Medtronic E2DR01 Programming Guide

TM

ENPULSE

E2DR00/20/30 Series
E2D00 Series

E2VDD00 Series
E2SR00 Series

Vision



Programmer Software Model 9991

Pacemaker Programming Guide

Caution: Federal law (USA) restricts this device to sale by or on
the order of a physician or properly licensed practitioner.

EnPulse Pacemaker Programming
Guide

A guide to using the 9790/C and
2090 programmers with EnPulse
pacemakers

Refer to the EnPulse Pacemaker
Reference Guide for information on the
pacemakers.

The following are trademarks of Medtronic:

Capture Management, Checklist, Fast Path, EnPulse, Implant Detection, Key Parameter History, Marker
Channel, Medtronic, Medtronic Carelink, Rate Profile Optimization, Remote Assistant, Auto-PVARP,
Quick Look II, Search AV+, Sensing Assurance, Observations, Sinus Preference, and Vision.

How to use this guide

Information is contained in two guides

Product information about EnPulse software and pacemakers is
presented in two separate guides.

The Pacemaker Programming Guide (PPG) accompanies EnPulse
software and contains instructions on how to use the programmer and the
programming software.

The Pacemaker Reference Guide (PRG) provides detailed information on
EnPulse pacemakers.

About the Pacemaker Programming Guide

The Pacemaker Programming Guide presents the following information to
use the 9790/C and 2090 programmers.

■

How to setup and configure the programmer and access on-line 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 program parameter values and verify rate response
parameters settings.

■

How to run EP Studies.

How to use this guide

EnPulse Pacemaker Programming Guide v

How to use this guide

About the Pacemaker Reference Guide

The Pacemaker Reference Guide describes in detail, how the pacemaker
operates and specifies the capabilities of each model.

■

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.

vi EnPulse Pacemaker Programming Guide

Table of contents

Table of contents

How to use this guide v

1. Setting up the programmer

Operating differences between the 9790/C and 2090
programmers 1-2

The 2090 programmer system components 1-5
The 9790/C programmer system components 1-11
Connecting an external printer 1-15
Connecting peripheral devices 1-19
The display screen 1-23

2. Using the programmer

Setting programmer preferences 2-2
About the Checklist feature 2-7
Using Checklist 2-8
Creating a custom checklist 2-9
Connecting the programmer to skin electrodes 2-13
Positioning and using the programming head 2-14
Programming Emergency parameters 2-19
Recording an ECG strip 2-21
Using the On-line Help feature 2-24

3. Conducting a patient session

Programmer features 3-2
Automatically adapting parameters 3-2
Starting a patient session 3-4
Proceeding with session tasks 3-11
Interrogating the pacemaker 3-16
Taking a quick look at pacemaker operation 3-17
Viewing Battery and Lead Measurements 3-22
Checking the present parameter settings 3-25
Viewing and programming patient information stored in the

pacemaker 3-26
Recording an ECG Strip of magnet operation 3-27
Checking the patient’s Underlying Rhythm 3-30
Printing reports 3-33
Saving session data on a diskette 3-36
Ending a patient session 3-38

4. Viewing the patient’s ECG and EGM traces

Viewing the ECG and other rhythm waveforms 4-2

EnPulse Pacemaker Programming Guide vii

Table of contents

Adjusting and arranging the waveform traces 4-7
Freezing and analyzing a waveform strip 4-16
Recalling and viewing waveform strips 4-24

5. Collecting diagnostic data

About diagnostic data collection 5-2
Viewing the collected data 5-8
The automatically collected data displays 5-11
Clinician-selected detailed data displays 5-30
Programming data collection options 5-45
Clearing data from the pacemaker 5-47

6. Evaluating parameter settings

Measuring stimulation thresholds 6-2
Determining a sensitivity setting 6-22
Using temporary programming to evaluate parameter settings 6-30

7. Programming pacemaker parameters

Programming parameters 7-2
Saving/retrieving a set of parameter values 7-15
Retrieving Key Parameter History information 7-18

8. Rate Response setup

Using Exercise test to verify Rate Response 8-2

9. Using the EP Studies function

About the EP Studies function 9-2
Starting the EP Studies function 9-10
Setting up and executing a PES protocol 9-16
Setting up and executing a Burst protocol 9-21
Setting up and executing a VOO Burst 9-25
PES parameter definitions and values 9-27
Burst parameter definitions and values 9-30

A. Appendix: Parameter values and restrictions

Programmable modes and parameters A-2
Automatic and clinician-selectable diagnostics A-12
Programming restrictions A-17

B. Appendix: Implant information

Warnings B-2
Precautions B-5
Device operation B-11
Device information B-14

viii EnPulse Pacemaker Programming Guide

I. Index

Table of contents

EnPulse Pacemaker Programming Guide ix

Setting up the programmer

This chapter provides an overview of setting up the
programmer and covers information you should be familiar
with before you begin a patient session.

