Abstract
Ventricular Capture Management™ (VCM) is a Medtronic Kappa pacemakers (PM) feature that automatically measures pacing threshold through detection of the evoked response after a pacing stimulus. The aim of this study was to evaluate the range of variation of ventricular pacing threshold in pediatric patients with endocardial and epicardial pacing leads. Thirty-one patients (median age 6.5 years) were implanted with a Kappa 901 PM for atrioventricular block or sinus node dysfunction. Congenital heart defects (CHD) were present in 58% of patients. Ventricular leads were epicardial in 52% of patients. VCM was programmed to automatically measure threshold every 2 hours. In a median follow-up of 12 months, 27,110 threshold measurements, 72% of which were successful, have been taken in 94% of patients. Measurement success was 99% in the endocardial leads group (age at implantation 12 ± 6 years) and 31% in epicardial leads (age 4 ± 5 years) (P <0.05). Main reasons for unsuccessful measurements were high heart rate and, in a patient with an endocardial lead, competition with intrinsic rhythm. Undersensing or oversensing of the evoked responses was not detected. In all successful VCM measurements, epicardial pacing and CHD contributed to stability of thresholds (multivariate analysis). Pacing threshold showed specific circadian patterns: higher thresholds were found between 00.00 and 06.00 a.m., but the variation was low, 0.03 ± 0.01 V. In conclusion, children and young patients show stable ventricular thresholds, especially in presence of CHD, and epicardial leads are at least as stable as endocardial leads. Ventricular pacing threshold showed a circadian variability similar to that described in adults, that does not seem to influence VCM functioning and PM programming.
| Original language | English |
|---|---|
| Pages (from-to) | 175-181 |
| Number of pages | 7 |
| Journal | PACE - Pacing and Clinical Electrophysiology |
| Volume | 30 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2007 |
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Keywords
- Cardiac pacing
- Circadian variation
- Endocardial pacing
- Epicardial pacing
- Pediatric age
- Ventricular threshold
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Ventricular pacing threshold variations in the young. / Silvetti, Massimo Stefano; De Santis, Antonella; Grovale, Nicoletta; Grutter, Giorgia; Baccarini, Andrea; Drago, Fabrizio.
In: PACE - Pacing and Clinical Electrophysiology, Vol. 30, No. 2, 02.2007, p. 175-181.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ventricular pacing threshold variations in the young
AU - Silvetti, Massimo Stefano
AU - De Santis, Antonella
AU - Grovale, Nicoletta
AU - Grutter, Giorgia
AU - Baccarini, Andrea
AU - Drago, Fabrizio
PY - 2007/2
Y1 - 2007/2
N2 - Ventricular Capture Management™ (VCM) is a Medtronic Kappa pacemakers (PM) feature that automatically measures pacing threshold through detection of the evoked response after a pacing stimulus. The aim of this study was to evaluate the range of variation of ventricular pacing threshold in pediatric patients with endocardial and epicardial pacing leads. Thirty-one patients (median age 6.5 years) were implanted with a Kappa 901 PM for atrioventricular block or sinus node dysfunction. Congenital heart defects (CHD) were present in 58% of patients. Ventricular leads were epicardial in 52% of patients. VCM was programmed to automatically measure threshold every 2 hours. In a median follow-up of 12 months, 27,110 threshold measurements, 72% of which were successful, have been taken in 94% of patients. Measurement success was 99% in the endocardial leads group (age at implantation 12 ± 6 years) and 31% in epicardial leads (age 4 ± 5 years) (P <0.05). Main reasons for unsuccessful measurements were high heart rate and, in a patient with an endocardial lead, competition with intrinsic rhythm. Undersensing or oversensing of the evoked responses was not detected. In all successful VCM measurements, epicardial pacing and CHD contributed to stability of thresholds (multivariate analysis). Pacing threshold showed specific circadian patterns: higher thresholds were found between 00.00 and 06.00 a.m., but the variation was low, 0.03 ± 0.01 V. In conclusion, children and young patients show stable ventricular thresholds, especially in presence of CHD, and epicardial leads are at least as stable as endocardial leads. Ventricular pacing threshold showed a circadian variability similar to that described in adults, that does not seem to influence VCM functioning and PM programming.
AB - Ventricular Capture Management™ (VCM) is a Medtronic Kappa pacemakers (PM) feature that automatically measures pacing threshold through detection of the evoked response after a pacing stimulus. The aim of this study was to evaluate the range of variation of ventricular pacing threshold in pediatric patients with endocardial and epicardial pacing leads. Thirty-one patients (median age 6.5 years) were implanted with a Kappa 901 PM for atrioventricular block or sinus node dysfunction. Congenital heart defects (CHD) were present in 58% of patients. Ventricular leads were epicardial in 52% of patients. VCM was programmed to automatically measure threshold every 2 hours. In a median follow-up of 12 months, 27,110 threshold measurements, 72% of which were successful, have been taken in 94% of patients. Measurement success was 99% in the endocardial leads group (age at implantation 12 ± 6 years) and 31% in epicardial leads (age 4 ± 5 years) (P <0.05). Main reasons for unsuccessful measurements were high heart rate and, in a patient with an endocardial lead, competition with intrinsic rhythm. Undersensing or oversensing of the evoked responses was not detected. In all successful VCM measurements, epicardial pacing and CHD contributed to stability of thresholds (multivariate analysis). Pacing threshold showed specific circadian patterns: higher thresholds were found between 00.00 and 06.00 a.m., but the variation was low, 0.03 ± 0.01 V. In conclusion, children and young patients show stable ventricular thresholds, especially in presence of CHD, and epicardial leads are at least as stable as endocardial leads. Ventricular pacing threshold showed a circadian variability similar to that described in adults, that does not seem to influence VCM functioning and PM programming.
KW - Cardiac pacing
KW - Circadian variation
KW - Endocardial pacing
KW - Epicardial pacing
KW - Pediatric age
KW - Ventricular threshold
UR - http://www.scopus.com/inward/record.url?scp=33847352554&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33847352554&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.2007.00646.x
DO - 10.1111/j.1540-8159.2007.00646.x
M3 - Article
C2 - 17338712
AN - SCOPUS:33847352554
VL - 30
SP - 175
EP - 181
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 2
ER -