for internal use only

How

Works

for internal use only

• Mitral valve closure can be estimated by measuring the interatrial conduction time (P-wave duration)¹

• Onset of isovolemic contraction can be measured using the peak of the R-wave²

QuickOpt Timing Cycle Optimization Hypothesis

1 Worley, et al. “Optimization of cardiac resynchronization: left atrial electrograms measured at implant eliminates the need for echo and identifies patients where AV optimization is not possible”

2 Koglek, et al. 3 Meine, et al. “IEGM Based Method For Estimating Optimal VV Delay in Cardiac Resynchronization Therapy” Europace Supplements, Vol. 6, June 2004 (#149/2)

for internal use only

The IEGM estimates inter-atrial conduction delay by measuring the width of the P wave. The QuickOpt™ algorithm utilizes this measurement to calculate the optimal sensed and paced AV delays, with the goal maximizing preload and allowing for proper timing of mitral valve closure.

The optimal sensed AV delay is the sum of AS (sensed P wave) and (an added interval that allows for ventricular filling). The interval added is 30 or 60 ms, depending on the measured P Wave. A short P wave would have a longer interval added, while a longer P wave would have a shorter interval added.

Electronic Optimization of Sensed AV Delays

SAVopt = AS +

= 30 or 60 ms

SAV is Sensed AV DelayAS is sensed P wave is added interval

AS SAVopt

for internal use only

Electronic Optimization of Sensed AV Delays

Short P WaveExample

Long P WaveExample

AS + = SAVopt

50 + 60 = 110

AS + = SAVopt

120 + 30 = 150

SAVopt = AS + = 30 or 60

time

QRS

time

QRS

AS SAVopt

AS SAVopt

for internal use only

Electronic Optimization of Paced AV Delays

• If sensed AV Delay is 110 ms then the paced AV Delay would be:• 110 ms + 50 ms = 160 ms

• If the sensed AV Delay is 150 ms then the paced AV Delay would be:• 150 ms + 50 ms = 200 ms

for internal use only

QuickOpt Timing Cycle Optimization ProgrammabilityQuickOpt electrically characterizes the conductionproperties of the heart and calculates the optimal sensed and paced AV delays

for internal use only

QuickOpt Timing Cycle Optimization Programmability

• Tests can be run automatically or manually • Parameters required for testing are adjusted automatically

for internal use only

QuickOpt Timing Cycle Optimization Test in Progress

• Automatic testing performs all relevant tests

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QuickOpt Timing Cycle Optimization Results

• Results are displayed in about a minute

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QuickOpt Timing Cycle Optimization Results

• Press “Manual Testing and Results”

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QuickOpt Timing Cycle Optimization Results

• Display of Optimized values and EGM button

90 + 60 = 150 ms150 + 50 = 200 ms

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QuickOpt Timing Cycle Optimization Results

• Display of EGM

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QuickOpt Timing Cycle Optimization Results

• If the test was unable to be performed at the current settings a message prompts you to make changes

for internal use only

QuickOpt Timing Cycle Optimization Summary

• QuickOpt can be used as a practical approach to optimizing all patients, can be the optimal AV delay to use as a start before VIP™ extension

• Allows frequent optimization (at every follow-up) in response to changing timing cycles

• Quick and easy

• Clinically proven

• QuickOpt provides optimized therapy…not just another diagnostic

• Why wouldn’t you want the option to optimize all patients?