{"id":258,"date":"2025-07-10T08:13:06","date_gmt":"2025-07-10T08:13:06","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=258"},"modified":"2025-11-18T13:49:12","modified_gmt":"2025-11-18T13:49:12","slug":"atrial-pacing","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/pacemaker\/atrial-pacing\/","title":{"rendered":"Stimulation atriale"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"258\" class=\"elementor elementor-258\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3472961 e-con-full e-flex e-con e-parent\" data-id=\"3472961\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d52690e elementor-widget elementor-widget-heading\" data-id=\"d52690e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Stimulation atriale<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b3d9c86 e-con-full e-flex e-con e-parent\" data-id=\"b3d9c86\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0ad6fc3 elementor-widget elementor-widget-text-editor\" data-id=\"0ad6fc3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Il existe un certain nombre de sp\u00e9cificit\u00e9s en fonction des constructeurs en termes de mesure automatique de seuil atrial et d'adaptation automatique de la programmation.<\/p><ol><li>Les stimulateurs Biotronik, Boston Scientific, Medtronic et Abbott permettent une mesure automatique du seuil de stimulation atriale avec adaptation de la programmation; pas de mesure automatique pour les stimulateurs Microport CRM-Sorin.<\/li><li>Les diff\u00e9rents syst\u00e8mes ne fonctionnent pas avec une v\u00e9rification cycle \u00e0 cycle de la capture; le seuil est mesur\u00e9 toutes les X heures (variable en fonction des constructeurs) avec adaptation de la programmation pour la p\u00e9riode entre 2 mesures de seuil.<\/li><li>La mesure de seuil est bas\u00e9e sur la mise en \u00e9vidence d'oreillettes ou de ventricules spontan\u00e9s pour les stimulateurs Biotronik et Medtronic, sur la r\u00e9ponse \u00e9voqu\u00e9e pour les stimulateurs Boston Scientific et sur la morphologie pour les stimulateurs Abbott.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7fb5ca9 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"7fb5ca9\" data-element_type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h3&quot;,&quot;h4&quot;],&quot;exclude_headings_by_selector&quot;:[],&quot;no_headings_message&quot;:&quot;No headings were found on this page.&quot;,&quot;marker_view&quot;:&quot;numbers&quot;,&quot;minimize_box&quot;:&quot;yes&quot;,&quot;minimized_on&quot;:&quot;tablet&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tG\u00e9n\u00e9ralit\u00e9s\t\t\t<\/h4>\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__7fb5ca9\" aria-expanded=\"true\" aria-label=\"Ouvrir la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__7fb5ca9\" aria-expanded=\"true\" aria-label=\"Fermer la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div id=\"elementor-toc__7fb5ca9\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<svg class=\"elementor-toc__spinner eicon-animation-spin e-font-icon-svg e-eicon-loading\" aria-hidden=\"true\" viewbox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M500 975V858C696 858 858 696 858 500S696 142 500 142 142 304 142 500H25C25 237 238 25 500 25S975 237 975 500 763 975 500 975Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1eaf680 elementor-widget elementor-widget-heading\" data-id=\"1eaf680\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Abbott<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a799007 elementor-widget elementor-widget-text-editor\" data-id=\"a799007\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Principes de fonctionnement<\/h6><ul><li>ACap Confirm ON : le seuil de stimulation atriale est mesur\u00e9 et m\u00e9moris\u00e9 automatiquement sur la courbe + adaptation automatique de la programmation ; ACap Confirm on monitor : le seuil de stimulation atriale est mesur\u00e9 et m\u00e9moris\u00e9 automatiquement sans adaptation automatique de la programmation<\/li><li>seuil r\u00e9alis\u00e9 syst\u00e9matiquement toutes les 8 ou 24 heures, selon le r\u00e9glage du param\u00e8tre Intervalle de recherche<\/li><li>contr\u00f4le de capture bas\u00e9 sur l'analyse de la morphologie de la r\u00e9ponse \u00e9voqu\u00e9e atriale<\/li><li>pas de contr\u00f4le cycle \u00e0 cycle de la