Atrial Capture Management

Question 1

When is ACM enabled in a pacemaker or CRT-P?

Answer 1

When implant detection is completed.

Question 2

When is ACM enabled in a ICD/CRT-D?

Answer 2

When detection is turned on.

Question 3

What are the programming options for ACM?

Answer 3

“Off,” “Adaptive” (nominal), “Monitor Only”

Question 4

In what modes does ACM operate?

Answer 4

DDD or DDDR

Question 5

Does ACM work during MVP mode?

Answer 5

Yes, but the device changes to DDD or DDDR while ACM is functioning.

Question 6

How is “Adaptive” different from “Monitor Only”?

Answer 6

Outputs are changed only when the device is in “Adaptive” mode.

Question 7

What programming parameters are available within ACM?

Answer 7

Amplitude Margin, Minimum Adapted Amplitude, Capture Test Frequency, Acute Phase Days Remaining

Question 8

What is the Amplitude Margin?

Answer 8

Safety margin applied to threshold results for amplitude.

Question 9

What is the Minimum Adapted Amplitude?

Answer 9

The lowest voltage to which the output may be set by ACM.

Question 10

What are the Acute Phase Days Remaining?

Answer 10

Number of days where the outputs may be adjusted up or down, but not below programmed output.

Question 11

Where is ACM found?

Answer 11

Params>Pacing>Atrial Amplitude

Question 12

What are the “Additional Parameters” for ACM?

Answer 12

Capture Test Frequency, Capture Test Time, Acute Phase Days Remaining, Sensing During Search

Question 13

What are the highest outputs capture management will program?

Answer 13

5.0V@1.0ms

Question 14

To what mode must the device be programmed in order to utilize ACM?

Answer 14

DDD, DDDR, AAI>DDD, AAIR>DDDR

Question 15

Can epi leads be used with ACM?

Answer 15

No

Question 16

What is the nominal setting for Capture Test Time?

Answer 16

1 a.m.

Question 17

When is the first threshold test administered?

Answer 17

12 hours (day at rest) after implant detection in pacers and CRT-P’s and when detection is turned on in tachy devices

Question 18

How often are threshold tests administered?

Answer 18

In 24hr intervals from the last successful test or every 30 minutes after an unsuccessful search

Question 19

In what situations is the test aborted?

Answer 19

If patient’s heart rate or other device features take precedence over the search.

Question 20

How does ACM determine if the patient’s rhythm is stable enough to perform a test?

Answer 20

When a stable atrial rhythm is observed for eight cycles and the sensor rate is less than the ADL rate.

Question 21

When will ACM NOT operate?

Answer 21

During mode switch, when the sensed atrial rate is faster than 87 bpm, or if the paced atrial rate is faster than 90 bpm.

Question 22

How does ACM determine the threshold?

Answer 22

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.

Question 23

What two methods are used to determine capture and when is each used?

Answer 23

Atrial Chamber Reset - for patients with stable sinus rhythm or AV conduction - for patients who do not have a stable sinus rhythm

Question 24

What features are disabled during ACM’s threshold search?

Answer 24

Sensing Assurance, Rate Drop Response, AV Modulation, Blanked Flutter Search, Lead Monitor, Lower Rate Modulation (Atrial Preference Pacing, Sinus Preference, and Conducted AF Response)

Question 25

Describe the Atrial Chamber Reset method.

Answer 25

Algorithm determines if test pace captured myocardium by looking for the presence of an AR event in the AV interval. No AR=Capture.

Question 26

Describe AV Conduction method.

Answer 26

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.

Question 27

At what pulse width is the threshold search conducted?

Answer 27

0.40ms

Question 28

When is a High Threshold Warning issued?

Answer 28

When amplitude threshold is greater than 2.5V @ 1.0 ms or if the programmed output is greater than 5.0V @ 1.0 ms.

Question 29

What conditions can affect ACM?

Answer 29

Lead fixation issues, intrinsic event rejection/inability to differentiate between intrinsic and paced events, unipolar lead programming and low amplitude P waves

Question 30

What is the minimum sensed P wave amplitude at which ATM will function?

Answer 30

.45 mV

Question 31

In what pacemakers/CRT-P’s is ACM available?

Answer 31

Advisa MRI SureScan, Adapta DR, Versa DR, Sensa DR, Consulta CRT-P

Question 32

In what ICD’s is ACM available?

Answer 32

Evera XT DR, Evera S DR, Protecta XT DR, Secura DR

Question 33

In what CRT-D’s is ACM available?

Answer 33

Viva XT CRT-D, Viva S CRT-D, Protecta XT CRT-D, Consulta CRT-D