Medtronic ADDR01, ADDRS1, ADDR03, ADDR06, ADDRL1 Pacemaker Reference Manual
...
ADAPTA®/VERSA®/SENSIA®/
RELIA™
Adapta ADDR01/03/06
Adapta S ADDRS1
Adapta L ADDRL1
Adapta ADD01
Adapta ADVDD01
Adapta ADSR01/03/06
Versa VEDR01
Sensia SEDR01
Sensia L SEDRL1
Sensia SED01
Sensia SESR01
Sensia SES01
Relia REDR01
Relia RED01
Relia RESR01
Relia RES01
Relia REVDD01
Pacemaker Reference Guide
Contents
How to use this guide 9
1 Pacing modes 13
Introduction 14
Rationale for mode selection 15
Indications 17
Contraindications 17
MVP modes 18
DDDR mode 18
DDD mode 20
DDIR mode 21
DDI mode 22
DVIR mode 23
DVI mode 24
VDD mode 25
AAIR / ADIR modes 26
AAI / ADI modes 27
VVIR / VDIR modes 28
VVI / VDI modes 29
AAT / VVT modes 30
DOOR / AOOR / VOOR modes 31
DOO / AOO / VOO modes 32
ODO / OAO / OVO modes 33
2 Rate response 35
Introduction to rate responsive pacing 36
Preset rate response at implant 37
Rate Profile Optimization operation 39
Individualizing Rate Profile Optimization 46
Activity sensor operation 48
Manual control of Rate Profile Optimization 53
3 Pacemaker timing 55
Rates 56
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
4
Contents
AV intervals 63
Rate Adaptive AV 66
Search AV+ and diagnostic 69
Blanking periods 73
Refractory periods 75
High rate atrial tracking 84
4 Lead/cardiac tissue interface 87
Implant Detection 88
Automatic polarity configuration 89
Lead Monitor 94
Lead impedance data 97
Capture Management and diagnostic 98
Sensing Assurance and diagnostic 118
Manually selecting pacing parameters 122
Manually selecting sensing parameters 125
Transtelephonic follow-up features 129
5 Special therapy options 133
Mode Switch and diagnostic 134
Managed Ventricular Pacing (MVP) 142
Conducted AF Response 147
Non-competitive atrial pacing 148
PMT intervention 150
PVC Response 153
Ventricular Safety Pacing 155
Sinus Preference 156
Atrial Preference Pacing 160
Rate Drop Response and diagnostic 164
Sleep Function 171
Single Chamber Hysteresis 173
6 Telemetry data 175
Establishing telemetry 176
Parameter summary 176
Patient information 178
Using TherapyGuide to select parameter values 179
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Battery and lead information 181
Marker Channel telemetry 182
Intracardiac electrograms 184
Extended Telemetry 186
7 Miscellaneous operations 187
Magnet Mode operation 188
Temporary programming 190
Electrical reset 191
Recommended Replacement Time (RRT/ERI) 193
Emergency pacing 194
8 Diagnostics 195
Introduction to diagnostics 196
Heart Rate Histograms 200
AV Conduction Histograms 202
Search AV+ Histogram 204
Sensor Indicated Rate Profile 205
High Rate Episodes 206
Ventricular Rate Histogram During Atrial Arrhythmias 213
Atrial Arrhythmia Trend 214
Atrial Arrhythmia Durations 216
Custom Rate Trend 216
Key Parameter History 219
Contents
5
9 Troubleshooting the pacing system 221
Troubleshooting strategy 222
Troubleshooting electrical problems 223
Troubleshooting hemodynamic problems 226
A Pacemaker description 231
Model number designator 232
Radiopaque codes 233
Physical dimensions 234
Connector dimensions 235
B Preset parameter settings 237
Shipping and nominal settings 238
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
6
Contents
Electrical reset settings 251
Emergency settings 263
C Longevity projections 265
Projected service life 266
Prolonged service period 282
Recommended Replacement Time (RRT/ERI) 282
Battery specifications 283
D Telemetry and diagnostic values 285
Magnet Mode operations 286
Telemetry functions 287
Automatic diagnostics 290
Clinician-selectable diagnostics 292
Cardiac event counters 297
E Parameter values and restrictions 299
Programmable modes and parameters 300
Rate Response programming guidelines 315
F Implant information 317
Warnings 318
Precautions 320
Potential complications 328
Replace a device 329
Patient counseling information 330
G Glossary 333
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Adapta/Versa/Sensia/Relia 0
Pacemaker Reference Guide 0
A guide to the Adapta/Versa/Sensia/Relia pacemakers
Refer to the Adapta/Versa/Sensia/Relia Pacemaker Programming Guide for
information on software and programming.
