{"id":265,"date":"2025-07-10T09:29:34","date_gmt":"2025-07-10T09:29:34","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=265"},"modified":"2025-11-18T15:24:33","modified_gmt":"2025-11-18T15:24:33","slug":"ventricular-pacing","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/pacemaker\/ventricular-pacing\/","title":{"rendered":"Stimulation ventriculaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"265\" class=\"elementor elementor-265\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-214d8fa e-con-full e-flex e-con e-parent\" data-id=\"214d8fa\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a55a196 elementor-widget elementor-widget-heading\" data-id=\"a55a196\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ventricular pacing<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6036a46 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"6036a46\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h3&quot;,&quot;h4&quot;,&quot;h5&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;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;fas fa-circle&quot;,&quot;library&quot;:&quot;fa-solid&quot;,&quot;rendered_tag&quot;:&quot;&lt;svg class=\\&quot;e-font-icon-svg e-fas-circle\\&quot; viewBox=\\&quot;0 0 512 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&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\tContent\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__6036a46\" 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__6036a46\" 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__6036a46\" 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>\n\t\t<div class=\"elementor-element elementor-element-bc0cbd2 e-con-full e-flex e-con e-parent\" data-id=\"bc0cbd2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cc366f0 elementor-widget elementor-widget-heading\" data-id=\"cc366f0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">General information<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5303376 elementor-widget elementor-widget-heading\" data-id=\"5303376\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Definition of stimulation threshold<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ae587b elementor-widget elementor-widget-text-editor\" data-id=\"1ae587b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The stimulation threshold corresponds to the smallest electrical impulse, delivered outside all natural refractory periods, capable of generating the propagation of a depolarization. It can be measured in voltage (volts) or pulse width (milliseconds).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b34062 elementor-widget elementor-widget-heading\" data-id=\"7b34062\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Chronaxy and rheobase<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07c36a9 elementor-widget elementor-widget-text-editor\" data-id=\"07c36a9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Lapicque&#8217;s voltage-duration relationship, or chronaxy-rheobase, describes the non-linear relationship between threshold voltage and pulse duration. The amplitude at the stimulation threshold increases significantly with decreasing pulse duration (in practice below 0.2 ms). All points defined by voltage and pulse duration above the curve are associated with effective stimulation, while those below are not.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-740a04e elementor-widget elementor-widget-image\" data-id=\"740a04e\" data-element_type=\"widget\" data-e-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_ventricalstimulation1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ4MywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uMS5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"699\" height=\"414\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation1.png\" class=\"attachment-large size-large wp-image-3483\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation1.png 699w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation1-300x178.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation1-18x12.png 18w\" sizes=\"(max-width: 699px) 100vw, 699px\" \/>\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-f8c4947 elementor-widget elementor-widget-text-editor\" data-id=\"f8c4947\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The rheobase is the smallest rms voltage for an infinite pulse duration (in practice, greater than 2 ms).<\/p><p>Chronaxy is the smallest effective pulse duration for a voltage twice the rheobase. Energy consumption is minimal for a pulse duration corresponding to chronaxy.<\/p><p>Chronaxy and rheobase electrically qualify a stimulation electrode. Today, chronaxy values range from 0.3 to 0.4 ms, whatever the probe used; this value corresponds to the usual nominal pulse width of stimulators. Chronaxy is often longer on left ventricular pacing electrodes.<\/p><p>The pacing threshold is usually lower when the voltage is gradually decreased than when it is gradually increased: this is the Wedensky effect.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cbe8dc7 elementor-widget elementor-widget-heading\" data-id=\"cbe8dc7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Parameters influencing pacing threshold<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-98f1fd7 elementor-widget elementor-widget-text-editor\" data-id=\"98f1fd7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Activity<\/h6><p>Acceleration of heart rate can lower threshold. During exercise, the threshold may be lowered slightly by catecholamines. Sleep and postprandial phases increase it.<\/p><h6>Drugs and metabolic disorders<\/h6><p>Glucocorticoids, epinephrine, ephedrine and isoproterenol lower the threshold, while propranolol, verapamil, spirinolactone, quinidine and amiodarone do not. Class IC antiarrhythmics (flecainide and propafenone) can increase the threshold considerably. Any change in medical therapy should, in theory, lead to verification of the pacing threshold.<\/p><p>Hyperkalemia, hypoxia, hypercapnia, hyperglycemia, acidosis or metabolic alkalosis all increase the stimulation threshold.<\/p><h6>Degree of fibrosis<\/h6><p>On implantation, the direct trauma of the electrode on the endocardium creates a lesion current and a threshold rise that lasts only a few minutes. Before the use of steroid-eluting leads, a rise in pacing thresholds in the first 6 weeks after implantation was frequently observed, due to the inflammatory phenomenon induced by electrode trauma. During this period, high stimulation amplitude values were programmed to guarantee an adequate safety margin. Since the advent of steroid-eluting leads, stimulation thresholds have remained stable from the post-implantation phase, enabling a nominal stimulation voltage of 2.5 Volts to be programmed.<\/p><p>In the longer term, and due to a chronic inflammatory reaction to foreign bodies, fibrosis tissue develops in the vicinity of the electrode in contact with the endocardium, moving the electrode away from excitable myocardial cells. The stimulation threshold therefore tends to increase over time, even though modern probes offer much more stable thresholds than in the past. This possible increase in thresholds then leads to the programming of higher stimulation energies, and hence a reduction in battery life. In this context, it is possible to use an algorithm for automatic adaptation of delivered energy, enabling myocardial stimulation just above the stimulation threshold, with continuous cycle-by-cycle or daily monitoring of effectiveness.<\/p><h6>Influence of electrode configuration on threshold and impedance<\/h6><p>Electrode size, shape and material influence stimulation threshold. The current density applied to the distal electrode should be as high as possible to reduce threshold. This current density is highest at the edges of the electrode. Thus, a spherical electrode is associated with a higher threshold than an annular one.