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Page 1: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation
Page 2: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Dual-Chamber Timing

Göran Mathson, 2005

Page 3: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

Page 4: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

AV Delay

Page 5: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AV and PV interval... Late atrial activation

150 ms250 ms

The AV Delay can be programmed max. 100 ms longer than the PV Delay

Page 6: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

AV Delay

Page 7: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A terminated by intrinsic P-wave

A-A

AV Delay

Page 8: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A terminated by a PVC A-A – AV delay timer starts on detection of a PVC

A-A

AV Delay

Page 9: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Noise Mode, Atrial Channel

PVARP

Programmable PVARP

Absolute RelativeA-A Interval

Page 10: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

PVARP

VRP Ventricular Refractory Period

AV Delay

Page 11: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

PVARP

VRP

VentricularBlanking Period

AV Delay

Page 12: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

125300

325350

375400150

175200

225250

425450

47527512…51ms

Example of programmability...

Page 13: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

PVARP

VRP

MTRI

Maximum Tracking Rate Interval

AV Delay

Page 14: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Maximum Tracking Rate Interval

A-A

PVARP

VRP

MTRI

AV Delay

Page 15: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

MTR Interval MTR Interval MTR Interval MTR Interval

Pseudo Wenckebach Upper Rate Behaviour

Page 16: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A-A

PVARP

VRP

MTRI

MSRI

AV Delay

Page 17: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A = Atrial paced event

P = Atrial sensed event

V = Ventricular paced event

R = Ventricular sensed event

Markers…

Page 18: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AV-Pacing

AR-Pacing

PV-Pacing

PR-Pacing

DDD(R) Pacing States

Page 19: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AV-Pacing

DDD(R) Pacing States

Page 20: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

PV-Pacing

DDD(R) Pacing States

Page 21: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

PR-Pacing

DDD(R) Pacing States

Page 22: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AR-Pacing

DDD(R) Pacing States

Page 23: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AA V PR RV P

Pacing States

Page 24: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Markers

AV

PR

142546

694

170617

759

P

R

Atrial Refractory period

Ventricular Refractory period

Page 25: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

DDI Timing

Page 26: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

PVARP

VRP

MSRI

AEI

AVI

VEI

Page 27: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AVI

AEI

PVARP

VRP

VEI

MSRI

Page 28: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AVI

AEI

PVARP

VRP

VEI

MSRI

P P P P P PV

Page 29: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

AVI

AEI

PVARP

VRP

VEI

MSRI

Page 30: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Intervention-rate

Hysteresisrate

Basic rate

Advanced Hysteresis Response

Cycle Count

Intervention Duration

Sensor

Recovery

Rate

SearchInterval

Cycle Count

Page 31: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

A V A V A V A V A VP VAR

AR

P V

Crosstalk…

Page 32: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Crosstalk

Decrease atrial output?

Decrease ventricular sensitivity?

Prolong ventricular blanking?

Enable Ventricular Safety Standby!

Page 33: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Ventricular Safety Standby

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Page 34: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Ventricular Safety Standby

Crosstalk V. Safety Pacing after 120 ms

Page 35: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Is Ventricular Safety Pacing Present In This Panel?

Page 36: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Vetricular Safety Pacing

Page 37: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Ventricular Safety Standby

Sensing in Crosstalk Detection WindowV. Safety Pacing after 120 ms

Page 38: Dual-Chamber Timing Göran Mathson, 2005 Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation

Ventricular Safety Standby

Blanking Period UndersensingV. Pacing after programmed AV Interval


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