Performance of automatic capture confirmation algorithm in a large cohort of pacemaker patients with left bundle branch area pacing

Journal of Interventional Cardiac Electrophysiology · 2026-02-23

Automatic capture confirmation algorithms regularly evaluate pacing capture threshold (PCT) and adjust energy output to deliver a tailored safety margin over the PCT. Abbott AutoCapture™ Algorithm provides beat-by-beat capture confirmation and delivers a high-output backup safety pulse in the event of non-capture. Our objective was to evaluate the longitudinal performance and stability of the Abbott AutoCapture™ algorithm in patients with LBBAP. De-identified remote device data were retrospectively analyzed from consecutive patients in our hospital who received AutoCapture enabled Abbott pacemakers with LBBAP from June 2021 to August 2023. Device stored AutoCapture PCT measurements were then evaluated incrementally over an approximate 2-year period, to evaluate longer-term trends and performance, and also compared with the in-clinic manual PCT. A total of 619 patients with either single chamber (n = 89) or dual-chamber Abbott devices (n = 530) were identified. AutoCapture and manually measured PCTs in-clinic were within 0.25 V in 600/615 (97.6%) patients, with average PCTs of 0.76 V ± 0.28 and 0.80 V ± 0.26 respectively. At 1, 3, 6, 12, and 24-month remote follow-up, average AutoCapture PCTs were 0.67 V ± 0.29 (n = 594), 0.66 V ± 0.25 (n = 560), 0.71 V ± 0.29 (n = 543), 0.77 V ± 0.29 (n = 447) and 0.81 V ± 0.28 (n = 112), respectively. AutoCapture was found to be effective in assessing PCT and was activated in the majority of patients (619/644, 97%) with no clinical complications related to its usage. The AutoCapture algorithm measured accurate PCTs compared to manual in-clinic and showed stable trend during follow-up of 2 years in patients with LBBAP.

PO-01-187 LEAD TIP BIOPSY FOR DIAGNOSIS OF CARDIAC AMYLOIDOSIS: A SINGLE-CENTER FEASIBILITY STUDY

Heart Rhythm · 2026-04-01

Left Ventricular Entry to Reduce Brain Lesions During Catheter Ablation: A Randomized Trial

Circulation · 2025-02-24 · 13 citations

BACKGROUND: Catheter ablation of ventricular arrhythmias, one of the most rapidly growing procedures in cardiac electrophysiology, is associated with magnetic resonance imaging-detected brain lesions in more than half of cases. Although a retrograde aortic approach is conventional, modern tools enable entry through a transseptal approach that may avoid embolization of debris from the arterial system. We sought to test the hypothesis that a transseptal puncture would mitigate brain injury compared with a retrograde aortic approach. METHODS: The TRAVERSE trial (Transseptal Versus Retrograde Aortic Ventricular Entry to Reduce Systemic Emboli) was a multicenter randomized controlled comparative effectiveness trial. Patients with left ventricular arrhythmias undergoing catheter ablation procedures were randomly assigned to a transseptal puncture approach compared (1:1) with a retrograde aortic approach. The primary outcome was the presence of an acute brain lesion detected by magnetic resonance imaging. Secondary outcomes included clinically manifest complications, procedural efficacy, and 6-month neurocognitive assessments. RESULTS: =0.036). No differences in clinically manifest complications or procedural efficacy were observed. More patients in the retrograde aortic arm were categorized as having a high likelihood of cognitive impairment at 6 months (33% compared with 19% of those in the transseptal arm), but substantial loss to follow-up was present. CONCLUSIONS: Among patients undergoing left ventricular catheter ablation procedures, a transseptal approach reduced the risk of acute brain lesions by nearly half compared with a retrograde aortic approach without sacrificing safety or efficacy. Given a likely embolic pathogenesis, the brain magnetic resonance imaging findings may reflect a propensity to other organ damage; these findings may extend to other procedures requiring left ventricular entry. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03946072.