<\/p><p>Given the formula E = U2 x t \/Z, the higher the stimulation impedance, the lower the current consumption. Stimulation impedance represents the sum of the forces opposing current flow in an electrical circuit.<\/p><p>It is made up of 3 ohmic resistances:<\/p><ol><li>resistance of the conductor (which must be as low as possible, as the current spent overcoming this resistance is lost as pure waste and heat);<\/li><li>resistance of the electrode (which must be as high as possible, to reduce current consumption and extend battery life). The smaller the electrode radius, the higher the electrode resistance, which increases current density and reduces the stimulation threshold;<\/li><li>polarization impedance, which should be as low as possible.<\/li><\/ol><p><span style=\"font-size: 1rem;\">\u00a0<\/span><\/p><p><span style=\"font-size: 1rem;\">A porous surface with a large microscopic area covers the electrode to 1) maintain a small radius of curvature and thus increase its resistance 2) reduce polarization impedance.<\/span><\/p><p><span style=\"font-size: 1rem;\">\u00a0<\/span><\/p><h6>Influence of polarity<\/h6><p>Cathodic stimulation generates a lower threshold than anodic stimulation.<\/p><p>In fact, cathodic stimulation creates a decrease in the transmembrane potential difference of cardiomyocytes, whereas anodic stimulation creates hyperpolarization, followed by depolarization, with an increase in the amount of energy required.<\/p><p>Moreover, natural refractory periods are shorter with anodic stimulation, which is associated with a higher theoretical arrhythmogenic risk, especially in high-risk situations such as ischemia or hypoxia.<\/p><p>The anode of a pacing lead is theoretically floating; the risk of anodic stimulation is therefore very low, but is observed when the anode is in contact with the wall and the stimulation amplitude is high. In the majority of cases, bipolar stimulation therefore corresponds to cathodic stimulation.<\/p><p>The threshold for unipolar stimulation is generally lower than for bipolar stimulation.<\/p><h6>Influence of the stimulation waveform<\/h6><p>Antibradycardic stimulation is performed using monophasic stimuli. A monophasic stimulation threshold is lower than a biphasic stimulation threshold.<\/p><h6>The concept of Auto Threshold and Auto Capture<\/h6><p>Determining the stimulation threshold is of major importance, as programming the voltage and pulse duration affects the safety margin and determines the energy consumption of the prosthesis and therefore the rate of battery wear. It is generally recommended to program a safety margin of 100%, which corresponds to twice the threshold voltage. This safety margin is intended to take into account circadian variations in the stimulation threshold, which varies from one subject to another depending on sleep, meals, physical activity, fever, etc.<\/p><p>All modern pacemakers can now be programmed with a function for automatic measurement of the ventricular threshold, which may or may not be combined with automatic adjustment of the stimulation amplitude with cycle-by-cycle verification of capture efficiency (Autocapture model allowing amplitudes very close to the threshold to be delivered with high-amplitude safety stimulation in the event of loss of capture) or adaptation for prolonged periods after planned threshold checks but without cycle-by-cycle verification (Autothreshold model requiring larger margins).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-92ebb6f elementor-widget elementor-widget-heading\" data-id=\"92ebb6f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Brand specific information<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8e61dbc elementor-widget elementor-widget-text-editor\" data-id=\"8e61dbc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ol><li>All modern pacemakers enable automatic measurement of the pacing threshold, with automatic adaptation of the amplitude delivered.<\/li><li>For the 5 major companies, ventricular capture assessment is based on evoked response analysis (differentiation between polarization and evoked response).<\/li><li>Biotronik, Boston Scientific and Abbott pacemakers feature cycle-by-cycle control of capture efficiency, enabling them to deliver amplitudes very close to the measured threshold.<\/li><li>For Medtronic and Microport CRM-Sorin stimulators, threshold is measured periodically, and amplitude is adapted accordingly, without cycle-by-cycle verification of capture, necessitating greater safety margins.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca8c378 elementor-widget elementor-widget-heading\" data-id=\"ca8c378\" data-element_type=\"widget\" data-e-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-5e11939 elementor-widget elementor-widget-text-editor\" data-id=\"5e11939\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Operating principles<\/h6><ul><li>On-run ventricular AutoCapture: measurement of ventricular stimulation threshold + adaptation of programming with cycle-by-cycle control;<\/li><li>threshold systematically measured at least every eight hours (other programming possible: measurement every 24 hours)<\/li><li>cycle-by-cycle control of capture based on analysis of evoked response<\/li><li>safety margin of 0.25 V<\/li><li>maximum amplitude that can be delivered: 4.5 V for programmed pulse duration<\/li><\/ul><h6>Ventricular AutoCapture in practice<\/h6><p>The ventricular AutoCapture pacing system automatically sets the pacemaker&#8217;s ventricular pulse amplitude above the patient&#8217;s regularly measured threshold (at least every eight hours), and enables cycle-by-cycle capture verification. To use the AutoCapture V function in Microny or Victory pacemakers (and previous ranges), a bipolar ventricular lead had to be implanted. The detection mode had to be programmed as bipolar and the stimulation mode as unipolar.<\/p><p>Since the Zephyr pacemaker platform (and subsequent ranges: Accent, Endurity, Assurity), AutoCapture can be activated regardless of the detection and pacing configurations programmed: Uni pacing\/Uni detection; Bi pacing\/Bi detection; Bi pacing\/Uni detection; Uni pacing\/Bi detection.<\/p><p>Prior to the first activation request, an automatic configuration test is performed to check probe compatibility according to polarization, and to differentiate capture from capture failure. This test is optional (but recommended) before each threshold measurement.<\/p><p>Three AutoCapture V settings are available:<\/p><ol><li>Configuration: this setting is available on first activation. The programmer then proposes to start the Configuration Test and then the Stimulation Test if AutoCapture is recommended; <\/li><li>On: the device measures the threshold, automatically adjusts the pulse amplitude and records the threshold measurement in the Threshold Curve, and stores the EGM corresponding to the last threshold; <\/li><li>Off: the device does not measure the stimulation threshold and does not automatically adjust the pulse amplitude.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2478918 elementor-widget elementor-widget-image\" data-id=\"2478918\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1NCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"686\" height=\"314\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb1.png\" class=\"attachment-large size-large wp-image-3454\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb1.png 686w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb1-300x137.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb1-18x8.png 18w\" sizes=\"(max-width: 686px) 100vw, 686px\" \/>\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-f7f5475 elementor-widget elementor-widget-text-editor\" data-id=\"f7f5475\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The following parameters can be set in the Auto Capture Settings window:<\/p><ul><li>backup pacing configuration which programs the polarity configuration of backup pacing to bipolar or unipolar (nominal value);<\/li><li>search interval which programs the periodicity of threshold measurement to 8 hours (nominal value) or 24 hours;<br \/>stimulated\/detected AV delays for AutoCapture\u2122 V which program the Stimulated AV Delay and Detected AV<\/li><li>Delay parameters used during a threshold search to 50\/25 ms (nominal value) or 100\/70 ms or 120\/100 ms. The recommended setting for this parameter is 50\/25 to avoid merging. Merging is more likely with longer delays and can lead to incorrect threshold search results.