1. RYTHMIQ™
Operation
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
AV Synchrony Restored
RYTHMIQ and conduction block
When intact conduction is present RYTHMIQ™ is pacing in AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates as 2 separate pacemakers that immediately triggers a EGM and switch to DDD(R) pacing when a conduction block is detected. To switch back to AAI(R) pacing AV Search+ is used to periodically check for a return of intrinsic conduction.

2. RYTHMIQ™
Operation
During normal conduction, RYTHMIQ operates like two pacemakers running concurrently – one in AAI(R) mode and one in VVI mode.
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 background
RYTHMIQ and conduction block
When intact conduction is present RYTHMIQ™ is pacing in AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates as 2 separate pacemakers that immediately triggers a EGM and switch to DDD(R) pacing when a conduction block is detected. To switch back to AAI(R) pacing AV Search+ is used to periodically check for a return of intrinsic conduction.
Normal Conduction

3. RYTHMIQ™
Operation
The device monitors for loss of AV synchrony to determine when to switch to DDD(R) mode
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
RYTHMIQ and conduction block
When intact conduction is present RYTHMIQ™ is pacing in AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates as 2 separate pacemakers that immediately triggers a EGM and switch to DDD(R) pacing when a conduction block is detected. To switch back to AAI(R) pacing AV Search+ is used to periodically check for a return of intrinsic conduction.
Loss of AV Synchrony

4. RYTHMIQ™
Operation
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 settings
“When RYTHMIQ detects loss of AV synchrony, the device records a RYTHMIQ episode along with 20 seconds of electrogram data. The RYTHMIQ episode will be noted by the PRM and can be inspected in detail by selecting the appropriate episode from the Arrhythmia Logbook screen. When the DDD(R) stage of RYTHMIQ is active, the RYTHMIQ episode is identified as “in progress”.” 1
# # #3

5. RYTHMIQ™
Operation
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.
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.
AV Synchrony Restored
RYTHMIQ and conduction block
When intact conduction is present RYTHMIQ™ is pacing in AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates as 2 separate pacemakers that immediately triggers a EGM and switch to DDD(R) pacing when a conduction block is detected. To switch back to AAI(R) pacing AV Search+ is used to periodically check for a return of intrinsic conduction.
Normal Conduction Restored

6. RYTHMIQ™
Operation
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
Loss of AV Synchrony
AV Synchrony Restored
RYTHMIQ and conduction block
When intact conduction is present RYTHMIQ™ is pacing in AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates as 2 separate pacemakers that immediately triggers a EGM and switch to DDD(R) pacing when a conduction block is detected. To switch back to AAI(R) pacing AV Search+ is used to periodically check for a return of intrinsic conduction.

7. RYTHMIQ™
Exception During ATR Mode Switch
If RYTHMIQ went directly from AAI(R) into ATR Mode Switch, when the mode switch ends, it goes directly back into AAI(R) mode
RYTHMIQ and atrial arrhythmia
This feature is designed for patients with intact conduction to pace AAI(R) with VVI backup to eliminate unnecessary right ventricular pacing. It operates a 2 separate pacemakers that immediately mode switches when an atrial arrhythmia is detected (ATR mode). If the mode switch ends RYTHMIQ™ will return to normal AAI(R) mode but it has also the flexibility to switch directly to DDD(R) or visa versa.

8. RYTHMIQ™
Operation
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, EN US 11/10

9. BSC also offers AV Search+
RYTHMIQ™
Managing RV Pacing – Two Algorithms
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.
BSC also offers AV Search+
AV Search+ is designed to reduce unnecessary RV pacing by providing backup ventricular pacing for every beat while searching for intrinsic activity

10. Patient’s AV Conduction Status
RYTHMIQ™
Managing RV Pacing – Two Algorithms
INGENIO™ pacemakers have two algorithms to help minimize unnecessary RV pacing
Patient’s AV Conduction Status
Boston Scientific1
Medtronic2
St. Jude3
Normal
RYTHMIQ™
MVP®
Nominally ON for all patients
Search AV™
VIP™
Only available algorithm
1st Degree Block
2nd Degree Block
AV SEARCH+
3rd Degree Block5
Fixed AV Delay
With both RYTHMIQ™ & AV Search+, clinicians now have options to appropriately manage RV pacing in patients with varying degrees of conduction block
Therapy recommendations made by Indications-Based Programming
2) Source: Medtronic Adapta/Versa/Sensia Pacemaker Programming Guide (M929948A001C )
3) Source: St. Jude Medical Unity Platform Reference Guide ( 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