capture et adaptation pour les 8 heures<\/li><li>marge de s\u00e9curit\u00e9  variable en fonction du seuil: si seuil \u2264 1.5V, marge \u00e0 + 1.0V; si seuil entre 1.625V et 2.25V, marge \u00e0 + 1.5V; si seuil entre 2.375V et 3.0V, marge \u00e0 + 2.0V; si seuil &gt; 3V, amplitude \u00e0 5V<\/li><li>amplitude maximale pouvant \u00eatre d\u00e9livr\u00e9e: 5 V pour dur\u00e9e d'impulsion programm\u00e9e<\/li><\/ul><h6>L'ACap Confirm en pratique<\/h6><p>Le contr\u00f4le du seuil atrial est bas\u00e9 sur l'analyse de la morphologie de la r\u00e9ponse \u00e9voqu\u00e9e atriale mais sans surveillance et v\u00e9rification cycle \u00e0 cycle de la capture. L\u2019appareil m\u00e9morise la morphologie de l\u2019\u00e9chec de capture. La morphologie est constitu\u00e9e de points de mesure \u00e9chantillonn\u00e9s entre le premier stimulus et le stimulus de secours \u00e0 5 V (30 ms apr\u00e8s le premier) et de points de mesure qui suivent le stimulus de secours. La mise \u00e0 jour du mod\u00e8le de perte de capture est effectu\u00e9e avant chaque mesure de seuil lors du test de configuration.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a63ecd0 elementor-widget elementor-widget-image\" data-id=\"a63ecd0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQzNiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"684\" height=\"318\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb1.png\" class=\"attachment-large size-large wp-image-3436\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb1.png 684w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb1-300x139.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb1-18x8.png 18w\" sizes=\"(max-width: 684px) 100vw, 684px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b141e23 elementor-widget elementor-widget-text-editor\" data-id=\"b141e23\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Lors du test de configuration, pr\u00e9alable incontournable \u00e0 la mesure de seuil, 3 paires de stimulation sont d\u00e9livr\u00e9es pour tester la morphologie de la r\u00e9ponse \u00e9voqu\u00e9e (RE):<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-846c41e elementor-widget elementor-widget-image\" data-id=\"846c41e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQzNywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjIucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"651\" height=\"307\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb2.png\" class=\"attachment-large size-large wp-image-3437\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb2.png 651w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb2-300x141.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb2-18x8.png 18w\" sizes=\"(max-width: 651px) 100vw, 651px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a1366aa elementor-widget elementor-widget-text-editor\" data-id=\"a1366aa\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>L\u2019Acap Confirm utilise un score pour proc\u00e9der \u00e0 la diff\u00e9renciation entre la morphologie de perte de capture et la morphologie de capture. Si le score de capture est tr\u00e8s diff\u00e9rent du score de perte de capture, alors la configuration est recommand\u00e9e et le seuil de stimulation est automatiquement mesur\u00e9.<\/p><p>Les tests 2 et 3 sont utilis\u00e9s pour la mise \u00e0 jour du mod\u00e8le de perte de capture. Le mod\u00e8le de morphologie RE de perte de capture est r\u00e9actualis\u00e9 en permanence.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b214ea elementor-widget elementor-widget-image\" data-id=\"7b214ea\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQzOCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjMucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"694\" height=\"343\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb3.png\" class=\"attachment-large size-large wp-image-3438\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb3.png 694w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb3-300x148.