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9fd7e5e elementor-widget elementor-widget-image\" data-id=\"9fd7e5e\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1NSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjIucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"693\" height=\"319\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb2.png\" class=\"attachment-large size-large wp-image-3455\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb2.png 693w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb2-300x138.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb2-18x8.png 18w\" sizes=\"(max-width: 693px) 100vw, 693px\" \/>\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-f75f97e elementor-widget elementor-widget-text-editor\" data-id=\"f75f97e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The AutoCaptureTM system uses 4 algorithms to monitor capture cycle by cycle:<\/p><ol><li>Capture verification<\/li><li>Capture loss recovery<\/li><li>Fusion avoidance<\/li><li>Periodic measurement of stimulation threshold<\/li><\/ol><p>\u00a0<\/p><p><span style=\"text-decoration: underline;\">1. Capture verification<\/span><\/p><p>Capture efficiency verification is based on Evoked Response (ER) analysis. If the ventricular pacing configuration is set to bipolar, the area under the curve is used (Paced Depolarization Integral). If the ventricular pacing configuration is set to unipolar, the signal slope (DMAX) is used.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-379da5a elementor-widget elementor-widget-image\" data-id=\"379da5a\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1NiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjMucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"325\" height=\"275\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb3.png\" class=\"attachment-large size-large wp-image-3456\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb3.png 325w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb3-300x254.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb3-14x12.png 14w\" sizes=\"(max-width: 325px) 100vw, 325px\" \/>\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-0da5131 elementor-widget elementor-widget-text-editor\" data-id=\"0da5131\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>To verify the existence of capture, there is an initial blanking phase of 14 ms, followed by an evoked response search window of 46 ms. If the device detects an evoked response within this window, capture is confirmed. If no evoked response signal is detected, the device emits a 5 V back-up pulse within 80 to 100 ms of the initial pulse to ensure capture.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2f3293 elementor-widget elementor-widget-image\" data-id=\"b2f3293\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1NywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjQucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"529\" height=\"694\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb4.png\" class=\"attachment-large size-large wp-image-3457\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb4.png 529w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb4-229x300.png 229w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb4-9x12.png 9w\" sizes=\"(max-width: 529px) 100vw, 529px\" \/>\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-91e6ce5 elementor-widget elementor-widget-text-editor\" data-id=\"91e6ce5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>A setup test is necessary to confirm that the AutoCapture system works with the implanted probe. This test measures evoked response and polarization artifact to enable effective capture evaluation. It is used to determine an appropriate RE detection sensitivity. If there is a sufficient safety margin between RE Sensitivity and probe polarization, then AutoCapture operation will be reliable.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5bcaf0e elementor-widget elementor-widget-image\" data-id=\"5bcaf0e\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb5.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb5\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1OCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjUucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"401\" height=\"228\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb5.png\" class=\"attachment-large size-large wp-image-3458\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb5.png 401w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb5-300x171.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb5-18x10.png 18w\" sizes=\"(max-width: 401px) 100vw, 401px\" \/>\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-790324c elementor-widget elementor-widget-text-editor\" data-id=\"790324c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>At the end of the configuration test, the device indicates whether AutoCapture is recommended or not.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-005cb60 elementor-widget elementor-widget-image\" data-id=\"005cb60\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb6.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb6\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ1OSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjYucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"694\" height=\"320\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb6.png\" class=\"attachment-large size-large wp-image-3459\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb6.png 694w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb6-300x138.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb6-18x8.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-e5a4f6b elementor-widget elementor-widget-text-editor\" data-id=\"e5a4f6b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Configuration test result: not recommended in this example for bipolar detection and unipolar stimulation. There remains the option of changing the detection and stimulation mode (Zephyr range and higher) and\/or pulse duration, then restarting the test.<\/p><p><span style=\"text-decoration: underline;\">2. Capture loss recovery<\/span><\/p><p>If the capture check confirms two consecutive capture losses, the device starts the capture loss recovery algorithm. The next cycle, the stimulator delivers a rescue pulse, then increases the automatic pulse amplitude by 0.25 V and searches for a capture. If no capture is confirmed, the device increases the pulse amplitude by 0.125 V on the next cycle and searches for capture. When two successive captures are confirmed at the same voltage, the device starts a threshold search.<\/p><p>If no capture is confirmed before the device automatically increases the pulse amplitude to 3.875 V, the device switches to High Amplitude Mode: the pulse amplitude is set to 5 V and the pulse duration to 0.5 ms (or more if the programming value is higher). After 128 cycles, the device starts a threshold search.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-15a6cc5 elementor-widget elementor-widget-image\" data-id=\"15a6cc5\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb7.