rythmiq tm for incepta™ episode based education

© 2012 by Boston Scientific Corporation or its affiliates. All rights reserved. CRM-57107-AA JAN 2012© 2012 by Boston Scientific Corporation or its affiliates. All rights reserved. CRM-57107-AA JAN 2012

RYTHMIQTM

for INCEPTA™

Episode Based Education

1

© 2012 by Boston Scientific Corporation or its affiliates. All rights reserved. CRM-57107-AA JAN 2012

RYTHMIQ™ vs. AV SEARCH + Based on IBP Recommendations

AV Node Atrial Arrhythmias (if Permanent selected, single chamber mode is recommended)

Feature Recommendations

Normal None RYTHMIQNormal Paroxysmal/Persistent RYTHMIQ1st Degree None RYTHMIQ1st Degree Paroxysmal/Persistent RYTHMIQ2nd Degree None AV SEARCH +2nd Degree Paroxysmal/Persistent AV SEARCH +3rd Degree None Paced and Sensed AV Delays3rd Degree Paroxysmal/Persistent Paced and Sensed AV Delays

Sinus Node status does not affect IBP recommendations on RYTHMIQ, AV SEARCH + or Paced and Sensed AV Delays, unless Neurovascular Syndromes is selected

RYTHMIQ™ & AV Search + give you options to appropriately manage RV pacing in patients with varying degrees of conduction block


AV Search +Two Refinements of the AlgorithmAV Search AV Search + Results

With AV Search Hysteresis, search is initiated after the programmed number of consecutive paced cycles.

AV Search + counts both paced and sensed cycles when determining when to initiate the search.

More frequent searches.

With AV Search Hysteresis, search remains in affect until a single ventricular paced cycle during extension period occurs.

With AV Search +, the search remains in affect until two of ten ventricular paced cycles occur during the extension period.

Will stay at the extension period for longer periods of time.


AV Search + Programming

AV Search AV Search + Results

AV Delay = 200 ms AV Delay = 200 ms AV Search + operates with longer AV delays over a wider range of patient heart rates.

PVARP = 250 ms PVARP = 250 msAV Search HysteresisSearch Interval

= 32 cycles AV Search HysteresisSearch Interval

= 32 cycles

AV increase = 100% Search AV Delay = 400 msThe Maximum Tracking Rate Allowed is

95 bpm The Maximum Tracking Rate Allowed is

130 bpm

AV Delay Extension with Higher Maximum Tracking Rates

For AV Search +, the Maximum Tracking Rate limit is determined by the programmed AV Delay and PVARP (TARP), but the Search AV Delay is allowed to be longer since the rhythm will typically be a conducted ventricular sense following the atrial event.

© 2012 by Boston Scientific Corporation or its affiliates. All rights reserved. CRM-57107-AA JAN 2012 48

RYTHMIQTM : Programmer Screens


RYTHMIQTM Operation“The following occurs during the RYTHMIQ™ stage of AAI(R) with VVI backup:

• The device provides AAI(R) at the LRL and/or sensor indicated rate according to the normal brady DDD(R) mode.

• The device provides backup VVI pacing at a rate of 15 ppm slower than the LRL. The backup VVI pacing rate is limited to no slower than 30 ppm and no faster than 60 ppm. When there is good conduction, ventricular pacing does not occur as the VVI backup mode runs in the background at a reduced LRL.

• The device monitors for 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.”1 The 150 ms value is used to allow for normal variations between cardiac cycles.

1Reference Guide, INCEPTA ICD, Page 4-28, 358430-003 EN US 01/11

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RYTHMIQTM Example 1

The atrial lower rate limit is 55 bpm, which then makes the VVI rate limit 55 – 15 bpm, or 40 ppm.


A PVC occurs which is not sensed because it falls in the atrial pacing blanking period.

RYTHMIQTM Example 1


Pacing occurs at the VVI lower rate limit of 40 ppm or 1,500 ms. Slow ventricular beat #1.

Beat 1

RYTHMIQTM Example 1


Pacing occurs again at the VVI lower rate limit of 40 ppm or 1,500 ms. Slow ventricular beat #2.

Beat 2

RYTHMIQTM Example 1


A ventricular senses beat then occurs at 1,338 ms, which is slower than the atrial LRL of 55 bpm plus 150 ms (1090 ms + 150 ms = 1240 ms). This is slow ventricular beat #3 in the last 11.

Beat 3

RYTHMIQTM Example 1


RYTHMIQ™ transitions from AAI(R) mode to DDD(R) and an event with electrogram is stored.

DDD(R)EGM Stored

RYTHMIQTM Example 1


RYTHMIQTM Operation

AAI(R) at programmed LRL

VVI backup at LRL – 15 ppm,bounded by [30,60]

DDD(R) at programmed LRL

3 slow ventricular beats in moving window of last 11

Declare Event/Record EGM

Sustained conduction

detected

Reference Guide, INCEPTA ICD, Page 4-28, 358430-003 EN US 01/11


RYTHMIQTM Operation

AAI(R) at programmed LRL

VVI backup at LRL – 15 ppm,bounded by [30,60]

DDD(R) at programmed LRL

Sustained conduction

detected

ATR Mode Switch

RYTHMIQ can detectAFib from either AAI(R) or DDD(R)

3 slow ventricular beats in moving window of last 11

Declare Event/Record EGM

Reference Guide, INCEPTA ICD, Page 4-28, 358430-003 EN US 01/11

rythmiq tm for incepta™ episode based education

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