Kam R M, Tan C S, Teo W S
Department of Cardiology, National Heart Centre, Singapore, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752.
Ann Acad Med Singap. 2000 Nov;29(6):732-4.
Autocapture management aims to extend pacemaker longevity without compromising on patient safety by automatically monitoring the pacing threshold and adjusting the pacemaker output for consistent capture. This paper describes our initial experience with the Pacesetter Regency pacemaker with autocapture management.
Nineteen patients were implanted with single chamber pacemakers with autocapture management. Autocapture was programmed "ON" the day after implantation if Evoked Response (ER) amplitude was at least 2.8 mV. The patients were followed up at 2 weeks, 2 months and 6 months. At each visit, pacing threshold and lead impedance were measured. Autocapture was turned "ON" during follow-up if it had not been done previously.
In 16 out of 19 patients, autocapture could be turned "ON" the day after implantation. One patient had an ER signal that was less than 2.8 mV and 2 patients were in fast atrial fibrillation of more than 120 beats per minute which precluded ER signal testing. These patients could not have autocapture programmed "ON".
The benefits of autocapture management can only be realised if an ER signal of at least 2.8 mV is obtained. This requires intraoperative testing of the ER signal. Since there is no commercially available pacing system analyser presently that can measure this, modification of the standard implantation procedure with some prolongation of procedure time is needed.
自动夺获管理旨在通过自动监测起搏阈值并调整起搏器输出以实现持续夺获，从而在不影响患者安全的前提下延长起搏器使用寿命。本文介绍了我们使用具备自动夺获管理功能的百盛丽晶起搏器的初步经验。
19例患者植入了具备自动夺获管理功能的单腔起搏器。如果诱发反应（ER）幅度至少为2.8mV，则在植入后的第二天将自动夺获功能编程为“开启”状态。对患者进行为期2周、2个月和6个月的随访。每次随访时，均测量起搏阈值和电极阻抗。如果之前未开启自动夺获功能，则在随访期间将其开启。
19例患者中有16例在植入后的第二天可开启自动夺获功能。1例患者的ER信号小于2.8mV，2例患者处于每分钟超过120次的快速心房颤动状态，这使得无法进行ER信号测试。这些患者无法将自动夺获功能编程为“开启”状态。
只有获得至少2.8mV的ER信号，才能实现自动夺获管理的益处。这需要在术中对ER信号进行测试。由于目前尚无市售的能够测量此信号的起搏系统分析仪，因此需要对标准植入程序进行修改，并适当延长手术时间。