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb7\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2MCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjcucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"631\" height=\"778\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb7.png\" class=\"attachment-large size-large wp-image-3460\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb7.png 631w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb7-243x300.png 243w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb7-10x12.png 10w\" sizes=\"(max-width: 631px) 100vw, 631px\" \/>\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-45270d5 elementor-widget elementor-widget-text-editor\" data-id=\"45270d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"text-decoration: underline;\">3. Avoiding mergers<\/span><\/p><p>Mergers with AutoCapture must be avoided, as the algorithm will conclude that capture losses have occurred as a result of threshold elevation, and will trigger its capture loss recovery algorithm.<\/p><p>In dual-chamber mode, a single absence of ER detection, requiring the delivery of a 5 V backup pulse, automatically causes the stimulated and detected AV delay to be lengthened by 100 ms during the next cycle, in order to search for spontaneous conduction. In the first instance, the algorithm \u201cassumes\u201d that the loss of capture is due to fusion and not to a lack of pulse energy. This function acts in a similar way to <span style=\"font-size: 1rem;\">VIP<sup>TM<\/sup><\/span>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-99716b8 elementor-widget elementor-widget-image\" data-id=\"99716b8\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb8.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb8\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2MSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjgucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"499\" height=\"233\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb8.png\" class=\"attachment-large size-large wp-image-3461\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb8.png 499w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb8-300x140.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb8-18x8.png 18w\" sizes=\"(max-width: 499px) 100vw, 499px\" \/>\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-c77b812 elementor-widget elementor-widget-text-editor\" data-id=\"c77b812\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>If loss of capture is confirmed after prolongation of the stimulated or detected AV delay (2 consecutive cycles requiring delivery of a 5 V safety pulse), the stimulator triggers its capture recovery algorithm:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ba437b5 elementor-widget elementor-widget-image\" data-id=\"ba437b5\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb9.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb9\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2MiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjkucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"487\" height=\"190\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb9.png\" class=\"attachment-large size-large wp-image-3462\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb9.png 487w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb9-300x117.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb9-18x7.png 18w\" sizes=\"(max-width: 487px) 100vw, 487px\" \/>\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-5b4c3a2 elementor-widget elementor-widget-text-editor\" data-id=\"5b4c3a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"text-decoration: underline;\">4. Periodic measurement of stimulation threshold<\/span><\/p><p>When the automatic threshold search is initiated (every 8h or 24h), the device decreases the pulse amplitude by 0.25 V every two cycles. If this leads to a loss of capture, the device emits a 5 V backup pulse (safety margin) 80 to 100 ms after the first test pulse. If capture is lost on two consecutive cycles at the same amplitude, the algorithm then increases the pulse amplitude in steps of 0.125 V every two cycles. Two consecutive captures at the same amplitude must be confirmed to determine the new stimulation threshold value. When the new value is found, the device determines a new automatic amplitude by adding a working margin of 0.25 V.<\/p><p>If the decreasing search fails to determine a loss of capture at the lowest pulse amplitude setting, i.e. 0 V, the device switches to \u201cHigh amplitude mode\u201d for a duration of 128 cardiac cycles, then restarts the threshold search.<\/p><p>If the stimulation threshold determined by the algorithm exceeds 3.875 V for a given pulse duration, AutoCapture is automatically deactivated and the pulse amplitude is reprogrammed to 5 V (High Amplitude Mode). In this case, a higher pulse duration setting may enable AutoCapture to be reactivated.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-53a4dbb elementor-widget elementor-widget-image\" data-id=\"53a4dbb\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb10.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb10\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2MywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjEwLnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"404\" height=\"404\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb10.png\" class=\"attachment-large size-large wp-image-3463\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb10.png 404w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb10-300x300.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb10-150x150.png 150w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb10-12x12.png 12w\" sizes=\"(max-width: 404px) 100vw, 404px\" \/>\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-1820911 elementor-widget elementor-widget-text-editor\" data-id=\"1820911\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The threshold search is repeated 1) after each loss-of-capture recovery operation 2) automatically every 8 hours 3) on removal of the telemetry head 4) on removal of the magnet 5) when the operator runs the stimulator threshold test via Autocapture\u2122.<\/p><p>To avoid fusions, the Stimulated AV Delay is programmed to 50 ms and the Detected AV Delay is programmed to 25 ms. The programmed values are restored when the search is complete.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c8b8d64 elementor-widget elementor-widget-image\" data-id=\"c8b8d64\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb11.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb11\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2NCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjExLnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"671\" height=\"777\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb11.png\" class=\"attachment-large size-large wp-image-3464\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb11.png 671w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb11-259x300.png 259w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb11-10x12.png 10w\" sizes=\"(max-width: 671px) 100vw, 671px\" \/>\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-279b9c9 elementor-widget elementor-widget-image\" data-id=\"279b9c9\" data-element_type=\"widget\" data-e-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_ventricalstimulation_abb12.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_abb12\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2NSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2FiYjEyLnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"730\" height=\"860\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb12.png\" class=\"attachment-large size-large wp-image-3465\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb12.png 730w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb12-255x300.png 255w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_abb12-10x12.png 10w\" sizes=\"(max-width: 730px) 100vw, 730px\" \/>\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-96c6584 elementor-widget elementor-widget-text-editor\" data-id=\"96c6584\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Trend curve showing threshold evolution over one year<\/p><p>Recorded EGM corresponding to the most recent threshold<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8566637 elementor-widget elementor-widget-heading\" data-id=\"8566637\" data-element_type=\"widget\" data-e-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-6194066 elementor-widget elementor-widget-text-editor\" data-id=\"6194066\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Operating principles<\/h6><ul><li>ventricular capture control on run: ventricular stimulation threshold measurement + programming adaptation with cycle-by-cycle control; ventricular capture control on ATM: ventricular stimulation threshold measurement without adaptation; ventricular capture control on stop: fixed programming (no automatic threshold performed)<\/li><li>ventricular threshold performed systematically every day at 2:00 am (programmable measurement time and frequency)<\/li><li>cycle-by-cycle capture verification based on evoked response analysis<br \/>programmable safety margin (nominal value + 0. 