Reliability of auto-thresholds for remote surveillance of pacemakers: insights from the Calliope study

In recent years, remote monitoring technology has transformed the management of CIEDs, by transferring part of historical in-hospital follow-up to dedicated teams and internet-based platforms allowing time saving. Auto-threshold or auto-capture algorithms have been introduced in modern devices to improve patient management, particularly by enabling early detection of capture issues and dynamic output adjustment during fluctuations in pacing thresholds, by checking the minimal energy required to induce a depolarization wave in the RA or RV cavity. This allows permanently adapted pacing output, and potentially battery longevity extension if safety margins are reduced. The MicroPort pacemakers (ALIZEA, BOREA and CELEA) provide remote monitoring via Bluetooth Low Energy, including RA and RV auto-threshold algorithms (RAAT and RVAT) and remote alerts. The CALLIOPE investigation (NCT05165095) confirms the high accuracy of auto-threshold algorithms, in the range of 98%, which provide a reliable alternative to on-site follow-up in a vast majority of patients, when combined with the remote monitoring functions of ALIZEA, BOREA, and CELEA pacemakers.