Atrial Capture Management Flashcards
When is ACM enabled in a pacemaker or CRT-P?
When implant detection is completed.
When is ACM enabled in a ICD/CRT-D?
When detection is turned on.
What are the programming options for ACM?
“Off,” “Adaptive” (nominal), “Monitor Only”
In what modes does ACM operate?
DDD or DDDR
Does ACM work during MVP mode?
Yes, but the device changes to DDD or DDDR while ACM is functioning.
How is “Adaptive” different from “Monitor Only”?
Outputs are changed only when the device is in “Adaptive” mode.
What programming parameters are available within ACM?
Amplitude Margin, Minimum Adapted Amplitude, Capture Test Frequency, Acute Phase Days Remaining
What is the Amplitude Margin?
Safety margin applied to threshold results for amplitude.
What is the Minimum Adapted Amplitude?
The lowest voltage to which the output may be set by ACM.
What are the Acute Phase Days Remaining?
Number of days where the outputs may be adjusted up or down, but not below programmed output.
Where is ACM found?
Params>Pacing>Atrial Amplitude
What are the “Additional Parameters” for ACM?
Capture Test Frequency, Capture Test Time, Acute Phase Days Remaining, Sensing During Search
What are the highest outputs capture management will program?
5.0V@1.0ms
To what mode must the device be programmed in order to utilize ACM?
DDD, DDDR, AAI>DDD, AAIR>DDDR
Can epi leads be used with ACM?
No
What is the nominal setting for Capture Test Time?
1 a.m.
When is the first threshold test administered?
12 hours (day at rest) after implant detection in pacers and CRT-P’s and when detection is turned on in tachy devices
How often are threshold tests administered?
In 24hr intervals from the last successful test or every 30 minutes after an unsuccessful search
In what situations is the test aborted?
If patient’s heart rate or other device features take precedence over the search.
How does ACM determine if the patient’s rhythm is stable enough to perform a test?
When a stable atrial rhythm is observed for eight cycles and the sensor rate is less than the ADL rate.
When will ACM NOT operate?
During mode switch, when the sensed atrial rate is faster than 87 bpm, or if the paced atrial rate is faster than 90 bpm.
How does ACM determine the threshold?
Through a series of support cycles followed by a test pace applied at a slightly faster rate, then monitoring the placement of sensed P and R waves to evaluate capture.
What two methods are used to determine capture and when is each used?
Atrial Chamber Reset - for patients with stable sinus rhythm or AV conduction - for patients who do not have a stable sinus rhythm
What features are disabled during ACM’s threshold search?
Sensing Assurance, Rate Drop Response, AV Modulation, Blanked Flutter Search, Lead Monitor, Lower Rate Modulation (Atrial Preference Pacing, Sinus Preference, and Conducted AF Response)
Describe the Atrial Chamber Reset method.
Algorithm determines if test pace captured myocardium by looking for the presence of an AR event in the AV interval. No AR=Capture.
Describe AV Conduction method.
Runs when stable 1:1 AV conduction is present. Atrial pacing rate is increased by 15 bpm and AV delay is lengthened. Test pace is followed by a back-up pace. Capture or non-capture is determined by placement of the next VS. If it falls within the expected AP-VS interval following the test pace it assumes capture.
At what pulse width is the threshold search conducted?
0.40ms
When is a High Threshold Warning issued?
When amplitude threshold is greater than 2.5V @ 1.0 ms or if the programmed output is greater than 5.0V @ 1.0 ms.
What conditions can affect ACM?
Lead fixation issues, intrinsic event rejection/inability to differentiate between intrinsic and paced events, unipolar lead programming and low amplitude P waves
What is the minimum sensed P wave amplitude at which ATM will function?
.45 mV
In what pacemakers/CRT-P’s is ACM available?
Advisa MRI SureScan, Adapta DR, Versa DR, Sensa DR, Consulta CRT-P
In what ICD’s is ACM available?
Evera XT DR, Evera S DR, Protecta XT DR, Secura DR
In what CRT-D’s is ACM available?
Viva XT CRT-D, Viva S CRT-D, Protecta XT CRT-D, Consulta CRT-D