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb3-18x9.png 18w\" sizes=\"(max-width: 694px) 100vw, 694px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cc1e1ac elementor-widget elementor-widget-image\" data-id=\"cc1e1ac\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQzOSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjQucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"710\" height=\"411\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb4.png\" class=\"attachment-large size-large wp-image-3439\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb4.png 710w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb4-300x174.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb4-18x10.png 18w\" sizes=\"(max-width: 710px) 100vw, 710px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-edb0127 elementor-widget elementor-widget-text-editor\" data-id=\"edb0127\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Le stimulus de secours \u00e0 5 V est d\u00e9livr\u00e9 cycle \u00e0 cycle pendant le seuil, qu\u2019il y ait capture ou \u00e9chec de capture du premier stimulus, pour pouvoir \u00e9valuer le score de morphologie.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2d47f97 elementor-widget elementor-widget-image\" data-id=\"2d47f97\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb5.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb5\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0MCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjUucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"695\" height=\"385\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb5.png\" class=\"attachment-large size-large wp-image-3440\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb5.png 695w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb5-300x166.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb5-18x10.png 18w\" sizes=\"(max-width: 695px) 100vw, 695px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2ace2d0 elementor-widget elementor-widget-text-editor\" data-id=\"2ace2d0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Suite \u00e0 une mesure de seuil r\u00e9alis\u00e9e toutes les 8 ou 24 heures, l\u2019amplitude atriale est adapt\u00e9e automatiquement avec la marge suivante:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9f003c1 elementor-widget elementor-widget-image\" data-id=\"9f003c1\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb6.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_abb6\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0MSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2FiYjYucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"619\" height=\"139\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb6.png\" class=\"attachment-large size-large wp-image-3441\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb6.png 619w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb6-300x67.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_abb6-18x4.png 18w\" sizes=\"(max-width: 619px) 100vw, 619px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6521971 elementor-widget elementor-widget-text-editor\" data-id=\"6521971\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Si le seuil de stimulation d\u00e9termin\u00e9 par l\u2019algorithme d\u00e9passe 3,875 V, l\u2019Acap Confirm est d\u00e9sactiv\u00e9e automatiquement et l\u2019amplitude d\u2019impulsion est reprogramm\u00e9e \u00e0 5 V.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fe6161a elementor-widget elementor-widget-heading\" data-id=\"fe6161a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Biotronik<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2c09438 elementor-widget elementor-widget-text-editor\" data-id=\"2c09438\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Principes de fonctionnement<\/h6><ul><li>contr\u00f4le de la capture atriale sur ON : mesure automatique du seuil de stimulation atriale + adaptation de la programmation ; contr\u00f4le de la capture atriale sur ATM : mesure automatique du seuil de stimulation atriale sans adaptation ; contr\u00f4le de la capture atriale sur stop : pas de mesure automatique du seuil<\/li><li>seuil de stimulation atriale r\u00e9alis\u00e9 syst\u00e9matiquement tous les jours \u00e0 2h00 du matin (ou programmable suivant des intervalles : 24h, 12h, 6h, 3h, 1h, 0.3h, 0.1h)<\/li><li>seuil de stimulation atriale bas\u00e9 sur la mise en \u00e9vidence de signaux atriaux d\u00e9tect\u00e9s r\u00e9v\u00e9lateurs de la perte de capture<\/li><li>pas de v\u00e9rification cycle \u00e0 cycle de la capture; adaptation de l'amplitude pour