User Manual Part 2

IMPLANT INFORMATION
IMPLANTING THE PULSE GENERATOR
9-5
• Connect the pace/sense lead(s) to a pacing system analyzer (PSA).
Pace/sense lead measurements, measured approximately 10 minutes
after placement, are listed below (Table 9-1 on page 9-5). Note that the
pulse generator measurements may not exactly correlate to the PSA
measurements due to signal filterin g.
Table 9-1. Lead measurements
Pace/sense lead
(acute)
Pace/sense lead
(chronic)
Shocking lead
(acute)
Shocking lead
(chronic)
R-wave amplitude
ab
> 5 mV > 5 mV > 1.0 mV > 1.0 mV
P-wave amplitude
ab
>1.5mV >1.5mV
R-wave duration
bcd
< 100 ms < 100 ms
Pacing threshold (right
ventricle)
<1.5V
endocardial
< 2.0 V epicardial
< 3.0 V endocardial
<3.5Vepicardial
Pacing threshold (atrium)
<1.5V
endocardial
< 3.0 V endocardial
Lead impedance (at 5 V and
0.5 ms atrium and ventricle)
200–2000 Ω 200–2000 Ω 20–80 Ω 20–80 Ω
a. Amplitudes less than 2 mV cause inaccurate rate counting in the c hronic state, and result in inability to sense a tachyarrhythmia or
the misinterpretation of a normal rhythm as abnormal.
b. Lower R-wave amplitudes and longer duration may be associated with placement in ischemic or scarred tissues. Since signal
quality may deteriorate chronically, efforts should be made to meet the above criteria by repositioning the leads to obtain signals
with the largest possible amplitude and shortest duration.
c. Durations longer than 135 ms (the pulse generator’s refractory period) may result in inaccurate cardiac rate determination, inability
to sense a tachyarrhythmia, or in the misinterpretation of a normal rhythm as abnormal.
d. This measurement is not inclusive of current of injury.
Step E: Form the Implantation P ocket
Using standard operating procedures to prepare an implantation pocket,
choose the position of the pocket based on the implanted lead configuration and
the patient’s body habitus. Giving consideration to patient anatomy and pulse
generator size and motion, gently coil any excess lead and place adjacent to
the pulse generator. It is important to place the lead into the pocket in a manner
that minimizes lead tension, twisting, sharp angles, and/or pressure. Pulse
generators are typically implanted subcutaneously in order to minimize tissue
trauma and facilitate explant. However, deepe r implan ta tion (e.g., subpectoral)
may help avoid erosion or extrusion in some patients. Verify magnet function
and wanded telemetry to ensure the pulse generator is within acceptable range.
Consider the following situations during the implant the procedure:
- DRAFT -