The following are trademarks of Medtronic:
Adapta, Checklist, Find Patient, Marker Channel, Medtronic, Medtronic Carelink, MVP,
Quick Look, Relia, Search AV, Sensia, SessionSync, TherapyGuide, and Versa.
How to use this guide
Information is contained in two guides
Product information about Adapta/Versa/Sensia/Relia
pacemakers and the associated software for the 9790/C series
programmer and the 2090 programmer is presented in two
separate guides.
The Pacemaker Reference Guide (PRG) provides detailed
information on the pacemakers.
The Pacemaker Programming Guide (PPG) contains instructions
on how to use the programmer and the programming software.
About the Pacemaker Reference Guide
The Pacemaker Reference Guide describes in detail how the
pacemakers operate and specifies the capabilities of the
pacemakers. The PRG includes the following information:
■
Describes the pacing modes, rate response options, special
therapy features, telemetry types, and data collection options.
In some cases, guidelines are given on how to configure the
pacemaker operation.
■
Contains troubleshooting information for electrical and
hemodynamic problems.
■
Specifies parameter and data collection capabilities, longevity
projections, and mechanical and electrical specifications.
■
Provides general warnings and cautions, potential
interference sources, and general indications for pacing.
■
Contains a glossary of terms.
9
How to use this guide
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
10
How to use this guide
About the Pacemaker Programming Guide
The Pacemaker Programming Guide describes how to program
Adapta, Versa, Sensia, and Relia pacemakers using a
programmer. The PPG presents the following information:
■
How to set up and configure the programmer and access
online help.
■
How to start a patient session, use the various follow-up
features during the session, and properly end the session.
■
How to use Checklist to streamline a follow-up session.
■
How to view and print the patient’s ECG and EGM waveform
traces.
■
How to configure the pacemaker to collect diagnostic data and
how to retrieve and view this information.
■
How to measure stimulation thresholds and sensing levels.
■
How to use TherapyGuide to obtain suggested parameter
values.
■
How to program parameter values and verify rate response
parameters settings.
■
How to run EP Studies.
The Implant Manuals supplement these guides
For each pacemaker model in the Adapta/Versa/Sensia/Relia
family, there is an Implant Manual. The Pacemaker Programming
Guide and the Pacemaker Reference Guide do not specify which
features apply to each individual pacemaker model. Refer to the
applicable implant manual for specific capabilities of individual
models.
Also, in various places throughout this manual, for example
“Programmable modes and parameters” on page 300, you are
asked to refer to the applicable implant manual for specific
capabilities of individual models
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
How to use this guide
New nomenclature for product battery life terms
This manual uses a new nomenclature for certain terms related to
product battery life. This new nomenclature is defined in
CENELEC pacemaker standard EN 45502-2-1:2003, which
applies to Active Implantable Medical Devices (AIMD) intended to
treat bradyarrhythmias. This standard was approved and
published in December 2003.
Medtronic has adopted the new nomenclature to comply with the
CENELEC standard and in anticipation of the nomenclature
becoming an international standard.
