Automatic capture management may cause unnecessary battery depletion in
selective His bundle pacing
A modern implantable pulse generator is equipped with an automatic
capture management (ACM) program that provides reliable pacing threshold
management and potential device longevity benefit. However, an accurate
His bundle pacing (HBP) lead threshold value is not always the same as
the ACM algorithm measurement. We reported a patient who presented with
a high ventricular pacing output that caused shortening of device
longevity because of the wrong ACM algorithm HBP threshold measurement.
Because of the time interval between pacing stimulation and the
ventricular electrogram during HBP, the ACM algorithm considers “pacing
capture loss” despite His bundle capture. The ACM algorithm
overestimates an accurate HBP threshold and unnecessarily changes pacing
parameters to high ventricular pacing output. A routine change in the
ACM algorithm from “adaptive” to “off or monitor” is needed to
conserve device longevity.