les 24 heures suivantes<\/li><li>marge de s\u00e9curit\u00e9 programmable (valeur nominale + 1 V)<\/li><li>amplitude maximale pouvant \u00eatre d\u00e9livr\u00e9e: amplitude de d\u00e9marrage du test soit 4,8V         V pour 0,4 ms<\/li><li>amplitude minimale pouvant \u00eatre d\u00e9livr\u00e9e programmable: valeur nominale 1 V<\/li><\/ul><h6>Contr\u00f4le automatique de la capture atriale en pratique<\/h6><p>Il existe beaucoup de similitudes avec le contr\u00f4le de capture ventriculaire mais \u00e9galement quelques diff\u00e9rences. Le contr\u00f4le automatique de la capture atriale n'est pas bas\u00e9 sur l'analyse de la r\u00e9ponse \u00e9voqu\u00e9e mais sur la mise en \u00e9vidence de signaux atriaux d\u00e9tect\u00e9s r\u00e9v\u00e9lateurs de la perte de capture: reprise du rythme intrins\u00e8que ou conduction r\u00e9trograde si patient d\u00e9pendant sur l'oreillette (dysfonction sinusale).<\/p><p>Les param\u00e8tres programmables sont les m\u00eames (possibilit\u00e9 marche, arr\u00eat et ATM) mais certaines valeurs nominales sont diff\u00e9rentes: l'amplitude minimale est programmable avec une valeur nominale de 1 V; marge de s\u00e9curit\u00e9, valeur nominale de 1 V;<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-037fde0 elementor-widget elementor-widget-image\" data-id=\"037fde0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bio1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0MiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2JpbzEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"515\" height=\"374\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio1.png\" class=\"attachment-large size-large wp-image-3442\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio1.png 515w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio1-300x218.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio1-18x12.png 18w\" sizes=\"(max-width: 515px) 100vw, 515px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-612cd7a elementor-widget elementor-widget-text-editor\" data-id=\"612cd7a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Pour la mesure du seuil, la fr\u00e9quence de stimulation atriale est augment\u00e9e pour d\u00e9passer la fr\u00e9quence atriale spontan\u00e9e. Si la fr\u00e9quence spontan\u00e9e est inf\u00e9rieure \u00e0 108 bpm, le seuil est r\u00e9alis\u00e9 \u00e0 une fr\u00e9quence plus \u00e9lev\u00e9e de 20% par rapport \u00e0 la fr\u00e9quence spontan\u00e9e. Si la fr\u00e9quence spontan\u00e9e est sup\u00e9rieure \u00e0 108 bpm, le test ne peut pas \u00eatre r\u00e9alis\u00e9.<\/p><p>Le test est r\u00e9alis\u00e9 en mode DDI avec un d\u00e9lai AV de 50 ms avec un blanking atrial post stimulation ventriculaire de 150 ms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6d5af11 elementor-widget elementor-widget-image\" data-id=\"6d5af11\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bio2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0MywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2JpbzIucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"346\" height=\"248\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio2.png\" class=\"attachment-large size-large wp-image-3443\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio2.png 346w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio2-300x215.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio2-18x12.png 18w\" sizes=\"(max-width: 346px) 100vw, 346px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c3f5624 elementor-widget elementor-widget-text-editor\" data-id=\"c3f5624\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Comme pour le contr\u00f4le ventriculaire, la proc\u00e9dure de seuil d\u00e9bute \u00e0 la valeur programm\u00e9e avec r\u00e9duction par pas de 0.6 V jusqu\u2019\u00e0 la mise en \u00e9vidence de 2 cycles atriaux spontan\u00e9s sur 5. La deuxi\u00e8me phase de pas de 0.1 V est identique \u00e0 celle du contr\u00f4le ventriculaire.<\/p><p>Chaque amplitude est test\u00e9e 5 fois \u00e0 la suite.