This chapter briefly explains the components associated with
the 9790/C and 2090 programmers. This chapter also
includes information on connecting an external printer,
connecting peripheral devices, and using the display screen.

For more detailed information on setting up your
programmer, refer to your programmer manual.

1

Operating differences between the
9790/C and 2090 programmers 1-2

The 2090 programmer system
components 1-5

The 9790/C programmer system
components 1-11

Connecting an external printer 1-15

Connecting peripheral devices 1-19

The display screen 1-23

EnPulse Pacemaker Programming Guide 1-1

Setting up the programmer

Operating differences between the 9790/C and 2090 programmers

Operating differences between the 9790/C and 2090
programmers

Medtronic pacemakers (IPGs) can be programmed with either the
Model 9790/C programmer or Medtronic CareLink programmer
(Model 2090). There are operating differences between the Model 9790/C
and Model 2090 programmers.

The major operating differences between the Model 9790/C and the 2090
programmers include:

■

Display screen changes

■

Calibration button

■

Built-in keyboard

Display screen changes

■

A task bar has been added at the top of the screen on the
Model 2090 programmer. It includes two new indicators:

– Position Head Light Array

– Remote View icon

Refer to the Medtronic CareLink Programmer Reference Guide for
complete information on these features.

■

Additional waveform display. (This display screen change applies
only to Vision software applications.)

All screens display an additional waveform. For example, if a screen
displays two waveform on the Model 9790/C programmer, this screen
displays three waveforms on the Model 2090 programmer.

1-2 EnPulse Pacemaker Programming Guide

Operating differences between the 9790/C and 2090 programmers

Setting up the programmer

1

2

3

3

1 Task Bar with Position Head Light Array

2 Remote View icon

3 Live Rhythm Monitor window

Figure 1-1. Additional display screen features of the Model 2090

programmer

Select Model screen

For pacemaker applications, the [Nominals...] button is inactive for Vision
software.

Calibrate button

The Calibrate button1 is located on the Adjust button menu (when this
menu is available) on the Model 2090 programmer. To add a reference
signal to the waveform, place the touch pen on the Calibrate button (see
Figure 1-2).

1

1 The Calibrate button is located on the Adjust... menu.

Figure 1-2. Calibrate button

1

For Vision software applications.

EnPulse Pacemaker Programming Guide 1-3

Setting up the programmer

Operating differences between the 9790/C and 2090 programmers

Built-in keyboard operation

The Model 2090 programmer includes a built-in keyboard which is active
only when the on-screen keyboard is displayed.

Tap the touch pen outside the area of the keyboard to inactivate the
on-screen keyboard. When the soft keyboard is inactive, the hard
keyboard is also inactive.

1-4 EnPulse Pacemaker Programming Guide

The 2090 programmer system components

Setting up the programmer

The 2090 programmer system components

1

VVI

2

4

8

3

9

10

12

1 Display screen

2 Emergency
VVI button

3 Microphone jack

4 Headphone jack

7

15

6

11

5 Keyboard cover

6 Keyboard

7 Printer controls

8 Telephone cord

9 Printer paper

10 Programming head

11 Touch pen

12 Electrode leads

13 ECG Cable with Plug

Figure 1-3. Programmer components - front view

16

5

14

13

14 Reference guide

15 Disk drive,
Modem cover

16 Power cord

EnPulse Pacemaker Programming Guide 1-5

Setting up the programmer

The 2090 programmer system components

Note: Only accessories approved by the manufacturer should be used.

Display screen – The display can be positioned smoothly from closed to

nearly horizontal. Programming options are selected on the screen with
the touch pen.

Emergency VVI button – Used to deliver bradycardia VVI operation.

Microphone jack – Intended for future use.

Headphone jack – Intended for future use.

Keyboard cover – Slides forward to protect the keyboard.