The new nomenclature, and the terms replaced by the new
nomenclature, are presented in the following table:
New nomenclature Old nomenclature
BOS Beginning of Service BOL Beginning of Life
EOS End of Service EOL End of Life
11
RRT/ERI Recommended
Replacement Time
(RRT/ERI)
Prolonged service
period
Projected service life Longevity
ERI Elective Replacement
Post-ERI conditions
Indicator
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Introduction 14
Rationale for mode selection 15
Indications 17
Contraindications 17
MVP modes 18
DDDR mode 18
DDD mode 20
DDIR mode 21
DDI mode 22
DVIR mode 23
DVI mode 24
VDD mode 25
Pacing modes1
1
AAIR / ADIR modes 26
AAI / ADI modes 27
VVIR / VDIR modes 28
VVI / VDI modes 29
AAT / VVT modes 30
DOOR / AOOR / VOOR modes 31
DOO / AOO / VOO modes 32
ODO / OAO / OVO modes 33
14
Chapter 1
Introduction
Introduction
Pacing mode selection
This chapter provides an introduction to pacemaker modes as an
aid to pacing mode selection. The chapter is organized as follows:
Definition of basic pacing modes – The names for most of the
pacing modes are defined on the 1991 ACC/AHA guidelines for
pacemaker implantation.
1
Rationale for mode selection – In order to get pacing mode
suggestions, the use of TherapyGuide is recommended.
TherapyGuide is a programmer feature that suggests parameter
settings based on a patient's clinical conditions. For models which
do not contain TherapyGuide, refer to the device implant manual
for guidance in mode selection.
Mode descriptions – These descriptions provide indications and
contraindications for modes available with the pacemaker and
brief descriptions of how these modes operate.
NBG pacing codes
The pacemaker modes are defined in NBG Code.2 Each five-letter
NBG code describes a specific type of operation for implantable
pacemakers. For simplicity, this manual uses only the first three or
four letters, such as DDD, DDIR, DVIR, and so forth. Figure 1-1
describes the first four letters of the NBG code.
1
Dreifus LS, Fisch C, Griffin JC, et al. Guidelines for implantation of cardiac
pacemakers and antiarrhythmia devices. A report of the American College of
Cardiology/American Heart Association Task Force on Assessment of
Diagnostic and Therapeutic Cardiovascular Procedures (Committee on
Pacemaker Implantation). Journal of the American College of Cardiology. 1991;
18: 1-13.
2
Bernstein A., et al., “The NASPE/BPEG Pacemaker Code,” PACE, 10(4),
Jul-Aug 1987. (“NBG” stands for The North American Society of Pacing and
Electrophysiology [NASPE] and the British Pacing and Electrophysiology Group
[BPEG] Generic. NBG’s five-letter code supersedes the ICHD Code.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Pacing modes
Rationale for mode selection
15
Further information
CHAMBER PACED
V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None
CHAMBER SENSED
V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None
Figure 1-1. NBG pacing codes
DDDR
MODE OF RESPONSE
T = Triggered
I = Inhibited
D = Double (Both)
O = None
PROGRAMMABLE/
RATE RESPONSE
P = Programmable
M = Multiprogrammable
C = Communicating
R = Rate Responsive
O = None
The mode descriptions in this chapter provide only a basic
overview of each mode. For further details on the rate response,
timing, and therapy capabilities, refer to “Rate response” on
page 36, “Pacemaker timing” on page 55, and “Special therapy
options” on page 133.
Rationale for mode selection
TherapyGuide offers a simple clinically-focused method for a
clinician to obtain suggested parameter values. At implant or an
early follow-up appointment, the clinician enters information about
the patient's clinical conditions. Based on those inputs the
programmer suggests parameter settings. The suggestions are
based on clinical studies, literature, current practice, and the
consensus of physicians.
For more information about TherapyGuide, refer to page 179.
For each pacemaker model, TherapyGuide suggests a
programmable mode. It bases the suggestion on clinical
conditions such as the condition of the sinus node and the quality
of AV conduction.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
16
Chapter 1
Rationale for mode selection
TherapyGuide offers a Rationale screen that shows the basis for
each setting of pacing modes and of other parameters. Figure 1-2
shows a typical Rationale screen. To access the screen, perform
the following steps:
Figure 1-2. Mode selection rationale used by TherapyGuide
1. Interrogate the pacemaker (before or after implant).
2. Select the Params icon. On the Therapy Parameters screen, select
the [TherapyGuide] button to open the TherapyGuide window.
