Key result
The ventricular Autocapture algorithm increased estimated pacemaker longevity by 55-60% compared with standard output programming and reduced projected 10-year pacing-related costs by 42%.
Why the study?
Does the ventricular Autocapture algorithm improve estimated device longevity in patients with DDD-DDDR pacemakers?
RCT (n=83)
Randomized cross-over
Does the ventricular Autocapture algorithm improve estimated device longevity in patients with DDD-DDDR pacemakers?
The use of ventricular Autocapture in dual-chamber pacemakers substantially increases estimated generator longevity and reduces projected costs compared to standard programming.
May extend DDD pacemaker longevity and cut costs with Autocapture; leaves open randomized confirmation before practice change.
AIMS: 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. METHODS AND RESULTS: 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. CONCLUSION: 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.
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Boriani et al. (2006) conducted an RCT in Implanted with a DDD-DDDR pacemaker (n=83). Ventricular Autocapture algorithm vs. Standard output (3.5 V, 0.4 ms) and low output (2.5 V, 0.4 ms) programming was evaluated on Estimated device longevity. The ventricular Autocapture algorithm increased estimated pacemaker longevity by 55-60% compared with standard output programming and reduced projected 10-year pacing-related costs by 42%.
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