User Manual

7. PATIENT SELECTION AND TREATMENT
7. PATIENT SELECTION AND TREATMENT
7.1. INDIVIDUALIZATION OF TREATMENT
Exercise stress testing:
If the patient’s condition permits, use exercise stress testing to:
─ Determine the maximum rate of the patient’s normal rhythm,
─ Identify any supraventricular tachyarrhythmias,
─ Identify exercise-induced tachyarrhythmias.
The maximum exercise rate or the presence of supraventricular tachyarrhythmias may
influence selection of programmable parameters. Holter monitoring or other extended ECG
monitoring also may be helpful.
Electrophysiologic (EP) testing:
EP testing may be useful for ICD candidates.
EP testing may identify the classifications and rates of all the ventricular and atrial
arrhythmias, whether spontaneous or during EP testing.
Drug resistant supraventricular tachyarrhythmias (SVTs):
Drug resistant supraventricular tachyarrhythmias (SVTs) may initiate frequent unwanted
device therapy.
A careful choice of programming options is necessary for such patients.
Antiarrhythmic drug therapy:
If the patient is being treated with antiarrhythmic or cardiac drugs, the patient should be on a
maintenance drug dose rather than a loading dose at the time of ICD implantation. If
changes to drug therapy are made, repeated arrhythmia inductions are recommended to
verify ICD detection and conversion. The ICD also may need to be reprogrammed.
Changes in a patient’s antiarrhythmic drug or any other medication that affects the patient’s
normal cardiac rate or conduction can affect the rate of tachyarrhythmias and/or efficacy of
therapy.
Direct any questions regarding the individualization of patient therapy to Sorin’s
representative.
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SORIN – INTENSIA SonR CRT-D 184 – U150A
CAUTION: To avoid inappropriate therapy during an exercise stress test, do not reprogram
any parameter during the test. When a parameter is reprogrammed, PARAD/PARAD+
algorithm forces acceleration to "ventricular". During conducted sinus tachycardia within the
programmed Tachy zone, the device detects a 1:1 fast rhythm. Assuming that acceleration
was set to ventricular by reprogramming, the device may identify this as a VT, and may
immediately apply the corresponding therapy.