3. Select the [Rationale…] button to open the Rationale window.
4. Select [Close] twice to return to the Therapy Parameters screen.
Note: It is not necessary to do any parameter programming at this
time. Refer to the Adapta/Versa/Sensia/Relia Pacemaker
Programming Guide for instructions on programming parameters
using TherapyGuide.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Indications
Pacing modes
Indications
Note: This section contains information for all models of the
Medtronic Adapta/Versa/Sensia/Relia implantable pulse
generators. For information about a specific model or series, refer
to the implant manual for that device.
These Medtronic Adapta/Versa/Sensia/Relia implantable pulse
generators (IPGs) are indicated for use to improve cardiac output,
prevent symptoms, or protect against arrhythmias related to
cardiac impulse formation or conduction disorders.
These devices are indicated for use in patients who are
experiencing exercise intolerance or exercise restrictions related
to an arrhythmia. Using rate response modes may restore heart
rate variability and improve cardiac output.
Adapta/Versa/Sensia/Relia implantable pulse generators are
indicated for single use only.
This device is also indicated for VDD pacing in patients who have
adequate rates and one or both of the following conditions.
■
A requirement for ventricular pacing when adequate atrial
rates and adequate intracavitary atrial complexes are
present. This includes the presence of complete AV block
when atrial contribution is needed for hemodynamic
benefit or when pacemaker syndrome had existed or is
anticipated.
■
A requirement for intermittent ventricular pacing despite a
normal sinus rhythm and normal AV conduction.
17
Contraindications
Note: This section contains information for all models of the
Medtronic Adapta/Versa/Sensia/Relia implantable pulse
generators. For information about a specific model or series, refer
to the implant manual for that device.
There are no known contraindications for the use of pacing as a
therapy to control heart rate. The patient’s age and medical
condition may influence the selection of the pacing system, the
mode of operation, and the implant technique used by the
physician.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
18
Chapter 1
MVP modes
MVP modes
Rate responsive modes may be contraindicated for patients who
cannot tolerate pacing rates above the programmed Lower Rate.
Medtronic Adapta/Versa/Sensia/Relia implantable pulse
generators (IPGs) are contraindicated for the following
applications:
■
Use of an implantable cardioverter defibrillator (ICD) with a
unipolar-only IPG or in those cases in which unipolar leads are
implanted for the other models described. Pacing in the
unipolar configuration may cause the ICD to deliver
inappropriate therapy or to withhold appropriate therapy.
■
Dual chamber pacing in patients with chronic or persistent
supraventricular tachycardias, including atrial fibrillation or
flutter.
■
VDD mode operation in patients with sinus disorders.
■
Single chamber atrial pacing in patients with AV conduction
disturbance.
Two MVP modes are available: AAIR<=>DDDR and AAI<=>DDD.
Note: For information about AAIR<=>DDDR and AAI<=>DDD
modes, refer to “Managed Ventricular Pacing (MVP)” on page 142.
DDDR mode
Note: For information about the AAIR<=>DDDR mode, refer to
“Managed Ventricular Pacing (MVP)” on page 142.
In the DDDR mode, the pacemaker tracks the faster of the intrinsic
atrial rate or the sensor-indicated rate. If the intrinsic rate is faster,
the DDDR mode provides atrial synchronous pacing; otherwise,
AV sequential pacing occurs at the sensor-indicated rate.
■
Rate limits for atrial tracking (Upper Tracking Rate)1 and
sensor tracking (Upper Sensor Rate) are separately
programmable.
1
The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value. Refer to Chapter 3 for more information on TARP.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Pacing modes
DDDR mode
■
The AV intervals that follow sensed atrial events (SAV) and
paced atrial events (PAV) are separately programmable, and
they can be programmed to shorten with increasing rates
(Rate Adaptive AV) or to change with intrinsic conduction
times (Search AV+).
