Ventricular pacing threshold variations in the young

Massimo Stefano Silvetti, Antonella De Santis, Nicoletta Grovale, Giorgia Grutter, Andrea Baccarini, Fabrizio Drago

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)175-181
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume30
Issue number2
DOIs
Publication statusPublished - Feb 2007

Fingerprint

Congenital Heart Defects
Sick Sinus Syndrome
Atrioventricular Node
Atrioventricular Block
Multivariate Analysis
Age Groups
Heart Rate
Pediatrics

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 journalArticle

Silvetti, Massimo Stefano ; De Santis, Antonella ; Grovale, Nicoletta ; Grutter, Giorgia ; Baccarini, Andrea ; Drago, Fabrizio. / Ventricular pacing threshold variations in the young. In: PACE - Pacing and Clinical Electrophysiology. 2007 ; Vol. 30, No. 2. pp. 175-181.
@article{a96773345d4f480eb0b98ae7da3523dc,
title = "Ventricular pacing threshold variations in the young",
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.",
keywords = "Cardiac pacing, Circadian variation, Endocardial pacing, Epicardial pacing, Pediatric age, Ventricular threshold",
author = "Silvetti, {Massimo Stefano} and {De Santis}, Antonella and Nicoletta Grovale and Giorgia Grutter and Andrea Baccarini and Fabrizio Drago",
year = "2007",
month = "2",
doi = "10.1111/j.1540-8159.2007.00646.x",
language = "English",
volume = "30",
pages = "175--181",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "2",

}

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 -