Low Voltage Technology Pulse Generator Technology Lead Technology

Pulse Generator

1958, 8 October...

Identity ADx XL DR

Feed Through Telemetry Coil Sensor X-ray marker Capacitors Defib. protection Crystal

All bonding is doubled for safety reasons Golden Thread Welded Bonds

Magnet test rate Magnet Rate <99/min: (and normal energy consumption) 6 months F-U interval Magnet Rate ~93/min: (and normal energy consumption) Replacement within 3 months Magnet Rate <85/min: Immediate replacement Elective Replacement Indicator 98.6 BOL 86.3 ERI EOL EOJ

Stimulation rate EOLBOL Battery impedance kOhms Elective Replacement Indicator

Current drain µA 0,5ms1,0ms 1,0 Volt 0,5ms1,0ms 2,5 Volt 0,5ms1,0ms 7,5 Volt Single-chamber unit, rate 60min -1 and 500Ω lead imp. Intrinsic current consumption Stimulation current consumption Exemple of current drain

Lead Connectors

IS-1 Connector in the Header

Tightening the Set Screw

Silicone rubber sealing membrane How to find the set screw

VS 1 IS -1 Cordis 3.2 mm VS 1B IS -1 Different 3.2 mm Short Bore Connectors

IS -1 Cordis 3.2 mm VS 1B IS -1 VS 1A / IS -1 VS 1B / IS -1 Different 3.2 mm Long Bore Connectors

VS 1B / IS -1 IS -1 Sensolog* Dialog* Sensorithm* Regency* Paragon* Synchrony* Trilogy* Affinity* Entity Integrity Identity ADx Family * Integrity µ-size Identity µ-size ADx Family µ-size Microny Not µ-size cans * Not M/S version Connectors in our Products

Connectors M, 5 mm S, 6 mm K, 3.2 mm (IS-1) T, 3.2 mm (IS-1) Bifurcated 3.2 mm (VDD) C, 3.2 mm inline (VDD) (for old version AddVent, obsolete now)

Leads

Endocardial Myocardial Epicardial Lead position

Bi-polarUni-polar Polarity configuration

Advantages - Bi-polar Less risk of myopotential oversensing Less risk of musclestim. Less risk of Crosstalk and Far Field Sensing Advantages - Uni-polar Smaller diameter Larger spikes on ECG With a bipolar lead, you can program the device to e.g. stimulate unipolar but sense bipolar ( ) Uni-polar or bi-polar leads?

Far-field sensing Sensing intrinsic activity in the other chamber Crosstalk Sensing pacemaker- activity in the other chamber

Bi-polar Uni-polar IS-1 connector

Coaxial Coil Design

Passive Active Fixation methods

Passive and Active Fixation

Myocardial lead

J-shaped lead (1421T)

This fractal coating creates a microscopic area ~4-600 times larger than the macro- scopic area (~15 cm 2 vs 3,2 mm 2 (Isoflex)) Titanium nitride (TiN) coating

Lead position Inflammatory reaction Scar tissue Polarisation losses Insulation defects/ Conductor failure Factors affecting threshold

Insulation defect Conductor failure Lead defects

Reaction to sensing III 0=None T=Triggered I=Inhibited D=Dual (T+I) Rate Modulation IV 0=None R=Rate Modulation What is stimulated? I 0=None A=Atrium V=Ventricle D=Dual (A+V) S=Single (A or V) Multisite Pacing V 0=None A=Atrium V=Ventricle D=Dual (A+V) What is sensed? II 0=None A=Atrium V=Ventricle D=Dual (A+V) S=Single (A or V) The Revised NASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite Pacing, PACE, Volume 25, No. 2, February 2002 NASPE/BPEG Generic Pacemaker Code