PO-07-067 ORTHOTOPIC HEART TRANSPLANTATION FOLLOWING STEREOTACTIC BODY RADIOTHERAPY FOR REFRACTORY VENTRICULAR TACHYCARDIA: A CASE SERIES

Heart Rhythm · 2025-04-01

Stereotactic Body Radiation Therapy for Ventricular Tachycardia is Safe and Effective: Results from a Large Retrospective Cohort

International Journal of Radiation Oncology*Biology*Physics · 2025-09-01

Efficient Removal of Nascent Left Atrial Appendage Thrombus to Facilitate Left Atrial Appendage Closure

JACC Case Reports · 2025-10-01

BACKGROUND: Left atrial appendage (LAA) thrombus often precludes immediate closure owing to embolic risk, complicating care for high-risk patients needing stroke prevention. CASE SUMMARY: A 78-year-old woman with atrial fibrillation and recent intracranial hemorrhage was referred for left atrial appendage closure (LAAC). Imaging revealed a nascent thrombus at the LAA ostium. Given her high bleeding risk, thrombus aspiration was attempted. Using a deflectable delivery sheath and computer-assisted vacuum catheter, the thrombus was successfully removed en face without embolization. A 27-mm LAAC device was deployed, with excellent results. She was discharged on low-dose apixaban (2.5 mg bid) and remained event-free at 45 days. DISCUSSION: This case highlights a feasible, minimally invasive technique for aspirating LAA thrombus using standard LAAC tools, enabling safe closure without bypass. TAKE-HOME MESSAGE: Aspiration of LAA thrombus can be performed efficiently with a vacuum-assisted catheter delivered through a standard deflectable LAAC sheath.

PO-04-146 EFFECT OF SBRT FOR VENTRICULAR TACHYCARDIA ON CARDIAC FUNCTION

Heart Rhythm · 2025-04-01

Performance of an Automatic Capture Confirmation Algorithm in a Large Cohort of Pacemaker Patients with Left Bundle Branch Area Pacing

2025-03-08

Objectives Automatic capture confirmation (ACC) algorithms monitor the pacing capture threshold (PCT) and adjust energy output to deliver a tailored safety margin over the PCT, while providing a high-output backup safety pulse in the event of non-capture. Advantages of these algorithms include increased device longevity, enhanced patient safety, and improved remote monitoring capabilities. While such algorithms have been validated for conventional right ventricular pacing (RVP) locations, there is limited information on their performance for pacing in the increasingly utilized location of the left bundle branch area (LBBA). Our objective was to evaluate the longitudinal performance and stability of the Abbott AutoCapture™ algorithm in patients with left bundle branch area pacing (LBBAP). Methods De-identified remote device data were retrospectively analyzed from consecutive patients in our hospital who received AutoCapture enabled Abbott pacemakers with LBBAP from June 2021 to August 2023. Device stored AutoCapture PCT measurements were then evaluated incrementally over an approximate 2-year period, to evaluate longer-term trends and performance, and also compared with the original, manual PCT at the time of initial implant. Results A total of 619 patients with either single chamber (model 1272, n= 89) or dual-chamber Abbott devices (model 2272, n= 530) were identified. AutoCapture and manually measured PCTs at implant were within 0.25 V in 600/615 (97.6%) patients, with average PCTs of 0.76 V ± 0.28 and 0.80 V ± 0.26 respectively, at a pulse width of 0.5 ms. At 1, 3, 6, 12, and 24-month remote follow-up, average AutoCapture PCTs were 0.67 V ± 0.29 (n=594), 0.66 V ± 0.25 (n=560), 0.71 V ± 0.29 (n=543), 0.77 V ± 0.29 (n=447) and 0.81 V ± 0.28 (n=112), respectively. At the last remote follow-up, lead impedances were 536 ohms ±60, and sensed R-wave amplitude were 11 mV ± 3. AutoCapture was found to be effective in assessing PCT and was activated in the majority of patients (619/644, 97%) without complications related to its activation or usage during the follow-up period. Conclusion The AutoCapture algorithm measured accurate PCTs at implant and showed a stable trend during follow-up out to approximately 2 years in patients with LBBAP.