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-37e8a09 elementor-widget elementor-widget-image\" data-id=\"37e8a09\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bio3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0NCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2JpbzMucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"496\" height=\"583\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio3.png\" class=\"attachment-large size-large wp-image-3444\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio3.png 496w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio3-255x300.png 255w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio3-10x12.png 10w\" sizes=\"(max-width: 496px) 100vw, 496px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cbe4c3a elementor-widget elementor-widget-text-editor\" data-id=\"cbe4c3a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Une stimulation atriale de synchronisation (restauration de la synchronisation atrio-ventriculaire normale pour pr\u00e9venir la PMT) est d\u00e9livr\u00e9e \u00e0 la fin de chaque s\u00e9rie de 5 stimuli. L'amplitude de cette stimulation atriale varie en fonction du pitch (0,1 ou 0,6 V) et de l'existence d'une capture.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6df64a1 elementor-widget elementor-widget-image\" data-id=\"6df64a1\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bio4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0NSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2JpbzQucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"437\" height=\"249\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio4.png\" class=\"attachment-large size-large wp-image-3445\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio4.png 437w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio4-300x171.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio4-18x10.png 18w\" sizes=\"(max-width: 437px) 100vw, 437px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3bff115 elementor-widget elementor-widget-text-editor\" data-id=\"3bff115\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Le seuil mesur\u00e9 est alors confirm\u00e9 en 2 \u00e9tapes: une amplitude de stimulation sup\u00e9rieure de 0.3 V par rapport au seuil mesur\u00e9 est r\u00e9p\u00e9t\u00e9e 5 fois (\u00e9tape 1) puis une amplitude de stimulation inf\u00e9rieure de 0.3 V par rapport au seuil mesur\u00e9 est r\u00e9p\u00e9t\u00e9e 2 fois (\u00e9tape 2). 2 pertes de capture sur 5 suffisent; elles sont suivies d\u2019une stimulation de s\u00e9curit\u00e9. Le seuil est confirm\u00e9 si la capture est pr\u00e9sente durant l'\u00e9tape 1 et absente durant l'\u00e9tape 2.<\/p><p>L'amplitude de stimulation est adapt\u00e9e en ajoutant la valeur de la marge de s\u00e9curit\u00e9.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5a86600 elementor-widget elementor-widget-image\" data-id=\"5a86600\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio6.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bio6\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0NywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2JpbzYucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"643\" height=\"570\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio6.png\" class=\"attachment-large size-large wp-image-3447\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio6.png 643w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio6-300x266.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bio6-14x12.png 14w\" sizes=\"(max-width: 643px) 100vw, 643px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-768b176 elementor-widget elementor-widget-heading\" data-id=\"768b176\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Boston Scientific<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c45d330 elementor-widget elementor-widget-text-editor\" data-id=\"c45d330\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Principes de fonctionnement<\/h6><ul><li>Amplitude atriale sur AUTO: mesure du seuil de stimulation atrial + adaptation de la programmation; amplitude atriale sur valeur fixe et Tendances quotidiennes sur marche: mesure du seuil de stimulation atrial sans adaptation<\/li><li>seuil r\u00e9alis\u00e9 syst\u00e9matiquement toutes les 21 heures<\/li><li>mesure du seuil bas\u00e9e sur l'analyse de la r\u00e9ponse \u00e9voqu\u00e9e atriale (bague OD \u2013 boitier)<\/li><li>pas de contr\u00f4le cycle \u00e0 cycle de la capture mais adaptation pour les 21 heures<\/li><li>marge de s\u00e9curit\u00e9 non programmable de 2 fois le seuil mesur\u00e9<\/li><li>amplitude maximale