5 V)<\/li><li>maximum amplitude that can be delivered: 4.8 V for 0.4 ms<\/li><li>minimum amplitude that can be delivered: 0.7 V for 0.4 ms<\/li><\/ul><p>\u00a0<\/p><h6>Capture control in practice<\/h6><p>Various parameters can be programmed:<\/p><ul><li>the start amplitude, which corresponds to the start value of the threshold measurement; nominal value 3 V (from 2.4 to 4.8 V);<\/li><li>the safety margin, which corresponds to the value added in amplitude to the threshold measurement, nominal value 0.5 V (from 0.3 to 1.2 V); note that whatever the threshold value and the safety margin, the stimulation amplitude cannot fall below 0. 7 V;<\/li><li>search time and search interval correspond to the time when the threshold is systematically measured (nominal value 2:00 a.m.), even in the absence of loss of capture objectified by the device, and to the interval between each minimum search (nominal value 24 hours).<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dda15e0 elementor-widget elementor-widget-image\" data-id=\"dda15e0\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bio1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bio1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2NiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2JpbzEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"505\" height=\"346\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio1.png\" class=\"attachment-large size-large wp-image-3466\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio1.png 505w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio1-300x206.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio1-18x12.png 18w\" sizes=\"(max-width: 505px) 100vw, 505px\" \/>\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-584c626 elementor-widget elementor-widget-text-editor\" data-id=\"584c626\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The pacemaker can define different statuses for the automatic ventricular capture control function: 1) \u201cOK\u201d, which corresponds to correct operation; 2) \u2018disabled\u2019 (no threshold measurement), which can correspond to 4 possibilities: a) more than 25 capture losses in 24 hours b) impossibility of signal analysis c) 3 consecutive signal analysis failures and d) pacemaker in ERI; 3) \u201chigh threshold\u201d: as the last measured threshold is higher than the starting value, it is necessary to adapt this starting value; 4) \u201con hold\u201d (the threshold cannot temporarily be measured), which can occur if the heart rate is too high when the measurement was to be taken.<\/p><p>Automatic control is performed in stages, with measurement of evoked response, measurement of polarization artifact, measurement of threshold in 0.6 V steps, then measurement of threshold in 0.1 V steps.<\/p><p>&#8211; measurement of evoked response and polarization artifact: for effective capture evaluation, it is essential to be able to differentiate between evoked response and polarization artifact.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2aa421 elementor-widget elementor-widget-image\" data-id=\"b2aa421\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bio2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bio2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2NywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2JpbzIucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"361\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio2.png\" class=\"attachment-large size-large wp-image-3467\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio2.png 700w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio2-300x155.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio2-18x9.png 18w\" sizes=\"(max-width: 700px) 100vw, 700px\" \/>\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-6e1cbef elementor-widget elementor-widget-text-editor\" data-id=\"6e1cbef\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>5 stimulations are delivered at programmed frequency with a short AV delay (15 ms post atrial detection and 50 ms post atrial stimulation) to ensure effective ventricular capture without fusion and to highlight the evoked response and polarization artifact.<\/p><p>5 sequences of 2 ventricular stimulations with the same AV delay are then delivered with a short coupling of 100 ms between the 2 ventricular stimulations (on the first, capture: evaluation of evoked response and polarization artifact; on the second, no capture: evaluation of polarization artifact only).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0086e24 elementor-widget elementor-widget-image\" data-id=\"0086e24\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bio3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bio3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2OCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2JpbzMucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"709\" height=\"275\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio3.png\" class=\"attachment-large size-large wp-image-3468\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio3.png 709w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio3-300x116.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio3-18x7.png 18w\" sizes=\"(max-width: 709px) 100vw, 709px\" \/>\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-b3334f7 elementor-widget elementor-widget-text-editor\" data-id=\"b3334f7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>To differentiate between evoked response and polarization artifact, the device analyzes the positive and negative amplitude of the signals, the time at which the signal crosses the baseline, and different integrals of the signal at different times.<\/p><p>Signal analysis is validated if there is a significant difference between the amplitude of the evoked response and that of the polarization artifact.<\/p><p>To verify the existence of capture, there is an initial blanking phase of 20 ms, followed by a 60 ms evoked response search window, with the possibility of rescue stimulation after 130 ms if there is no capture.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5ba9a22 elementor-widget elementor-widget-image\" data-id=\"5ba9a22\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bio4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bio4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ2OSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2JpbzQucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"701\" height=\"346\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio4.png\" class=\"attachment-large size-large wp-image-3469\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio4.png 701w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio4-300x148.