University-Hospital Eppendorf, Hamburg, Germany.
Pacing Clin Electrophysiol. 1999 Oct;22(10):1476-80. doi: 10.1111/j.1540-8159.1999.tb00351.x.
The Autocapture function controls and optimizes the output of the ventricular pulse amplitude automatically. For this reason an automatic test has to be performed during follow-up to measure the evoked response signal and lead polarization for the calculation of the appropriate evoked response sensitivity setting. The aim of the study was to assess whether body position and exercise influence the evoked response and polarization. Both parameters were determined in the supine and upright position and subsequently during supine and upright symptom-limited ergometry. The study included 14 patients with the VVIR pacemaker Regency SR+ who had received the ventricular pacing leads Membrane E 1450 T (n = 8), CapSure Z 5034 (n = 4), or SX 60 (n = 2). The evoked response signal was 7.4 +/- 3.3 mV during supine and increased to 9.7 +/- 5.6 mV (+35%) during upright position (P < 0.05). The exercise tests were terminated at 105 +/- 36 W (supine) and 110 +/- 34 W (upright). There was a gradual insignificant decrease of the evoked response during each exercise test with a mean decrease of -1.1 +/- 0.9 mV (-15%; supine) and -1.6 +/- 2.1 mV (-16%; upright). The evoked response increased within 5 minutes during recovery to the initial values. Polarization remained unchanged during both tests. The pacemaker did not recommend activating autocapture in four patients who all had received high-ohmic pacing leads. In conclusions, the measurement of the evoked response in supine position seems to represent the worst case. Physical activities did not effect autocapture function in patients with the recommended lead, but the pacemaker did not always recommend Autocapture activation in some patients with high-ohmic pacing leads.
自动捕捉功能可自动控制并优化心室脉冲幅度的输出。因此，在随访期间必须进行自动测试，以测量诱发反应信号和导联极化，从而计算出合适的诱发反应灵敏度设置。本研究的目的是评估体位和运动是否会影响诱发反应和极化。在仰卧位和直立位以及随后的仰卧位和直立位症状限制性运动试验中测定这两个参数。该研究纳入了14例植入VVIR起搏器Regency SR+的患者，他们分别植入了心室起搏导线Membrane E 1450 T（n = 8）、CapSure Z 5034（n = 4）或SX 60（n = 2）。仰卧位时诱发反应信号为7.4±3.3 mV，直立位时增加到9.7±5.6 mV（增加35%）（P < 0.05）。运动试验在105±36 W（仰卧位）和110±34 W（直立位）时终止。在每次运动试验期间，诱发反应逐渐出现不显著下降，仰卧位平均下降-1.1±0.9 mV（-15%），直立位平均下降-1.6±2.1 mV（-16%）。恢复过程中，诱发反应在5分钟内恢复到初始值。两次测试期间极化均保持不变。4例均植入高阻抗起搏导线的患者，起搏器未建议激活自动捕捉功能。总之，仰卧位时诱发反应的测量似乎代表了最坏的情况。对于植入推荐导线的患者，体力活动并未影响自动捕捉功能，但对于一些植入高阻抗起搏导线的患者，起搏器并不总是建议激活自动捕捉功能。