■
A nonrefractory sensed event in either chamber inhibits
pacing in that chamber. A ventricular nonrefractory sensed
event in the VA interval that is not preceded by an atrial sense
(AS or AR) is a pacemaker-defined PVC and starts a new VA
interval.
19
Sensor-indicated
Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
Sensor-indicated Rate = 90 min
(667 ms)
A
P
-1
(1000 ms) PAV Interval = 200 ms PVARP = 280 ms
Figure 1-3. Example of DDDR mode operation
V
S
-1
SAV Interval = 170 ms
Sensor-indicated
Interval
A
S
V
S
A
P
V
P
A
S
V
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
20
DDD mode
Chapter 1
DDD mode
Note: For information about the AAI<=>DDD mode, refer to
“Managed Ventricular Pacing (MVP)” on page 142.
The DDD mode provides atrial synchronous pacing in the
presence of intrinsic atrial activity; otherwise, AV sequential
pacing occurs at the Lower Rate.
■
Each atrial paced or nonrefractory atrial sensed event starts
an AV interval and a lower rate interval. The AV intervals that
follow sensed atrial events (SAV) and paced atrial events
(PAV) are separately programmable, and the SAV may be
optionally programmed to shorten with increasing rate (Rate
Adaptive AV) or to change with intrinsic conduction times
(Search AV+).
■
A ventricular paced event may track an atrial sensed event up
to the programmed Upper Tracking Rate.
■
A ventricular nonrefractory sensed event in the VA interval that
1
is not preceded by an atrial sense (AS or AR) is a
pacemaker-defined PVC and starts a new VA interval.
Lower Rate Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
-1
(1000 ms) PAV Interval = 200 ms
A
P
V
S
SAV Interval = 170 ms
Figure 1-4. Example of DDD mode operation
1
The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value.
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Lower Rate Interval
A
S
V
S
200 ms
A
P
DDIR mode
Pacing modes
DDIR mode
The DDIR mode provides dual chamber, sensor-driven,
atrioventricular (AV) sequential pacing for heart rate variation
without atrial tracking.
■
Atrial pacing occurs at the sensor-indicated rate. If it is not
inhibited, ventricular pacing occurs at the end of the PAV
interval.
■
The AV intervals that follow paced atrial events (PAV) are
separately programmable, and they can be programmed to
shorten with increasing rates (Rate Adaptive AV) or to change
with intrinsic conduction times (Search AV+).
■
An atrial event sensed outside the PVARP will inhibit a
scheduled atrial stimulus but will not start an AV interval. That
is, ventricular paced events after such sensed atrial events
occur at the sensor-indicated rate. The following
ventriculoatrial (VA) interval may be extended slightly to avoid
an increasing atrial paced rate.
■
A ventricular nonrefractory sensed event in the VA interval
starts a new VA interval.
21
Sensor-indicated
Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
Sensor-indicated Rate = 90 min
-1
(1000 ms) PAV Interval = 200 ms
Figure 1-5. Example of DDIR mode operation
A
P
V
P
-1
(667 ms)
Sensor-indicated
Interval
A
S
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
Sensor-indicated VA
Interval
V
P
Sensor-indicated
A
A
P
P
V
P
Interval
200 ms
A
P
22
Chapter 1
DDI mode
DDI mode
The DDI mode provides dual chamber atrioventricular (AV)
sequential pacing with atrial sensing but without atrial tracking.
■
Atrial pacing occurs at the Lower Rate. If it is not inhibited,
ventricular pacing occurs at the end of the PAV interval.
■
The AV intervals that follow paced atrial events (PAV) are
separately programmable, and they can be programmed to
change with intrinsic conduction times (Search AV+).
■
An atrial event sensed outside the PVARP will inhibit a
scheduled atrial stimulus but will not start an AV interval.
Ventricular paced events after such sensed atrial events occur
at the Lower Rate.
■
A ventricular nonrefractory sensed event in the ventriculoatrial
(VA) interval starts a new VA interval.