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bio4-18x9.png 18w\" sizes=\"(max-width: 701px) 100vw, 701px\" \/>\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-0fef396 elementor-widget elementor-widget-text-editor\" data-id=\"0fef396\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Measurement of pacing threshold<\/h6><p>A ventricular threshold is set, with a 0.6 V drop in amplitude for each ventricular cycle. When loss of capture is detected, the test is repeated at the minimum amplitude ensuring the last capture, with a 0.1 V drop in amplitude. When loss of capture is detected, a higher-amplitude rescue stimulus occurs 100 ms after the first (amplitude increase of 0.1 V with a pulse duration of 1 ms). A second stimulus of the same amplitude as that associated with loss of capture is delivered. If the second stimulus captures, a third is delivered and the amplitude continues to decrease. If the 2nd stimulus fails to capture, a safety pulse is delivered and the threshold is determined.<\/p><p>Once the threshold has been measured, the stimulation amplitude is automatically adapted (nominal 0.5 V margin), with cycle-by-cycle verification of capture efficiency.<\/p><p>When a lack of capture is diagnosed on a cycle, a back-up stimulation occurs 100 ms after the first one (amplitude increase of 0.1 V with a pulse duration of 1 ms). A modification of the AV delay over 3 beats is then performed (AV delay extension) to ensure the absence of fusion. If the loss of capture persists, the AV delay is shortened again. If 3 consecutive loss-of-capture events are detected, a new threshold measurement is performed, adapting the amplitude to the new value.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c5d7dc1 elementor-widget elementor-widget-heading\" data-id=\"c5d7dc1\" data-element_type=\"widget\" data-e-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-cc1f92e elementor-widget elementor-widget-text-editor\" data-id=\"cc1f92e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Operating principles<\/h6><ul><li>Ventricular amplitude on AUTO: measurement of ventricular stimulation threshold + adaptation of programming with cycle-by-cycle control; Ventricular amplitude on fixed value and daily trends on run: measurement of ventricular stimulation threshold without adaptation<\/li><li>threshold systematically performed every 21 hours<\/li><li>cycle-by-cycle capture control based on evoked response analysis<\/li><li>non-programmable safety margin of + 0. 5 V<\/li><li>maximum amplitude that can be delivered: 3.5 V for 0.4 ms<\/li><li>minimum amplitude that can be delivered: 0.7 V for 0.4 ms<\/li><\/ul><div>\u00a0<\/div><h6>Automatic capture control in practice<\/h6><p>The PaceSafe RV algorithm enables automatic ventricular threshold testing, with adaptation of pacing amplitude to threshold value + 0.5 V and cycle-by-cycle verification of capture.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-982e5d6 elementor-widget elementor-widget-image\" data-id=\"982e5d6\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bosci1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bosci1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3MCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2Jvc2NpMS5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"356\" height=\"327\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci1.png\" class=\"attachment-large size-large wp-image-3470\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci1.png 356w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci1-300x276.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci1-13x12.png 13w\" sizes=\"(max-width: 356px) 100vw, 356px\" \/>\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-d69937d elementor-widget elementor-widget-text-editor\" data-id=\"d69937d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>This algorithm can work with either unipolar or bipolar ventricular leads. An automatic threshold test is performed every 21 hours. Pulse duration is set to 0.4 ms. Ventricular stimulation amplitude is set with a margin of 0.5 V above threshold, with a minimum value of 0.7 V and a maximum value of 3.5 V. The threshold must be between 0.2 and 3 V.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-30eb5fc elementor-widget elementor-widget-image\" data-id=\"30eb5fc\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bosci2.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bosci2\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3MSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2Jvc2NpMi5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"665\" height=\"289\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci2.png\" class=\"attachment-large size-large wp-image-3471\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci2.png 665w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci2-300x130.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci2-18x8.png 18w\" sizes=\"(max-width: 665px) 100vw, 665px\" \/>\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-b351cea elementor-widget elementor-widget-text-editor\" data-id=\"b351cea\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>To measure threshold, the starting ventricular stimulation amplitude is 3.5 V, pulse duration is set to 0.4 ms. The stimulated AV delay is set at 60 ms, the detected AV delay at 30 ms.<\/p><p>The test begins with an initialization phase (2 warm-up cycles to calibrate the evaluation of the evoked response measurement, then 12 cycles to initialize the evoked response channel filters. This initialization phase does not take place if the AUTO Capture function is already activated and a threshold has already been measured in AUTO mode).<\/p><p>Threshold measurement begins with an amplitude drop of 0.1 V every 3 beats. The stimulation threshold is determined when 2 capture losses out of 4 stimulated cycles are observed. The second cycle without capture is marked C-LOC (confirmed loss of capture). The stimulation threshold is set at the value preceding the loss of capture. Safety stimulation is provided for each loss of capture (70 ms after the first stimulation).<\/p><p>Once the threshold has been measured, the stimulation amplitude is automatically adapted (nominal 0.5 V margin), with cycle-by-cycle verification of capture efficiency.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4678c73 elementor-widget elementor-widget-image\" data-id=\"4678c73\" data-element_type=\"widget\" data-e-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_ventricalstimulation_bosci3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_bosci3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3MiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX2Jvc2NpMy5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"696\" height=\"362\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci3.png\" class=\"attachment-large size-large wp-image-3472\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci3.png 696w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci3-300x156.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_bosci3-18x9.png 18w\" sizes=\"(max-width: 696px) 100vw, 696px\" \/>\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-9057b3c elementor-widget elementor-widget-heading\" data-id=\"9057b3c\" data-element_type=\"widget\" data-e-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-7bea434 elementor-widget elementor-widget-text-editor\" data-id=\"7bea434\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Operating principles<\/h6><ul><li>right ventricular threshold control on automatic dynamics: daily measurement of ventricular stimulation threshold + adaptation of programming for 24 hours; ventricular capture control on monitor: measurement of ventricular stimulation threshold without adaptation; capture control on stop: fixed programming without threshold measurement<\/li><li>threshold performed systematically every day at 1:00 a.m.<\/li><li>pacing threshold based on evoked response analysis<\/li><li>a single daily measurement with adaptation for 24 hours<\/li><li>target amplitude by multiplying the VD amplitude safety margin (programmable) by the amplitude threshold measured at a pulse duration of 0.4 ms within an output range defined by a programmable lower limit (Adjusted minimum amplitude parameter) and the upper threshold limit of 5.0 V and 1.0 ms. The minimum pulse duration for ventricular threshold control is 0.4 ms.