1. EP Sale’s Training
Summary

2. BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
EP Summary - Agenda
Diagnostic Catheters
EP Study
Ablation Catheter Features
Blazer II™ Ablation Catheter
AVNRT
Blazer XP™ Ablation Catheter
A Flutter
Chilli II ™ Cooled Ablation Catheter
A Fib
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

3. Diagnostic Catheters EP Study
Sinus Rhythm:
regular
slim QRS
P before Q
P: > 90 ms
PQ: 120 – 200 ms
QRS: < 120 ms
QT: ca. 440ms T P Q S
P – Q QRS Q - T
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

4. Diagnostic Catheters EP Study
High Right Atrium
(near sinus node)
His
(near AV node)
Coronary Sinus
(left AV groove)
(used for left AVRT, Flutter and A fib)
Right Ventricle Apex
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

5. Diagnostic Catheters EP Study
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

6. Diagnostic Catheters EP Study
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

7. Diagnostic Catheters EP Study
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

8. Diagnostic Catheters EP Study
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

9. Diagnostic Catheters Clinical Applications
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

10. Diagnostic Catheters Fixed Curve
CURVE SHAPES
DISTAL TUBING
CONNECTORS
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

11. Diagnostic Catheters Fixed Curve Features
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

12. Diagnostic Catheters Steerable
STEEROCATH DX
POLARIS Dx
POLARIS X
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

13. Diagnostic Catheters Steerable Features
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

14. Diagnostic Catheters Conclusion
The purpose of diagnostic catheters is to facilitate understanding the mechanism of arrythmias and appropriate ablation location.
Diagnostic Catheter can be classified into two main groups:
Fixed Catheters
Steerable Catheters
Both type of catheters present a wide range of configurations (i.e. curve type, electrode numbers, electrode spacing etc.). The main difference between fixed and steerable catheters is the CLINICAL ease of use: the target for steerable catheters is mapping difficult sites, like the CS.
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

15. BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
Ablation Catheter Features
Distal Segment
Length & Curve Shape
Performance
Active Steering
Handle
Tension Control
Bi-wing Steering
Handle Ergonomics
Tip Electrode
Tip Size
Cooling
Temperature Sensor
Proximal Shaft
Torqueability
Pushability
Trackability
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

16. Blazer II™ Ablation Catheter AVNRT
Summary
Symptoms
Lightheadedness
Rapid palpitations
Pulsations in the neck
Regular rhythm with narrow QRS
No visible P wave (may be buried at end of QRS)
A and V stimulate simultaneously (reentry <50msecs)
Ventricular rates between 160 – 200 bpm
Paroxsysmal
Starts and stops suddenly
Most common SVT
Treated by ablating the slow pathway of the AV Node
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

17. Blazer II™ Ablation Catheter Feature Summary
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

18. BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
Blazer II™ Ablation Catheter Positioning
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

19. Blazer II™ Ablation Catheter How to Use
General Settings for AVNRT:
Fluro
9 o’clock on LAO view
ECG keys
AVNRT is successfully treated (fast pathway ablation) when A-H Jump is absent
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

20. Blazer II™ Ablation Catheter Conclusion
Positioning
AVNRT
Clinical
Needs
Sharp Electrograms
Micromovement
Tip Contact
Reach Anatomy
Catheter
Features
7f/4mm tip electrode
Bi-wing knob and steering mechanism
HTD distal & proximal
St’d curve = normal & K2 = Large
Customer
Evaluation
Min 2 AVNRT Cases
BSC Generator
STD or HT Distal?
STD or K2 Curve?
Order per List
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

21. Blazer II XP™ Ablation Catheter Atrial Flutter
Summary
Symptoms
Palpitations
Dizziness
Short of Breath
Rhythm
Narrow QRS
Variable conduction between the atrium and ventricle
Atrial cycle length of msecs
Typical = counter clockwise around the right atrium
Paroxysmal
Initiates and terminates spontaneously
Ablation
Line from the TV to the IVC through the Eustachian ridge
Bi-directional block along with cycle lengths confirms success
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

22. Blazer II XP™ Ablation Catheter Feature Summary
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

23. BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
Blazer II XP™ Ablation Catheter
Positioning
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

24. Blazer II XP™ Ablation Catheter How to Use
General Settings for FLUTTER:
Fluro
6 o’clock on LAO view
ECG keys
Bidirectional isthmus block
EP Marketing International BSC Confidential - For internal use Only -Do not copy or distribute
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

25. Blazer II XP™ Ablation Catheter Conclusion
Positioning
Flutter
Clinical
Needs
Deep Lesion
Linear Ablation
Tip Contact
Reach Anatomy
Catheter
Features
8f/8mm Tip Electrode
Bi-wing knob and mechanical steering
HT distal and proximal tubings
Large Curve
Customer
Evaluation
Min 2 AFL Cases
BSC Generator
Straight or VM Tip?
STD or HT Distal?
K2 or STD Curve?
Order per List
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

26. Chilli II™ Cooled Ablation Catheter Atrial Fibrillation
Summary
Symptoms
Palpitations
Dizziness
Short of Breath
Rhythm
Narrow QRS
Irregular
Paroxysmal, Persistant and Permanent
Ablation
Encirclement of the Pulmonary Veins
Possible other left atrial connecting lesions
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

27. Chilli II™ Cooled Ablation Catheter Feature Summary
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

28. BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
Chilli II™ Cooled Ablation Catheter
Positioning
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

29. Chilli II™ Cooled Ablation Catheter How to Use
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

30. Chilli II™ Cooled Ablation Catheter Conclusion
Positioning
AFIB
Clinical
Needs
Minimize Coagulum
Minimize secondary complications
Linear Ablation
Tip Contact
Access Anatomy
Deep Lesion
Catheter Features
Cooled 7f/4mm Tip
Closed loop cooling
Bi-wing Knob & mechanical steering
HT Distal and Proximal
Active Steering & proximal tubing
Cooled 7f/4mm
Customer
Evaluation
1 x AFL + 1 x AFIB Cases
BSC Generator
STD & K2 backup
Order per List
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute

31. EP Summary Clinical Summary
Sinus Rhythm
AVNRT
AVRT
A Flutter
V Tach
A fib
Rate (average)
bpm
bpm
a= msec
bpm
a >200 msecs
Regular Rhythm
yes
regular in atrium
irregular
P before QRS no
no (p after q)
no p wave
Narrow QRS
either
Testing
EP Study
AH jump, AV < 50msecs
AV time > 50 msecs
Bidirectional block
Isolated PVs
BSC Confidential – For Internal Use Only – Do Not Copy or Distribute