AV Synchrony Restored - PowerPoint Presentation

Slide1

AV Synchrony Restored

RYTHMIQ

operates in AAI(R) pacing mode with VVI backup during times of normal conduction, switching to DDD(R) mode when a conduction block is detected

Loss of AV Synchrony

Operation

RYTHMIQ™Slide2

The device provides AAI(R) at the LRL and/or sensor indicated rate with backup VVI pacing at a rate of 15 bpm slower than the LRL

When there is good conduction, ventricular pacing does not occur as the VVI backup mode runs in the backgroundDuring normal conduction, RYTHMIQ operates like two pacemakers running concurrently – one in AAI(R) mode and one in VVI mode.

Normal Conduction

Operation

RYTHMIQ™Slide3

The device

monitors for loss of AV synchrony to determine when to switch to DDD(R) mode

Loss of AV Synchrony

If 3 slow ventricular beats are detected in a window of 11 beats, then the device automatically switches to DDD(R) mode. A slow beat for RYTHMIQ is defined as a ventricular pace or ventricular sensed event that is at least 150 ms slower than the AAI(R) pacing rate.

Loss of AV Synchrony

Operation

RYTHMIQ™Slide4

#1

#

2

#

3

INGENIO™ records a RYTHMIQ Episode along with 20 seconds of

electrogram data when RYTHMIQ detects loss of AV synchrony. This can help the clinician to diagnose patient rhythm conduction disorders and determine appropriate algorithms and pacemaker settingsOperationRYTHMIQ™Slide5

If AV Search+ remains in AV hysteresis for at least 25 cardiac cycles, and less than 2 of the last 10 cycles are ventricular paced, then the device automatically switches the pacing mode back to AAI (R) with VVI backup.

The device uses AV Search+ to periodically check for a return of intrinsic conduction and determine when to mode switch back to AAI(R) with VVI backup.

Normal Conduction Restored

AV Synchrony Restored

Operation

RYTHMIQ™Slide6

AV Synchrony Restored

RYTHMIQ

is designed to adapt to a patient’s conduction disorder, by mode switching when AV synchrony is lost or restored, without clinically significant pauses

Operation

RYTHMIQ™

Loss of AV SynchronySlide7

If

RYTHMIQ

went directly from AAI(R) into ATR Mode Switch, when the mode switch ends, it goes directly back into AAI(R) modeException During ATR Mode SwitchRYTHMIQ™Slide8

RYTHMIQ is designed to minimize unnecessary pacing without clinically significant pauses

RYTHMIQ operates like two pacemakers running concurrently—one in AAI(R) and one in VVI

RYTHMIQ does not require dropped ventricular beats to switch to DDD(R) pacing

Reference Guide, INGENIO Pacemaker, Page 2-53, 358577-001 EN US 11/10OperationRYTHMIQ™Slide9

Patients may

require different algorithms at various stages of their conduction disease. RYTHMIQ adds another RV pacing algorithm to Boston Scientific devices, because no one algorithm is appropriate for every patient.

AV Search+ is designed to reduce unnecessary RV pacing by providing backup ventricular pacing for every beat while searching for intrinsic activity

Managing RV Pacing – Two Algorithms

RYTHMIQ™

BSC also offers

AV Search+Slide10

Patient’s AV Conduction Status

Boston Scientific

1

Medtronic

2

St. Jude

3Normal

RYTHMIQ™

MVP®

Nominally ON for all patients

Search AV™

VIP™

Only available algorithm

1st Degree Block

RYTHMIQ™

2nd Degree Block

AV SEARCH+

3rd Degree Block

5

Fixed AV Delay

Therapy recommendations made by Indications-Based Programming

2) Source: Medtronic

Adapta

/Versa/

Sensia

Pacemaker Programming Guide

(

M929948A001C 2008-01-18

)

3) Source: St. Jude Medical Unity Platform Reference Guide (

60020476

A, 07/09)

Boston Scientific Indications-Based Programming would recommend paced/sensed AV delays. While not an algorithm, an equivalent setting would be available in competitor devices

With both

RYTHMIQ

™

&

AV Search+,

clinicians now have options

to appropriately manage RV pacing in patients with varying degrees of conduction block

INGENIO™ pacemakers have two algorithms to help minimize unnecessary RV pacing

Managing RV Pacing – Two Algorithms

RYTHMIQ™