<\/li><li>maximum amplitude that can be delivered: 5 V for 1 ms<\/li><li>minimum amplitude that can be delivered: 1 V for 0.4 ms<\/li><\/ul><h6>Right ventricular threshold control in practice<\/h6><p>Every day at 1 a.m., the pacemaker performs a ventricular pacing threshold search, to determine the amplitude threshold at a fixed pulse duration of 0.4 ms. The device evaluates training by detecting the evoked response signal following each test stimulation.<\/p><p>The stimulation threshold search starts at an amplitude 0.125 V below the last measured threshold. In the absence of a previous search, the search starts at 0.75 V. The device continues to decrease amplitude in 0.125 V steps until capture is lost. It then increases the amplitude in steps of 0.125 V until it finds a capture 3 times in a row (corresponds to the new threshold value). During the threshold measurement procedure, backup pacing automatically follows each test pacing (whether capture has occurred or not), preventing the possibility of a ventricular pause during this procedure. Back-up pacing takes place 100 ms after test pacing, at the programmed amplitude and pulse duration of 1.0 ms.<\/p><p>Once the threshold has been measured, the stimulation amplitude is automatically adapted for the following 24 hours, without cycle-by-cycle verification of capture efficiency.<\/p><p>The amplitude delivered for these 24 hours depends on the values programmed for the \u201cRV amplitude safety margin\u201d and \u201cRV minimum adjusted amplitude\u201d parameters. After a successful stimulation threshold search, the device calculates a target amplitude by multiplying the RV amplitude safety margin by the amplitude threshold measured at a pulse duration of 0.4 ms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5acfcf9 elementor-widget elementor-widget-image\" data-id=\"5acfcf9\" data-element_type=\"widget\" data-e-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_ventricalstimulation_med1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_med1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3MywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21lZDEucG5nIn0%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"662\" height=\"210\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_med1.png\" class=\"attachment-large size-large wp-image-3473\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_med1.png 662w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_med1-300x95.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_med1-18x6.png 18w\" sizes=\"(max-width: 662px) 100vw, 662px\" \/>\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-2e12538 elementor-widget elementor-widget-text-editor\" data-id=\"2e12538\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>This adaptation can only take place within an output range defined by a programmable lower limit (parameter Adjusted minimum amplitude) and the upper threshold limit of 5.0 V and 1.0 ms. The minimum pulse duration for ventricular threshold control is 0.4 ms.<\/p><p>If the ventricular threshold is measured at 0.4 V for 0.4 ms with a minimum safety margin of 2 times the threshold and a minimum amplitude of 2 V, the delivered amplitude is 2 V for 0.4 ms.<\/p><p>If the ventricular threshold is measured at 1.4 V for 0.4 ms with a minimum safety margin of 2 times the threshold and a minimum amplitude of 2 V, the delivered amplitude is 2.8 V for 0.4 ms.<\/p><p>If the ventricular threshold is measured at 3 V for 0.4 ms with a minimum safety margin of 2 times the threshold and a minimum amplitude of 2 V, the pulse duration is increased to obtain a new threshold. If the new ventricular threshold is measured at 2.5 V for 0.8 ms, the delivered amplitude is 5 V for 0.8 ms (amplitude safety margin respected).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66029e9 elementor-widget elementor-widget-heading\" data-id=\"66029e9\" data-element_type=\"widget\" data-e-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-bbf2d80 elementor-widget elementor-widget-text-editor\" data-id=\"bbf2d80\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Operating principles<\/h6><ul><li>autoseuil on auto: regular measurements of ventricular stimulation threshold + adaptation of programming; autoseuil on suivi: regular measurements of ventricular stimulation threshold but without adaptation of programming; autoseuil on non: no threshold measurement and fixed value;<\/li><li>threshold performed systematically every 6 hours based on evoked response analysis<\/li><li>4 threshold measurements per day with adaptation for the following 6 hours (no cycle-by-cycle verification)<\/li><li>automatic amplitude adaptation to twice the threshold value (100% safety margin) within the limit of a programmable minimum value (1. 5, 2, 2.5, 3, 3.5 or 4 V)<\/li><\/ul><h6>\u00a0<\/h6><h6>Ventricular auto-thresholding in practice<\/h6><p>The capture test is based on differentiation between evoked potential (EPR) and residual probe polarization (Polar).<\/p><p>After an effective stimulus, for a period of 65 ms, both potentials are present (EPR + Polar) and measurable, whereas after an ineffective stimulus, only the residual polarization of the lead is present (Polar) and measurable.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e29de92 elementor-widget elementor-widget-image\" data-id=\"e29de92\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3NCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3IxLnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"737\" height=\"461\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr1.png\" class=\"attachment-large size-large wp-image-3474\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr1.png 737w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr1-300x188.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr1-18x12.png 18w\" sizes=\"(max-width: 737px) 100vw, 737px\" \/>\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-d2115a5 elementor-widget elementor-widget-text-editor\" data-id=\"d2115a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Waiting phase<\/h6><p>The aim of this phase is to stabilize the rhythm; 8 stimulations at 5 V are delivered.<\/p><h6>Calibration phase<\/h6><p>The aim of the calibration phase is twofold:<\/p><ol><li>To identify an initially high stimulation threshold (above 2V)<\/li><li>To evaluate the Evoked Response measurement<\/li><\/ol><p><br \/>In order to increase the probability of capturing the ventricle, the current AV delay is shortened by 65 ms (double-chamber stimulator) or the escape interval is shortened by 65 ms (single-chamber stimulator).<\/p><p>Three stimulations at 4 V (at the programmed pulse width) are delivered, and only the last 2 are followed by measurement of the evoked potential response\/polarization.<\/p><p>Three stimulations at 2 V (at the programmed pulse width) are delivered, and only the last 2 are followed by measurement of the evoked potential response\/polarization. These 3 stimulations at 2 V are each followed, after the measurement period (65 ms), by a safety stimulation at 2.5 V with a pulse width of 1 ms. The aim of these safety pacing sessions is to ensure ventricular capture if the pacing threshold exceeds 2 V. If these two series give acceptable and comparable measurements, the stimulator applies the next step.<\/p><p>Two &#8220;0 V stimulations&#8221; are effectively followed by a period of measurement of the evoked potential response\/polarization; they enable us to diagnose fusion, which can alter the threshold measurement. Indeed, if spontaneous evoked potentials are measured after a &#8220;0 V stimulation&#8221;, they are indicative of the presence of possible fusion or ectopic depolarizations during previous measurements (at 2 and 4 V). The calibration phase is then repeated with a short AV delay (65 ms) to avoid fusion. If, despite this adjustment, fusion is still detected, the test is stopped and the ventricular voltage is forced to 5 V for the next six hours.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c895a7c elementor-widget elementor-widget-image\" data-id=\"c895a7c\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr3.