Abstract 4363437: Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia in Patients with Left Ventricular Assist Devices

Circulation · 2025-11-03

Background: Patients with left ventricular assist devices (LVADs) may develop ventricular tachycardia (VT) refractory to conventional antiarrhythmic strategies. Catheter ablation is associated with increased procedural risks in this population and may be less effective, especially when critical substrate is epicardial or near the LVAD cannula. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a promising therapy for patients with VT refractory to antiarrhythmic drugs (AADs) and catheter ablation. However, clinical data on SBRT in patients with LVADs remain limited. Objective: To evaluate the safety and efficacy of cardiac SBRT in managing refractory VT in patients with durable LVAD support. Methods: We conducted a retrospective review of all patients with existing LVADs who underwent SBRT (25 Gy) for drug- and ablation-refractory VT at our institution. All patients had previously failed conventional therapies. Clinical outcomes, including VT recurrence, implantable cardioverter defibrillator (ICD) therapies, ventricular function, complications, and survival, were assessed over a follow-up period ranging from 3 to 28 months. Results: Four patients met inclusion criteria (see Table). Three experienced VT recurrence: one within the first month and two within two months post-SBRT. One of these recurrences resulted in an ICD shock. One patient has remained arrhythmia-free for 14 months post-treatment. Importantly, no patients experienced LVAD-related complications attributable to SBRT. Post-treatment echocardiographic assessment revealed no significant changes in left or right ventricular function. Three patients died during follow-up at 3, 17, and 22 months. Only one death was directly attributed to refractory VT; the remaining two were due to hypoxic respiratory failure and septic shock. Conclusion: In this small series, cardiac SBRT appeared safe and potentially beneficial for patients with LVADs and refractory VT. Although most patients experienced recurrent VT, SBRT may delay recurrence in selected high-risk individuals. One patient achieved sustained arrhythmia suppression. These findings support further investigation of SBRT as a non-invasive adjunctive therapy in this challenging population.

Leveraging a randomized trial to assess relationships between transeptal puncture, brain emboli, and migraine symptoms

Heart Rhythm · 2025-07-07

BACKGROUND: Catheter ablation procedures with transseptal punctures (usually for atrial fibrillation) are often associated with migraine-related visual auras, but the mechanism remains unknown. Whether this phenomenon is mediated by the creation of an atrial septal defect from transseptal puncture or by silent acute brain emboli detected on magnetic resonance imaging related to the procedure remains to be investigated. OBJECTIVE: This study aimed to evaluate whether randomization to a transseptal puncture during catheter ablation for ventricular arrhythmias is associated with postprocedural visual auras and assess the relationship between occipital and parietal lobes acute brain emboli and migraine-related visual auras. METHODS: In the Transseptal Versus Retrograde Aortic Ventricular Entry to Reduce Systemic Emboli trial, patients undergoing catheter ablation for ventricular arrhythmias were randomized to ventricular access via transseptal puncture vs a retrograde aortic approach. All had brain magnetic resonance imaging the day after their procedure and underwent a validated migraine assessment at 1 month. RESULTS: No differences in postablation visual auras were observed between transseptal (16% of 63) and retrograde aortic approaches (14% of 57; P = .78). However, more participants with acute brain emboli in the occipital or parietal lobes experienced migraine-related visual auras (38% vs 11%; P < .01). After multivariable adjustment, the presence of acute brain emboli was associated with 12-fold greater odds of visual auras. CONCLUSION: Transseptal puncture was not associated with visual auras; however, acute brain emboli involving the visual cortex were associated with such symptoms. These data suggest that transseptal puncture is not causal in migraine-related visual auras and that postprocedure acute brain emboli are apparently not always clinically silent.