Boriani Giuseppe, Rusconi Luigi, Biffi Mauro, Pavia Letterio, Sassara Massimo, Malfitano Dario, Bongiorni Maria Grazia, Padeletti Luigi, Filice Ignazio, Sanfelici Daniela, Maffei Pietro, Vicentini Alfredo, Branzi Angelo
Institute of Cardiology, University of Bologna, Azienda Ospedaliera Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138 Bologna, Italy.
Europace. 2006 Mar;8(3):216-20. doi: 10.1093/europace/euj027. Epub 2006 Feb 10.
Autocapture is an algorithm for automatic adaptation of ventricular output to capture threshold. The aim of this prospective study was to estimate the effects of ventricular Autocapture algorithm on DDD-DDDR pacemaker longevity.
Eighty-three patients implanted with a DDD-DDDR pacemaker (Affinity or Entity; St Jude Medical, USA) were enrolled and the Autocapture function was activated pre-discharge. Ventricular pulse duration was randomly programmed at 0.3 or 0.4 ms, with a cross-over at 8-12 weeks and again at 13-14 months. Diagnostic data were retrieved from device memory and by calculating battery current drain from long-term threshold recordings; device longevity was estimated at the following settings: Autocapture with a pulse duration of 0.3 and 0.4 ms, respectively, standard output (3.5 V, 0.4 ms) and conventional low output programming (2.5 V, 0.4 ms). According to a series of assumptions, Autocapture was associated with a 55-60% increase in estimated device longevity compared with standard output programming and a 6-7% increase in longevity compared with low output programming. No significant differences were found between Autocapture programmed with a pulse duration of 0.3 or 0.4 ms. In projections to a 10-year follow-up, use of the Autocapture function resulted in a 42% reduction in pacing-related estimated costs compared with standard output programming at 3.5 V, 0.4 ms.
Pacing with constant adaptation of ventricular output in dual-chamber devices has the potential to increase generator longevity and to reduce sizeably pacing-related costs compared with standard programming.
自动夺获是一种使心室输出自动适应夺获阈值的算法。本前瞻性研究的目的是评估心室自动夺获算法对DDD-DDDR起搏器使用寿命的影响。
纳入83例植入DDD-DDDR起搏器（Affinity或Entity；美国圣犹达医疗公司）的患者，在出院前激活自动夺获功能。心室脉冲宽度随机设定为0.3或0.4 ms，在8-12周时交叉，13-14个月时再次交叉。从设备内存中检索诊断数据，并通过计算长期阈值记录中的电池电流消耗；在以下设置下估计设备使用寿命：分别采用0.3和0.4 ms脉冲宽度的自动夺获、标准输出（3.5 V，0.4 ms）和传统低输出编程（2.5 V，0.4 ms）。根据一系列假设，与标准输出编程相比，自动夺获使估计的设备使用寿命增加55%-60%，与低输出编程相比，使用寿命增加6%-7%。采用0.3或0.4 ms脉冲宽度编程的自动夺获之间未发现显著差异。在预测的10年随访中，与3.5 V、0.4 ms的标准输出编程相比，使用自动夺获功能使起搏相关的估计成本降低了42%。
与标准编程相比，双腔设备中持续调整心室输出进行起搏有可能延长发生器使用寿命并大幅降低起搏相关成本。
