User Manual
Table Of Contents
- Cover
- 1 Product Description
- 2 General Safety Instructions
- 3 Implantation
- Implantation Procedure
- Having parts ready
- Keeping an external defibrillator ready
- Unpacking the device
- Checking parts
- Implantation site
- Preventing leakage currents
- Preventing unintentional shock delivery
- Avoiding damage to the header
- Preventing short circuits in the header
- Ensure that connector ports are clean
- Overview: Implanting
- Connecting the device
- Keeping distance between leads
- Applying the programming head
- Establishing RF telemetry
- Activating ICD therapy
- Precautionary Measures while Programming
- Performing standard tests and monitoring the patient
- Cancelling telemetry
- Avoiding critical parameter settings
- Avoiding risks in the case of exclusive LV pacing
- Monitoring the patient when setting asynchronous modes
- Complying with the morphology criteria
- Setting sensing
- Preventing device-induced complications
- Preventing conduction of atrial tachycardia
- Avoiding AV crosstalk
- Observing the shock impedance limit
- Preventing recurrence after therapy shock
- Phrenic nerve stimulation that cannot be terminated
- Note the reduced pulse amplitude due to a battery voltage drop
- Observe when inducing short-term cardiac arrest
- Checking the settings of the DX lead
- Checking for electrodes suitable for the shock path
- Recognizing lead failure
- Considering power consumption and service time
- Magnet Response
- Follow-up
- Patient Information
- Replacement Indications
- Explantation and Device Replacement
- Implantation Procedure
- 4 Parameters
- Bradycardia / CRT
- General ICD therapy
- Timing: Basic rate day/night and rate hystereses
- Timing: AV delay
- Timing: Post-shock pacing
- Timing: Upper rate
- Timing: Mode switching
- Timing: Ventricular pacing suppression
- Timing: Ventricular pacing
- Timing: Ventricular multi pole pacing
- Timing: Refractory periods and blanking periods
- Timing: PMT protection
- Timing: Rate adaptation via accelerometer
- Timing: Rate adaptation via CLS
- Pacing: Pulse amplitude and pulse width
- Pacing: Atrial capture control
- Pacing: Ventricular capture control
- Lead configuration LV on IS-1 connection
- Lead configuration LV on IS4 connection
- MRI program
- Tachycardia
- Sensing
- Diagnostics
- Home Monitoring
- Bradycardia / CRT
- 5 Technical Data
en • English
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Avoiding AV crosstalk
When pacing using atrial ATP parameters, atrial pacing pulses can either be conducted
into the ventricle or be sensed such that ventricular pacing is prevented.
•
Check the settings for the presence of crosstalk.
•
If necessary, temporarily set VVI and a rate for backup stimulation so that no
ventricular pulses are prevented.
Observing the shock impedance limit
The implanted device could be damaged if the shock impedance is too low.
•
The shock impedance must be > 25 Ω.
Preventing recurrence after therapy shock
After a therapy shock, pacing can be performed with a post-shock program if there is
no intrinsic rhythm.
•
The following post-shock program parameters can be adjusted: Post-shock
duration, basic rate, rate hysteresis, ventricular pacing, LV T-wave protection,
triggering, AV delay (fixed, not dynamic)
•
The default settings for the post-shock program are as follows:
A and RV: 7.5 V and 1.5 ms
LV: settings from the permanent program
Phrenic nerve stimulation that cannot be terminated
In rare cases, chronic phrenic nerve stimulation cannot be terminated by reprogram-
ming the available left ventricular pacing configuration or using other measures.
•
Set a right ventricular mode both in the permanent program as well as the ATP, in
the post-shock program and for mode switching if need be.
Note the reduced pulse amplitude due to a battery voltage drop
If the rate and amplitude are set very high and the pulse width is set too long at the
same time, the battery voltage may temporarily drop so low that the actual pulse
amplitude drops well below the selected level.
•
Continuously check the pacing efficiency using ECG monitoring.
Observe when inducing short-term cardiac arrest
To permit TAVI (transcatheter aortic valve implantation), the pressure in the heart must
be reduced so that the heart valve can be correctly positioned. Intentional cardiac
arrest by high-rate pacing (rapid pacing) should be brief, must be tolerated by the
patient and can trigger a life-threatening arrhythmia.
•
Take all necessary precautionary measures and keep required emergency
equipment ready.
•
Continually monitor the patient by ECG.
•
Complete the TAVI procedure before high-rate pacing ends. Extend the pacing
duration if necessary.
•
Abort the procedure if it is not successfully completed within the maximum pacing
duration so that cardiac arrest can be stopped.
•
Reactivate ICD therapy at a clinically indicated point in time when the TAVI process
is completed.
Checking the settings of the DX lead
The triple-chamber device allows for a DX lead to be implanted for the right atrium and
connected to the IS-1 connector of the device.
•
DX sensing in the atrium requires a special setting in the programmer which then
has to be transmitted.
Checking for electrodes suitable for the shock path
Three different shock paths can be set. Two of these form an electrical path to the
housing of the implanted device.
•
For the RV -> SVC shock path, a second shock coil must be available (dual shock
coil).
Recognizing lead failure
Automatic impedance measurement is always switched on.
•
Impedance values that indicate technical failure of a lead are documented in the
event list.
Permanent program Post-shock program
DDD(R), DDI(R), AAI(R), DDD-ADI(R)
7 series: DDD-CLS
DDI
VDD(R), VDI(R) VDI
VVI(R) and OFF
7 series: VVI-CLS
VVI
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