Question: What is Automatic Capture Control (ACC)?
Answer: Once activated, this algorithm looks to ensure capture on every single beat, while programmed slightly above threshold. The factory setting for ACC is ON, but it only works with a pulse width of 0.4ms. A pulse width of 0.5ms might gain more consistent capture than 0.4ms, but ACC will not work with 0.5ms. When active, ACC searches for an evoked response (capture) right after the output pulse. If none is seen within 100ms, the device emits an output pulse 0.5V higher than the current threshold, along with a pulse width of 1.0ms to ensure capture.
A more detailed version can be found in the following article:
When signal analysis is successful, voltage step-down occurs at every elicited beat, firstly in large (0.6V) and secondly in smaller (0.1V) steps, until an ineffective stimulus (loss of capture) is delivered. The last effective pulse is defined as the threshold, and the programmed safety margin (default 0.5V) is added to determine the current output. ACC works at 0.4ms pulse width only. EVERY paced beat is checked for ER detection, and a pack-up pulse at 1.0ms is delivered in the instance of loss of capture. In the event three (3) consecutive beats require delivery of the back-up pulse, signal analysis occurs again, and a new threshold measurement is triggered to update the current pacing output; if test start amplitude equals the current threshold, VCC reverts to a safety output as test start voltage +1.2V.
Reference: EP Europace, Vol 18, Issue 10, Oct 2016, p 1551-1560
In contrast to other companies, the BIOTRONIK algorithm works on a beat-to-beat basis, and again runs a threshold every day, at midnight. This is shown to be 97% effective in the Ventricle – the best in the industry.
In addition to being a great safety feature, the ACC adds significant longevity to the battery, usually increasing battery life by one (1) or two (2) years. This can be visualized on the programmer parameter page, in the lower right corner when you activate the ACC. The longevity is calculated at 100% pacing at the programmed output. If the patient has any intrinsic activity the pacer will inhibit, and the battery will last longer.