# Temporary Pacing Simulator: A Training Tool for Clinicians
## 3 Experimental Results
### Capture and Sensitivity Thresholds  
Capture thresholds are critical parameters in TP function, determining the minimum amount of electrical energy required to depolarise the myocardium and produce a paced heartbeat. Through multiple simulation runs, it was observed that when the user-input capture threshold was equal to or above the minimal threshold, the TCPS consistently achieved successful atrial and ventricular capture. An example of ventricular capture is illustrated in Figure 26. When the user inputs a value in the \"Ventricular Capture Threshold\" field and clicks the \"Insert V Capture Threshold\" button, the TCPS system compares the entered value to the randomly generated minimal ventricular capture threshold and verifies whether this threshold continues to successfully capture the ventricles. In this instance, the introduced threshold successfully captures the ventricles, and the following informational feedback message is generated on the screen: \"The capture threshold is the minimum amount of electrical energy required to consistently depolarise the myocardium and produce a paced heartbeat. Typically, the capture threshold is set between 0.5 to 2.0 milliamps (mA). It is essential to set the threshold to the lowest value that reliably produces a capture to minimise battery usage and avoid unnecessary high-energy delivery\". This message informs the user about the capture threshold and encourages them to use the minimal amount necessary to achieve capture, thus optimising both battery life and pacing efficiency. In contrast, input values below the minimal thresholds triggered corresponding failure modes (ALOC and VLOC), effectively simulating clinical scenarios where the TP fails to capture the myocardium. Figure 27 illustrates a VLOC scenario resulting from an inadequate capture threshold value entered by the user. The TCPS simulates this by automatically switching the failure mode dropdown menu to VLOC when the user's input is smaller than the randomly generated minimum capture threshold. Simultaneously with updating the signals to reflect the VLOC failure mode, the TCPS also generates a warning message on the screen, informing the user that the entered value caused VLOC. Sensitivity thresholds are equally crucial in the function of a temporary pacemaker (TP), determining the minimum intracardiac signal voltage that the TP must detect to recognise intrinsic cardiac activity. Clinicians must carefully set the sensitivity high enough to avoid sensing muscle noise and external interference, which can lead to oversensing, but low enough to prevent unnecessary inhibition of pacing, which can cause undersensing. Therefore, simulating these scenarios within the TTCPS is essential. To achieve this, the TCPS randomly generates minimal and maximal sensitivity thresholds for both the atria and ventricles. As shown in Figure 28, when the user inputs a value into the \"Atrial Sensitivity Threshold\" field and clicks the \"Insert A Sensitivity Threshold\" button, the TCPS system compares the entered value to the randomly generated minimal and maximal atrial sensitivity thresholds and verifies whether these thresholds continue to successfully sense the atria. In this instance, the introduced threshold successfully senses the atria, and the following informational feedback message is generated on the screen: \"The sensitivity threshold is the minimum intracardiac signal voltage that the pacemaker must detect to recognise intrinsic cardiac activity. The sensitivity threshold is usually set between 0.5 to 2.5 millivolts (mV). This setting ensures the pacemaker accurately detects the heart's intrinsic electrical activity and avoids inappropriate pacing due to oversensing or undersensing\". In contrast, when the user inputs values above the maximum sensitivity thresholds, the TCPS triggers corresponding failure modes (atrial or ventricular undersensing, or both), effectively simulating clinical scenarios where the TP fails to sense intrinsic cardiac activity.