Lower Rate Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
Lower Rate Interval Lower Rate VA Interval
A
P
V
P
-1
(1000 ms) PAV Interval = 200 ms
A
S
Figure 1-6. Example of DDI mode operation
A
P
V
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
DVIR mode
Pacing modes
DVIR mode
The DVIR mode provides AV sequential pacing at the
sensor-indicated rate unless inhibited by ventricular sensed
events.
■
Atrial pacing occurs at the sensor-indicated rate. If it is not
inhibited, ventricular pacing occurs at the end of the PAV
interval.
■
The AV intervals that follow paced atrial events (PAV) are
separately programmable, and they can be programmed to
shorten with increasing rates (Rate Adaptive AV) or to change
with intrinsic conduction times (Search AV+).
■
The DVIR mode ignores intrinsic atrial events. Sensing occurs
only in the ventricle. A ventricular nonrefractory sensed event
during the ventriculoatrial (VA) interval starts a new VA
interval.
23
Sensor-indicated
Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
Sensor-indicated Rate = 90 min
-1
(1000 ms) PAV Interval = 200 ms
Figure 1-7. Example of DVIR mode operation
A
P
V
S
-1
(667 ms)
Sensor-indicated VA
Interval
V
S
Sensor-indicated
A
P
V
P
Interval
A
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
24
Chapter 1
DVI mode
DVI mode
The DVI mode provides dual chamber AV sequential pacing
without atrial sensing/tracking.
■
Atrial pacing occurs at the Lower Rate. If it is not inhibited,
ventricular pacing occurs at the end of the PAV interval.
■
The AV intervals that follow paced atrial events (PAV) are
separately programmable, and they can be programmed to
change with intrinsic conduction times (Search AV+).
■
Sensing occurs only in the ventricle, and intrinsic atrial events
are ignored. A ventricular nonrefractory sensed event during
the VA interval starts a new ventriculoatrial (VA) interval.
Lower Rate Interval
A
P
V
P
Parameters:
Lower Rate = 60 min
Lower Rate VA Interval
A
P
V
S
-1
(1000 ms) PAV Interval = 200 ms
V
S
Figure 1-8. Example of DVI mode operation
A
P
V
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
VDD mode
Pacing modes
VDD mode
The VDD mode provides atrial synchronous pacing (or VVI pacing
at the Lower Rate). The ventricle is paced synchronously up to the
programmed Upper Tracking Rate.
1
Sensing occurs in both the
atrium and ventricle, but pacing occurs only in the ventricle.
■
To promote atrial synchronous pacing at slow rates, a sensed
atrial event occurring near the end of the Lower Rate interval
will be followed by the programmed SAV interval. The result is
an extension of the ventricular lower rate.
■
The AV intervals that follow sensed atrial events (SAV) are
separately programmable, and they can be programmed to
shorten with increasing rates (Rate Adaptive AV) or to change
with intrinsic conduction times (Search AV+).
■
A ventricular nonrefractory sensed event in the V-V interval
that is not preceded by an atrial sense (AS or AR) is a
pacemaker-defined PVC, and it starts a new V-V interval.
Lower Rate Interval
SAV
Interval
25
A
S
V
P
Parameters:
Lower Rate = 60 min
Upper Tracking Rate = 120 min
-1
(1000 ms) SAV Interval = 200 ms
Figure 1-9. Example of VDD mode operation
1
The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value.
A
S
V
P
-1
(500 ms) PVARP = 250 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
A
S
V
P
A
S
200 ms
26
pp
)
Chapter 1
AAIR / ADIR modes
AAIR / ADIR modes
Sensor-indicated Interval Sensor-indicated Interval
Note: For information about the AAIR<=>DDDR mode, refer to
“Managed Ventricular Pacing (MVP)” on page 142.
The AAIR mode provides atrial-based rate responsive pacing in
patients with intact AV conduction. Sensing and pacing occur only
in the atrium. In the absence of sensed events, the chamber is
paced at the sensor-indicated rate.