pouvant \u00eatre d\u00e9livr\u00e9e: 5 V pour 0.4 ms<\/li><li>amplitude minimale pouvant \u00eatre d\u00e9livr\u00e9e: 2 V pour  0.4 ms<\/li><\/ul><h6><strong>L'algorithme PaceSafe OD en pratique<\/strong><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f1827d elementor-widget elementor-widget-image\" data-id=\"6f1827d\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bosci1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0OCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2Jvc2NpMS5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"321\" height=\"269\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci1.png\" class=\"attachment-large size-large wp-image-3448\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci1.png 321w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci1-300x251.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci1-14x12.png 14w\" sizes=\"(max-width: 321px) 100vw, 321px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9bbfa2 elementor-widget elementor-widget-text-editor\" data-id=\"b9bbfa2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Cet algorithme ne peut fonctionner que si la sonde atriale est bipolaire. Il est activ\u00e9 en programmant l'amplitude de stimulation atriale sur AUTO. Le seuil de stimulation atriale est r\u00e9alis\u00e9 toutes les 21 heures avec adaptation de l'amplitude de stimulation pour les prochaines 21 heures. La marge de s\u00e9curit\u00e9 correspond au double du seuil mesur\u00e9, l'amplitude d\u00e9livr\u00e9e ne pouvant pas \u00eatre moindre que 2 V ou sup\u00e9rieure \u00e0 5 V. La marge de s\u00e9curit\u00e9 ne peut donc \u00eatre double du seuil que si le seuil est inf\u00e9rieur \u00e0 2.5 V. La dur\u00e9e d'impulsion est fix\u00e9e \u00e0 0.4 ms. Le seuil est r\u00e9alis\u00e9 en unipolaire. Cet algorithme ne fonctionne que si le seuil est compris entre 0.2 et 4 V.<\/p><p>L'\u00e9valuation de la capture atriale est bas\u00e9e sur l'analyse de la r\u00e9ponse \u00e9voqu\u00e9e. L'amplitude de stimulation atriale de d\u00e9part correspond \u00e0 l'amplitude d\u00e9livr\u00e9e au moment du test. Le d\u00e9lai AV stimul\u00e9 est fix\u00e9 \u00e0 85 ms, le d\u00e9lai AV d\u00e9tect\u00e9 \u00e0 55 ms. La fr\u00e9quence de stimulation est fix\u00e9e sur la fr\u00e9quence atriale moyenne, la fr\u00e9quence minimale ou la fr\u00e9quence indiqu\u00e9e par le capteur, selon la fr\u00e9quence la plus rapide. Si le nombre de stimulations atriales est insuffisant, la fr\u00e9quence de stimulation atriale est augment\u00e9e de 10 bpm.<\/p><p>Apr\u00e8s la stimulation d'initialisation, le stimulateur diminue l'amplitude de la stimulation auriculaire tous les 3 battements jusqu'\u00e0 la perte de capture (d\u00e9termin\u00e9e par l'absence de r\u00e9ponse \u00e9voqu\u00e9e auriculaire) et la d\u00e9termination du seuil. Si une perte de capture se produit 2 fois au cours des 3 mesures, le seuil est d\u00e9fini comme la valeur pr\u00e9c\u00e9dente test\u00e9e. Pour \u00e9viter l'apparition d'un PMT, le PVARP est allong\u00e9 \u00e0 500 ms apr\u00e8s une perte de capture auriculaire.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cc34a79 elementor-widget elementor-widget-image\" data-id=\"cc34a79\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bosci2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ0OSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2Jvc2NpMi5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"537\" height=\"335\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci2.png\" class=\"attachment-large size-large wp-image-3449\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci2.png 537w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci2-300x187.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci2-18x12.png 18w\" sizes=\"(max-width: 537px) 100vw, 537px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1bd0f69 elementor-widget elementor-widget-text-editor\" data-id=\"1bd0f69\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Exemple d'un test de seuil atrial avec capture \u00e0 0.8 V (pr\u00e9sence r\u00e9ponse \u00e9voqu\u00e9e atriale) et perte de capture \u00e0 0.7 V (LOC, loss of capture, absence de r\u00e9ponse \u00e9voqu\u00e9e atriale).