A comprehensive review explores the challenges of left ventricular pacing automatic management, including capture confirmation technologies, pacing percentage overestimation, and ineffective CRT issues.
This review highlights the technical challenges and clinical implications of automatic left ventricular pacing threshold management in modern CRT systems, emphasizing that pacing counters may overestimate effective CRT delivery.
Modern cardiac resynchronization therapy (CRT) device-based threshold detection enables capture management and voltage output adjusting to combine consistent left ventricular (LV) pacing with acceptable battery drainage. The current technologies available for LV capture automatic confirmation in most cases require the evoked response, as well as "LV pace to right ventricular sense" algorithms. The LV pacing percentage counter may overestimate the CRT delivery which may be reduced due to pacing inhibition (by sensed LV activation) or inadequate capture due to subthreshold current or pacing into refractory tissue. Moreover, the LV threshold at implant and its behavior over time (as a marker of electrical viability) and the ineffective CRT issues (subthreshold stimulation or concealed loss of capture) are discussed. The purpose of the present review is to explore these new challenges regarding LV pacing automatic management.
Zoppo et al. (Tue,) conducted a review in Cardiac resynchronization therapy (CRT). Left ventricle automatic pacing threshold management was evaluated. A comprehensive review explores the challenges of left ventricular pacing automatic management, including capture confirmation technologies, pacing percentage overestimation, and ineffective CRT issues.