2. for internal use only How Works

3. 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-wave ² 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)

4. 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 A S (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 SAV opt = A S +   = 30 or 60 ms SAV is Sensed AV Delay A S is sensed P wave  is added interval ASAS  SAV opt

5. for internal use only Electronic Optimization of Sensed AV Delays Short P Wave Example Long P Wave Example A S +  = SAV opt 50 + 60 = 110 A S +  = SAV opt 120 + 30 = 150 SAV opt = A S +   = 30 or 60 time QRS time QRS A S  SAV opt A S  SAV opt

6. 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

7. for internal use only QuickOpt Timing Cycle Optimization Programmability QuickOpt electrically characterizes the conduction properties of the heart and calculates the optimal sensed and paced AV delays

8. for internal use only QuickOpt Timing Cycle Optimization Programmability Tests can be run automatically or manually Parameters required for testing are adjusted automatically

9. for internal use only QuickOpt Timing Cycle Optimization Test in Progress Automatic testing performs all relevant tests

10. for internal use only QuickOpt Timing Cycle Optimization Results Results are displayed in about a minute

11. for internal use only QuickOpt Timing Cycle Optimization Results Press “Manual Testing and Results”

12. for internal use only QuickOpt Timing Cycle Optimization Results Display of Optimized values and EGM button 90 + 60 = 150 ms 150 + 50 = 200 ms

13. for internal use only QuickOpt Timing Cycle Optimization Results Display of EGM

14. for internal use only QuickOpt Timing Cycle Optimization Results If the test was unable to be performed at the current settings a message prompts you to make changes

15. 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?