Automatic atrial capture device control in real-life practice: A multicenter experience

Abstract Background Device-based fully automatic pacing capture detection is useful in clinical practice and important in the era of remote care management. The main objective of this study was to verify the effectiveness of the new ACAP Confirm® algorithm in managing atrial capture in the medium term in comparison with early post-implantation testing. Methods Data were collected from 318 patients (66% male; mean age, 73±10 years); 237 of these patients underwent device implantation and 81 box changes in 31 Italian hospitals. Atrial threshold measurements were taken manually and automatically at different pulse widths before discharge and during follow-up (7±2 months) examination. Results The algorithm worked as expected in 73% of cases, considering all performed tests. The success rate was 65% and 88% pre-discharge and during follow-up examination ( p Considering all examination types, manual and automatic measurements yielded threshold values of 1.07±0.47V and 1.03±0.47V at 0.2-ms pulse duration ( p =0.37); 0.66±0.37V and 0.67±0.36V at 0.4ms ( p =0.42); and 0.5±0.28V and 0.5±0.29V at 1ms ( p =0.32). Conclusions The results show that the algorithm works before discharge, and its reliability increases over the medium term. The algorithm also proved accurate in detecting the atrial threshold automatically. The possibility of activating it does not seem to be influenced by the lead type used, but by the time from implantation.