Keyboard – Used to enter information.

Printer controls – Selects paper speeds of 12.5, 25, or 50 mm/s. Push a

button once to select printing speed. Push it again to stop printing. The
Paper Advance button allows the user to properly align the paper.

Telephone cord – Connects the programmer’s modem to a telephone
jack. The telephone cord must be 26 wire gauge, minimum.

Printer paper – Paper for the internal printer.

Programming head – Provides the communication link between the

programmer and the patient’s implantable device. The programming head
contains a strong permanent magnet, radio-frequency (RF) transmitter
and receiver, and light array. It must be held over the implantable device
during programming or interrogation.

Touch pen – Used to select options on the display screen.
Predetermined options are selected by applying the pen to the screen.

Electrode leads / ECG cable – Connects the programmer to skin
electrodes on the patient for ECG and measurement functions requiring
surface detection of cardiac and implantable device signals. Five color­coded lead wires connect the cable to standard, disposable skin
electrodes applied to the patient.

Note: If you received a five-lead cable with a plug, the plug can be
removed for five-lead ECG applications.

Reference guide – The 2090 Programmer Reference Guide provides
information about setting up the programmer and between session
features.

1-6 EnPulse Pacemaker Programming Guide

The 2090 programmer system components

Setting up the programmer

Disk drive, Modem cover – Provides access to the disk drive, modem,
and parallel connector.

Power cord – Connects the programmer to an AC power outlet.

1 Programming head port (yellow marker)

2 Analog input/output port (green marker)

3 ECG cable port (black marker)

Figure 1-4. Front connectors (keyboard turned up)

Programming head port – Programming head connector. This
connector has a yellow marker.

Analog input/output port – Allows an external monitor or recorder to be
connected to the programmer. This connector has a green marker.

ECG cable port – Connects the ECG Cable to the programmer. This
connector has a black marker.

1

2

3

EnPulse Pacemaker Programming Guide 1-7

Setting up the programmer

The 2090 programmer system components

1

2

1 ON/OFF switch

2 Cooling fan

3

4

3 Expansion slot

4 Printer

Figure 1-5. Left view

ON/OFF switch – Controls power (AC) to the programmer. Once the
programmer is turned off, wait two seconds before turning it on again.

Cooling fan – Internal fan provides continuous airflow to prevent the
internal circuitry from overheating.

Expansion slot – Allows for additional features to be added, such as the
2290 analyzer that is available as an option.

Printer – Integral thermal printer with text and graphic output capabilities.
According to the selected function, the printer provides data reports, or it
prints out a continuous ECG with accompanying Marker Channel
telemetry, EGM, or both when available.

1-8 EnPulse Pacemaker Programming Guide

1

1 Disk drive, Modem cover

2 Infrared window

The 2090 programmer system components

Setting up the programmer

2

Figure 1-6. Right view

Disk drive, Modem cover – Provides access to the disk drive, modem,
and parallel connector.

w

Infrared window – Intended for future use.

2

1

1 Modem

2 Parallel connector

3 Floppy disk drive

3

Figure 1-7. Disk drive, Modem cover open

Modem – Intended for software updates and linking the programmer to a
consultant’s computer.

Warning: It is the responsibility of the user to ensure that the telecom
voltage does not exceed 125 V.

Parallel connector – Allows a printer or CD ROM drive to be connected
to the programmer.

EnPulse Pacemaker Programming Guide 1-9

Setting up the programmer

The 2090 programmer system components

Floppy disk drive – 3.5 inch formatted diskette that is IBM-compatible.
It can have a capacity of either 720 Kb (DS, DD) or 1.44 Mb (DS, HD).

#

2

3

1

1 USB port

2 VGA Output port

Figure 1-8. Back view (power cord door open)

USB port – Intended for future use.

VGA Output port – On some models of programmer the VGA port can

be used in porting the screen image of the programmer to an external
VGA monitor or for conversion of the output signal to NTSC/PAL format for
presentation on a television monitor. Please contact Medtronic Technical
Services at 1-800-328-2518 for technical guidance.

Caution: To protect against interference or surge/leak currents, the use
of a secondary VGA monitor that meets an applicable safety standard
such as UL 60950 or IEC 60950 is strongly recommended.

3 Power cord

Power cord – Cord connects the programmer to line (AC) power.