<\/p><p>L'amplitude de stimulation n'est pas ajust\u00e9e afin de correspondre \u00e0 2 fois la derni\u00e8re valeur de seuil mesur\u00e9 mais afin de correspondre au seuil maximal mesur\u00e9 au cours des 7 derniers tests ambulatoires. Cela permet une augmentation rapide de l'amplitude si une augmentation subite du seuil est observ\u00e9e. En revanche, une seule valeur basse du seuil ne r\u00e9duit pas l'amplitude de stimulation.<\/p><p>Il n'y a donc pas d'adaptation cycle \u00e0 cycle ou de stimulation de secours.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-69c446c elementor-widget elementor-widget-image\" data-id=\"69c446c\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_atrialstimulation_bosci3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1MCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX2F0cmlhbHN0aW11bGF0aW9uX2Jvc2NpMy5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"572\" height=\"336\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci3.png\" class=\"attachment-large size-large wp-image-3450\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci3.png 572w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci3-300x176.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_atrialstimulation_bosci3-18x12.png 18w\" sizes=\"(max-width: 572px) 100vw, 572px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c467b7c elementor-widget elementor-widget-heading\" data-id=\"c467b7c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Medtronic<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d6c2765 elementor-widget elementor-widget-text-editor\" data-id=\"d6c2765\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Principes de fonctionnement<\/h6><ul><li>contr\u00f4le du seuil atrial sur dynamique: mesure quotidienne du seuil de stimulation atriale + adaptation de la programmation pour les 24 heures; contr\u00f4le de capture atriale sur moniteur: mesure du seuil de stimulation atriale sans adaptation; contr\u00f4le du seuil atrial sur arr\u00eat: valeurs fixes et pas de seuil automatique mesur\u00e9<\/li><li>seuil r\u00e9alis\u00e9 syst\u00e9matiquement toutes les 24 heures \u00e0 1h00 du matin mesure du seuil atrial bas\u00e9e sur la synchronisation des ondes P et R d\u00e9tect\u00e9es (2 m\u00e9thodes en fonction de la pr\u00e9sence ou de l'absence de conduction auriculo-ventriculaire)<\/li><li>une seule mesure quotidienne avec adaptation pour les 24 heures suivantes<\/li><li>amplitude cible en multipliant la marge de s\u00e9curit\u00e9 en amplitude OD par le seuil mesur\u00e9 \u00e0 une dur\u00e9e d\u2019impulsion de 0,4 ms dans une plage de sortie d\u00e9finie par une limite inf\u00e9rieure programmable (param\u00e8tre Amplitude minimale ajust\u00e9e) et la limite de seuil sup\u00e9rieure de 5,0 V et 1,0 ms. La dur\u00e9e d\u2019impulsion minimale pour le contr\u00f4le du seuil atriale est 0,4 ms.<\/li><li>amplitude maximale pouvant \u00eatre d\u00e9livr\u00e9e: 5 V pour 1 ms<\/li><li>amplitude minimale pouvant \u00eatre d\u00e9livr\u00e9e: 1 V pour 0.4 ms<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a562c8e elementor-widget elementor-widget-text-editor\" data-id=\"a562c8e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>La gestion de la capture auriculaire (ACM) en pratique<\/h6><p><span style=\"font-size: 1rem;\">ACM\u00a0<\/span>est disponible lorsque l'appareil fonctionne en mode DDD(R) et MVP (AAI(R)DDD(R)). Si le mode de stimulation programm\u00e9 est le mode MVP, l'appareil passe temporairement en mode DDD(R) pour la dur\u00e9e de la recherche du seuil de stimulation.<\/p><p>Avant d\u2019initialiser une recherche de seuil de stimulation, le stimulateur \u00e9value si le patient est stimul\u00e9 ou s\u2019il y a une d\u00e9tection \u00e0 une fr\u00e9quence lente. Une recherche de seuil de stimulation atrial est effectu\u00e9e lorsqu'un rythme atrial stable est observ\u00e9 pendant huit cycles de stimulation et que la fr\u00e9quence du capteur est inf\u00e9rieure \u00e0 la fr\u00e9quence AQ.<\/p><p>La gestion de la capture auriculaire (ACM) observe la synchronisation des ondes P et R d\u00e9tect\u00e9es (il ne s'agit pas d'une r\u00e9ponse \u00e9voqu\u00e9e) afin d'\u00e9valuer le degr\u00e9 d'entra\u00eenement.<\/p><p><span style=\"font-size: 1rem;\">ACM\u00a0<\/span>s\u00e9lectionne automatiquement l'une des deux m\u00e9thodes d'\u00e9valuation de l'entra\u00eenement auriculaire, en fonction du rythme du patient au moment de la recherche du seuil de stimulation.