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr3\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3NiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3IzLnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"715\" height=\"302\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr3.png\" class=\"attachment-large size-large wp-image-3476\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr3.png 715w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr3-300x127.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr3-18x8.png 18w\" sizes=\"(max-width: 715px) 100vw, 715px\" \/>\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-73282df elementor-widget elementor-widget-text-editor\" data-id=\"73282df\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Ventricular pacing threshold measurement phase<\/h6><p>Once calibration is complete, the pacing threshold test starts at 1.95 V with a 0.15 V decrement until the loss-of-capture voltage or 0.15 V minimum is reached. Each stimulation is followed by a measurement period (65 ms). If loss of capture is detected, a safety stimulation at 2.5 V with a pulse width of 1 ms is delivered.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5f575a2 elementor-widget elementor-widget-image\" data-id=\"5f575a2\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr4.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr4\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3NywidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3I0LnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"559\" height=\"293\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr4.png\" class=\"attachment-large size-large wp-image-3477\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr4.png 559w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr4-300x157.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr4-18x9.png 18w\" sizes=\"(max-width: 559px) 100vw, 559px\" \/>\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-28eaa94 elementor-widget elementor-widget-text-editor\" data-id=\"28eaa94\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>In this example, the V threshold is 1.5 V. The amplitude is programmed to 3 V output for the next 6 hours. The 1.5 V value is displayed on the Auto-threshold curve, along with the stimulation voltage applied for the next 6 hours.<\/p><h6>Programming<\/h6><p>Ventricular Auto-threshold is not available in SafeR mode. It is performed if the heart rate is below 95 min-1. Ventricular pacing amplitude is not programmable when V Auto-threshold is set to \u201cAuto\u201d. Ventricular pulse duration values greater than 0.5 ms can no longer be programmed when the V Auto-threshold function is set to \u201cFollow-up\u201d or \u201cAuto\u201d. The AV rest delay is reprogrammed to 125 ms if it previously had a value of less than 125 ms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f4c17c9 elementor-widget elementor-widget-image\" data-id=\"f4c17c9\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr5.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr5\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3OCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3I1LnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"688\" height=\"551\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr5.png\" class=\"attachment-large size-large wp-image-3478\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr5.png 688w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr5-300x240.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr5-15x12.png 15w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/>\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-f09ec7a elementor-widget elementor-widget-text-editor\" data-id=\"f09ec7a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h6>Follow-up of V stimulation threshold in memories<\/h6><p>On the AIDA Diagnostics screen, in the PM tab, clicking on the AutoMoil Curves button displays the average value curve of the 4 daily measurements from the V Auto-threshold function. The ventricular output voltage applied is shown in parallel.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ae6bbe elementor-widget elementor-widget-image\" data-id=\"3ae6bbe\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr6.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr6\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ3OSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3I2LnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"692\" height=\"560\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr6.png\" class=\"attachment-large size-large wp-image-3479\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr6.png 692w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr6-300x243.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr6-15x12.png 15w\" sizes=\"(max-width: 692px) 100vw, 692px\" \/>\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-b8dc605 elementor-widget elementor-widget-text-editor\" data-id=\"b8dc605\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>During device checks, Auto-threshold V (with a slightly different calibration phase and starting voltage) is part of the automatic sequence of probe measurements, with EGM display for confirmation. This optional sequence is called SmartCheck.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a57a0d3 elementor-widget elementor-widget-image\" data-id=\"a57a0d3\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr7.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr7\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ4MCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3I3LnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"689\" height=\"554\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr7.png\" class=\"attachment-large size-large wp-image-3480\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr7.png 689w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr7-300x241.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr7-15x12.png 15w\" sizes=\"(max-width: 689px) 100vw, 689px\" \/>\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-8748939 elementor-widget elementor-widget-image\" data-id=\"8748939\" data-element_type=\"widget\" data-e-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_ventricalstimulation_micr8.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_ventricalstimulation_micr8\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MzQ4MSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTBcL3BtX3ZlbnRyaWNhbHN0aW11bGF0aW9uX21pY3I4LnBuZyJ9\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"672\" height=\"956\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr8.png\" class=\"attachment-large size-large wp-image-3481\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr8.png 672w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr8-211x300.png 211w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/10\/pm_ventricalstimulation_micr8-8x12.png 8w\" sizes=\"(max-width: 672px) 100vw, 672px\" \/>\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>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Ventricular pacing Content General information Definition of stimulation threshold The stimulation threshold corresponds to the smallest electrical impulse, delivered outside all natural refractory periods, capable of generating the propagation of a depolarization. It can be measured in voltage (volts) or pulse width (milliseconds). Chronaxy and rheobase Lapicque&#8217;s voltage-duration relationship, or chronaxy-rheobase, describes the non-linear relationship [&hellip;]<\/p>\n","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-265","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pacemaker Ventricular Pacing | ECG Tracings | Cardiocases<\/title>\n<meta name=\"description\" content=\"Pacemaker ventricular pacing \u2014 output, threshold, pacing spikes &amp; ECG interpretation. 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