1-10 EnPulse Pacemaker Programming Guide

The 9790/C programmer system components

Setting up the programmer

The 9790/C programmer system components

1

2

3

4

5

1 Position head light
2 Emergency button
3 Deliver button
4 Printer controls

Figure 1-9. External components - front view

6

7

8

5 Display panel
6 Touch pen
7 ECG cable
8 Programming head

Programming head – Provides the communication link between the
programmer and the patient’s implantable device. The programming head
contains a strong permanent magnet, radio-frequency (RF) transmitter
and receiver, and Light Array. It must be held over the implantable device
during a program or interrogate operation.

EnPulse Pacemaker Programming Guide 1-11

Setting up the programmer

The 9790/C programmer system components

ECG cable – Connects the programmer to skin electrodes on the patient
for ECG and measurement functions requiring surface detection of
cardiac and implantable device signals. Five color-coded lead wires
connect the cable to standard, disposable skin electrodes applied to
the patient.

Touch pen – Used to select programming options on the display screen.
Options are selected by applying the pen to the screen.

Display panel – Flat panel display with nine adjustable positions ranging
from nearly horizontal (15°) to vertical (90°). Programming options are
selected on the screen with the touch pen.

Position head light – Dual color (amber/green) light works with the
programming head to indicate when a valid communication link to the
implantable device exists. An amber colored light indicates no link. When
the light goes off, or green, the programming head is positioned and can
transmit and receive data. Use of the programming head Light Array is
described on page 2-15.

Emergency button – Used to deliver bradycardia VVI operation, or with
the Deliver Button, to deliver a tachycardia therapy.

Deliver button – Used with the Emergency Button to deliver tachycardia
therapies, which include a defibrillation shock.

Printer controls – Select paper speeds of 12.5 or 25 mm/s. Push a
button once to select printing speed. Push it again to stop printing. The
Paper Advance button allows you to properly align the paper.

1

2

1 On/Off switch
2 Cooling fan
3 Printer

Figure 1-10. External components - left view

1-12 EnPulse Pacemaker Programming Guide

3

The 9790/C programmer system components

Setting up the programmer

Printer – Integral thermal printer with text and graphic output capabilities.
Depending upon the selected function, the printer provides data reports,
or it prints a continuous ECG with accompanying Marker Channel
telemetry or EGM.

On/Off (1/0) switch – Controls power (AC) to the programmer. Once the
programmer is turned off, five seconds should pass before turning it on
again.

Cooling fans – Internal fans provide continuous airflow to prevent the
internal circuitry from overheating. Air is taken in from the front and right
side and expelled out the left side.

1

2

1 Calibration button
2 Analog Output
3 PCMCIA access
4 Disk drive

Figure 1-11. External components - right view

Disk drive – Used to install the software that operates the programmer.
The disk drive accepts 3.5 inch diskettes. Once installed, software is
permanently stored on an internal hard disk drive. Also used for save-to­disk and DMR-to-disk operations.

PCMCIA access – Personal Computer Memory Card International
Association compartment containing two ports for future use.

Analog Output – Provides four analog signals: ECG, Marker Channel
telemetry, EGM, and software application specific waveforms.

Calibration button – Used to calibrate the external device connected to
the Analog Output.

4

3

EnPulse Pacemaker Programming Guide 1-13

Setting up the programmer

The 9790/C programmer system components

1

3

2

1 Power cord
2 Input/Output ports
3 AC Power Input

Figure 1-12. External components - back view (power cord door removed)

AC Power Input – Receptacle for connecting the power cord.

Power cord – Cord connects the programmer to line power.

Input/Output ports: Keyboard, Parallel, Serial, and VGA – Currently,

the input/output ports are for Medtronic use only. When customer
applications for these ports are implemented, specific instructions will be
provided in the software manuals.

1-14 EnPulse Pacemaker Programming Guide

Connecting an external printer

Connecting a compatible printer to the programmer allows you to print full,
page-size reports of session data when available (see the reference guide
for the implanted device). This section describes how to connect a printer
to your programmer.

Setting up the programmer

Connecting an external printer

w

Warning: Peripheral equipment connected to the programmer must be
certified according to the applicable IEC standards (IEC 60950 for data
processing equipment and IEC 60601-1 for medical equipment). The
system formed by connecting peripheral equipment to the programmer
must comply with IEC 60601-1-1 for medical electrical systems. It is the
responsibility of the person who connects the peripheral equipment to
comply with IEC standards. It is the responsibility of the user to keep
peripheral equipment that is certified to IEC 60950 at least two meters
away from the patient. Contact the peripheral equipment manufacturer for
information about IEC certification.