<\/p><p>Si le rythme sinusal du patient est normal et stable, l'appareil s\u00e9lectionne la m\u00e9thode de r\u00e9initialisation de la cavit\u00e9 auriculaire (ACR). Dans le cas contraire, l'appareil s\u00e9lectionne la m\u00e9thode de conduction AV (AVC).<\/p><p>La r\u00e9initialisation de la cavit\u00e9 auriculaire (ACR) est utilis\u00e9e pour \u00e9valuer l'entra\u00eenement en observant la r\u00e9ponse du rythme intrins\u00e8que \u00e0 la stimulation auriculaire test. Si la stimulation test n'entra\u00eene pas, le n\u0153ud sinusal n'est pas r\u00e9initialis\u00e9 et un \u00e9v\u00e9nement auriculaire d\u00e9tect\u00e9 dans la p\u00e9riode r\u00e9fractaire est observ\u00e9 apr\u00e8s la stimulation test. Si aucun \u00e9v\u00e9nement auriculaire de la p\u00e9riode r\u00e9fractaire n'est observ\u00e9 pendant le d\u00e9lai AV, l'ACR conclut que la stimulation test a entra\u00een\u00e9 le myocarde.<\/p><p>La m\u00e9thode de conduction AV (AVC) est mise en \u0153uvre lorsqu'une conduction AV 1:1 stable est observ\u00e9e pendant la stimulation auriculaire. La fr\u00e9quence de stimulation auriculaire est augment\u00e9e de 15 bpm (sans d\u00e9passer 101 bpm) et le d\u00e9lai AV est allong\u00e9 pour tenter d'obtenir un rythme AP-VS stable. Le CVA \u00e9value le degr\u00e9 d'entra\u00eenement en observant la r\u00e9ponse ventriculaire \u00e0 la stimulation auriculaire test. Chaque stimulation auriculaire test est suivie d'une stimulation de secours d'une amplitude programm\u00e9e et d'une dur\u00e9e d'impulsion de 1,0 ms pour s'assurer que le rythme reste stable pendant toute la dur\u00e9e du test. Si un \u00e9v\u00e9nement de d\u00e9tection de sonde ventriculaire est observ\u00e9 \u00e0 l'intervalle AP-VS pr\u00e9dit (approximativement) apr\u00e8s la stimulation auriculaire test, le CVA conclut que la stimulation test a entra\u00een\u00e9 le myocarde.<\/p><p>Une recherche de seuil de stimulation commence \u00e0 une amplitude inf\u00e9rieure de 0,125 V au dernier seuil mesur\u00e9. En l\u2019absence de recherche ant\u00e9rieure, une nouvelle recherche commence \u00e0 0,75 V. Le dispositif continue \u00e0 diminuer l\u2019amplitude par \u00e9tapes de 0,125 V jusqu\u2019\u00e0 perte de capture. Il augmente alors l\u2019amplitude de test par \u00e9tapes de 0,125 V jusqu\u2019\u00e0 obtenir une capture 3 fois de suite. Cette amplitude correspond au seuil de stimulation atriale.<\/p><p>L\u2019amplitude cible repose sur les valeurs programm\u00e9es pour les param\u00e8tres Marge de s\u00e9curit\u00e9 en amplitude A. et Amplitude atriale minimale ajust\u00e9e.<\/p><p>Le contr\u00f4le du seuil atrial ne d\u00e9finit aucune sortie atriale \u00e0 des valeurs sup\u00e9rieures \u00e0 5,0 V ou 1,0 ms. L\u2019amplitude et la dur\u00e9e d\u2019impulsion atriales doivent \u00eatre programm\u00e9es manuellement si le patient n\u00e9cessite une sortie de stimulation atriale sup\u00e9rieure \u00e0 5,0 V ou 1,0 ms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dbd7e9f elementor-widget elementor-widget-heading\" data-id=\"dbd7e9f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Microport<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-050a9fd elementor-widget elementor-widget-text-editor\" data-id=\"050a9fd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Les stimulateurs cardiaques Microport ne mesurent pas automatiquement le seuil auriculaire.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Atrial pacing There are a number of manufacturer-specific features in terms of automatic atrial threshold measurement and automatic programming adaptation. Biotronik, Boston Scientific, Medtronic and Abbott pacemakers enable automatic measurement of atrial pacing threshold, with adaptation of programming; Microport CRM-Sorin pacemakers do not. The various systems do not work with cycle-by-cycle capture verification; threshold is [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-258","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pacemaker Atrial Pacing | AAI DDD ECG | Cardiocases<\/title>\n<meta name=\"description\" content=\"Pacemaker atrial pacing \u2014 AAI, DDD, atrial output, threshold &amp; ECG tracings. 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