Atrial Capture Management Flashcards

1
Q

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

A

When implant detection is completed.

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2
Q

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

A

When detection is turned on.

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3
Q

What are the programming options for ACM?

A

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

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4
Q

In what modes does ACM operate?

A

DDD or DDDR

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5
Q

Does ACM work during MVP mode?

A

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

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6
Q

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

A

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

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7
Q

What programming parameters are available within ACM?

A

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

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8
Q

What is the Amplitude Margin?

A

Safety margin applied to threshold results for amplitude.

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9
Q

What is the Minimum Adapted Amplitude?

A

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

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10
Q

What are the Acute Phase Days Remaining?

A

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

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11
Q

Where is ACM found?

A

Params>Pacing>Atrial Amplitude

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12
Q

What are the “Additional Parameters” for ACM?

A

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

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13
Q

What are the highest outputs capture management will program?

A

5.0V@1.0ms

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14
Q

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

A

DDD, DDDR, AAI>DDD, AAIR>DDDR

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15
Q

Can epi leads be used with ACM?

A

No

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16
Q

What is the nominal setting for Capture Test Time?

A

1 a.m.

17
Q

When is the first threshold test administered?

A

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

18
Q

How often are threshold tests administered?

A

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

19
Q

In what situations is the test aborted?

A

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

20
Q

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

A

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

21
Q

When will ACM NOT operate?

A

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

22
Q

How does ACM determine the threshold?

A

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.

23
Q

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

A

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

24
Q

What features are disabled during ACM’s threshold search?

A

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

25
Q

Describe the Atrial Chamber Reset method.

A

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

26
Q

Describe AV Conduction method.

A

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.

27
Q

At what pulse width is the threshold search conducted?

A

0.40ms

28
Q

When is a High Threshold Warning issued?

A

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

29
Q

What conditions can affect ACM?

A

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

30
Q

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

A

.45 mV

31
Q

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

A

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

32
Q

In what ICD’s is ACM available?

A

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

33
Q

In what CRT-D’s is ACM available?

A

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