Printers listed by this software are certified to IEC 60950 (based on
information provided by the manufacturers) except the Canon BJC-1000,
OKI Okipage 10ex, Samsung QwikLaser 6050, and the Xerox DocuPrint
P8ex. Only printers listed by this software may be connected to
the programmer.

Printer compatibility

The programmer supports a number of printers as indicated by the printer
options accessible on two software screens:

■

Session Preferences (see “To set up printing preferences” on
page 3-13)

■

Print Queue screen (see Figure 1-13)

Note: The print queue during a session lists print jobs for that session
only. See “Printing reports held in the Print Queue” on page 3-35 for more
information.

EnPulse Pacemaker Programming Guide 1-15

Setting up the programmer

Connecting an external printer

Available Reports

Print Queue

Printer field

Figure 1-13. Session Print Queue screen

If you are not conducting a patient session, select the Print Queue icon.

The printer that you connect to the programmer must be compatible with
one of the printer drivers listed. If your printer is not listed, refer to the
manual you received with your printer to see if it emulates (uses the same
“driver”) as one of those listed.

Materials you will need

To connect a printer to the programmer, you will need a Parallel Interface
printer cable. One end of the cable must fit the parallel interface port on
your printer. The other end of the cable must be a standard 25-pin male D
connector. To connect a printer to the 9790/C programmer, you will also
need a small Phillips screwdriver to open the parallel port access panel
on the back of the programmer.

Connecting the printer

Before connecting a printer to your programmer, you should exit the
patient session and turn the programmer off.

1-16 EnPulse Pacemaker Programming Guide

Setting up the programmer

Connecting an external printer

To connect a printer to your 2090 programmer

1

1 Parallel connector

Figure 1-14. Parallel connector

Procedure

1. Locate the Modem, Disk drive cover on the right side of the

programmer. Open the cover by pushing down on the small latch at
the top center of the panel.

2. Connect the printer cable to the parallel connector on the
programmer.

3. Connect the other end of the cable to the printer.

4. Connect the printer power cord to an outlet and turn the printer on.

Make sure that there is paper in the printer.

Note: Refer to the technical information provided with your printer
for information about connecting and operating the printer.

5. Turn the programmer on, and select the Print Queue icon.

Note: Be sure to select the correct printer driver from the options

listed when you select the Printer field on the Print Queue window.
You are now ready to use your programmer with the connected
printer.

EnPulse Pacemaker Programming Guide 1-17

Setting up the programmer

Connecting an external printer

To connect a printer to your 9790/C programmer

1. Locate the parallel port access panel on the back of the

programmer.

2. Remove the small Phillips head screw in the upper right corner of
the access panel.

3. Open the access panel by pushing downward on the small latch at
the top center of the panel.

4. Connect the printer cable to the parallel port on the programmer.

1

2

1 Parallel port
2 Printer cable

Figure 1-15. Connect the printer to the programmer

5. Connect the other end of the cable (if it is not already connected) to
the printer.

6. Connect the printer power cord to an appropriate power outlet, and
turn the printer on. Make sure that the printer has been loaded with
paper.

Note: Refer to the technical information provided with your printer for
information about connecting and operating the printer.

7. Turn the programmer on, and select the Print Queue icon.

1-18 EnPulse Pacemaker Programming Guide

From the Print Queue window, be sure to select the correct printer driver
from the options listed when you select the Printer field. You are now
ready to use your programmer with the connected printer. Refer to
“Printing reports” on page 3-33 for instructions on printing session
reports.

Connecting peripheral devices

An analog input/output connector allows the use of a peripheral isolated
medical grade recorder or monitor. A special adapter accessory (not
included with the programmer) is needed to use the input/output
connector. For a 9790/C series programmer, use a 9790AB analog
input/output cable, and for a 2090 programmer, use a 2090AB analog
input/output cable. Contact your Medtronic representative for more
information. The signals present at the output depend on the software
application but may include the following:

■

ECG

■

Marker Channel telemetry

■

EGM

■

Software specific waveforms

Setting up the programmer

Connecting peripheral devices

All electronic devices that are connected to the programmer must meet
the electrical safety requirements of IEC-60950.

