An implantable dual chamber stimulation device provides a novel detection scheme
for automatically detecting atrial capture and performing an atrial pacing threshold
assessment. The stimulation device preferably waits until the patient is at or
near rest and monitors the patient's P-wave activity to determine a detection window
where a next P-wave is expected to occur. The stimulation device then delivers
an atrial pulse prior to the next detection window, and monitors the window to
determine whether a P-wave occurs therein. If a P-wave does not occur, then atrial
capture is present, while occurrence of a P-wave indicates absence of atrial capture.
If atrial capture is absent, the stimulation device automatically determines an
appropriate atrial pacing threshold by monitoring the detection window while adjusting
the stimulation pulse energy level. Advantageously, the present invention further
employs a "bottom-up" adjusting scheme which starts at a low energy level, below
the expected atrial pacing threshold, and increases the energy level until atrial
capture is detected, thus saving energy and further avoiding corruption by large
polarization signals. The latter feature is compatible with the present detection
scheme and conventional evoked response detection schemes. The new atrial pacing
threshold is then set at the atrial pulse level at which atrial capture was effectuated
plus a predetermined safety margin.