The ADIR mode operates the same as the AAIR mode except that
events sensed in the ventricle are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the
conducted ventricular rhythm without affecting atrial pacing.
Note: In the AAIR and ADIR modes, atrial refractory sensed
events do not restart the Upper Sensor Rate interval.
A
P
A
R
A
P
A
S
A
P
200 ms
Parameters:
-1
Sensor-indicated Rate = 75 min
U
er Sensor Rate = 100 min-1 (600 ms
(800 ms) Atrial Refractory Period = 250 ms
Figure 1-10. Example of AAIR mode operation
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
AAI / ADI modes
Note: For information about the AAI<=>DDD mode, refer to
“Managed Ventricular Pacing (MVP)” on page 142.
The AAI mode provides single chamber inhibited atrial pacing.
Sensing and pacing occur only in the atrium. Pacing occurs at the
programmed Pacing Rate unless inhibited by sensed events.
The ADI mode operates the same as the AAI mode except that
events sensed in the ventricle are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the
conducted ventricular rhythm without affecting atrial pacing.
Pacing modes
AAI / ADI modes
27
Pacing Rate Interval
A
P
Parameters:
Pacing Rate = 75 min
A
R
Pacing Rate Interval
A
P
-1
(800 ms) Atrial Refractory Period = 250 ms
A
S
Figure 1-11. Example of AAI mode operation
A
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
28
Chapter 1
VVIR / VDIR modes
VVIR / VDIR modes
The VVIR mode provides ventricular rate responsive pacing in
patients for whom atrial-based pacing is deemed unnecessary or
inappropriate. In the absence of sensed events, the ventricle is
paced at the sensor-indicated rate.
The VDIR mode operates the same as the VVIR mode except that
events sensed in the atrium are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the
underlying atrial rhythm without affecting ventricular pacing.
Note: In the VVIR and VDIR modes, ventricular refractory sensed
events restart the Upper Sensor Rate interval.
Sensor-indicated
Interval
V
P
Parameters:
Lower Rate = 60 min
Sensor-indicated Rate = 90 min
-1
(1000 ms) Upper Sensor Rate = 120 min-1 (500 ms)
Figure 1-12. Example of VVIR mode operation
Sensor-indicated
Interval
Upper Sensor
Rate Interval
V
P
-1
(667 ms) Ventricular Refractory Period = 300 ms
V
R
Sensor-indicated
Interval
V
P
V
P
200 ms
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
VVI / VDI modes
The VVI mode provides single chamber inhibited pacing at the
programmed Pacing Rate unless inhibited by sensed events.
Sensing occurs only in the ventricle.
The VDI mode operates the same as the VVI mode except that
events sensed in the atrium are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the
underlying atrial rhythm without affecting ventricular pacing.
Pacing modes
VVI / VDI modes
29
Pacing Rate Interval
V
P
Parameters:
Pacing Rate = 60 min
Ventricular Refractory Period = 300 ms
-1
(1000 ms)
Figure 1-13. Example of VVI mode operation
Pacing Rate Interval
V
P
V
S
200 ms
V
P
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
30
Chapter 1
AAT / VVT modes
AAT / VVT modes
In the AAT and VVT modes, pacing occurs at the programmed
Lower Rate, but a nonrefractory sensed event triggers an
immediate pacing output (rather than inhibiting such output). With
the exception that pacing outputs occur when events are sensed,
the triggered modes operate identically to the corresponding
inhibited modes.
Note: Programmed triggered pacing will not occur faster than
300 ms (200 min
programmed triggered pacing is not limited to 300 ms (200 min
Pacing Rate Interval
V
P
Parameters:
Pacing Rate = 60 min
Ventricular Refractory Period = 300 ms
V
R
-1
(1000 ms)
Figure 1-14. Example of VVT mode operation
-1
) from the previous paced event. Temporary
Pacing Rate Interval
V
P
T
P
V
P
200 ms
-1
).
Adapta/Versa/Sensia/Relia Pacemaker Reference Guide
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