EnPulse Pacemaker Programming Guide 1-19

Setting up the programmer

Connecting peripheral devices

Locating the peripheral device connector on a 2090 programmer

1

Connector type: BNC

Output signal: ± 1 Volt or ± 5mV

(switchable)

Signal Output Adaptor

A

B

C

D

E

2090AB

1

2

2

Adaptor output signals (after model selection):

A - Patient’s ECG (uppermost ECG on display)

B - Telemetered EGM (uppermost EGM on display)

Adaptor input signals (after model selection):

1 - Intended for future use

2 - Intended for future use

C - Telemetered EGM (other EGM if programmed)

D - Marker Channel Telemetry

E - Intended for future use

1 Analog Input/Output connector with green marker (under the keyboard)

2 Model 2090AB Analog Input/Output adaptor

Figure 1-16. Analog Input/Output connector

1-20 EnPulse Pacemaker Programming Guide

Setting up the programmer

Connecting peripheral devices

Locating the peripheral device connector on a
9790/C programmer

Connector type: BNC

Output signal: ± 1 Volt or ± 5 mV (switchable)

Signal Output Adaptor

Calibrate Button

Connecting the Optional Adaptor to the Analog

Output Port on the Programmer.

Figure 1-17. Connecting the optional external adaptor

Using the Calibrate button

Selecting the Calibrate button located next to the analog output port adds
a reference signal (as shown in Figure 1-18 and Figure 1-19) to the trace
of Marker Channel and EGM telemetry.

The Marker Channel signal shows the relative marker amplitudes, which
are not annotated with character codes on an external device. The EGM
calibration signal acts as a voltage reference for the displayed EGM.

A

± 1V ± 5mV

Adaptor output signals (after model selection):

A - Patient’s ECG (uppermost ECG on display)

B - Telemetered EGM (uppermost EGM on display)

C - Telemetered EGM (other EGM if programmed)

D - Marker Channel Telemetry

B

MEDTRONIC 9790AB

C

D

EnPulse Pacemaker Programming Guide 1-21

Setting up the programmer

Connecting peripheral devices

Atrial Pace (AP)

Atrial Sense (AS)

Atrial Refractory Sense (AR)

Vent. Refractory Sense (VR)

Vent. Sense (VS)

Vent. Pace (VP)

Figure 1-18. Marker Channel signals

5 mV

1 mV

Figure 1-19. EGM calibration signals

1-22 EnPulse Pacemaker Programming Guide

The display screen

The programmer display screen is an interactive device that not only
displays information in the form of both text and graphics but also
functions as a control panel by displaying buttons and menu options that
you can select using the stylus.

Features and conventions of the
display screen

This section describes the features and conventions of the display screen.
The Therapy Parameters screen below shows the main elements of the
typical screen.

Status bar

Live Rhythm

Monitor window

Setting up the programmer

The display screen

Task area

Command bar

Active field Button Tool palette

Figure 1-20. Main elements of a display screen

Note: For information on changing the language in the screens (for
example, from English to German), see “Changing the language setting”
on page 2-4.

EnPulse Pacemaker Programming Guide 1-23

Setting up the programmer

The display screen

Status bar

The status bar

The status bar at the top of the screen shows this information:

■

The present pacing mode

■

Test conditions, when they exist

■

The pacemaker model

The Live Rhythm Monitor window

This window is a partial view of the full-screen display of ECG, Marker
Channel, and telemetered EGM waveform traces. You can expand this
window to its full size by selecting the small square button in the upper­right corner of the window or by selecting the [Adjust...] button.

■

Heart rate and rate interval show if the programming head is
positioned over the pacemaker.

■

Annotations above the waveform trace show the point of
programmed parameter changes.

Live Rhythm Monitor window

The waveform trace or traces that show in this window depend on the
selected task screen and how traces have been arranged in the full­screen view. Refer to “Viewing the patient’s ECG and EGM traces” on
page 4-1 for information about the live rhythm monitor.

The task area

The portion of screen between the live rhythm monitor window at the top
and the command bar at the bottom changes according to the task or
function you select. The example in Figure 1-20 shows the Therapy
Parameters screen for programming pacemaker parameter settings. This
task area would appear much different if you selected, for example, the
Threshold Test Setup screen.

1-24 EnPulse Pacemaker Programming Guide

Active fields show as

unshaded areas on

the screen.

Setting up the programmer

The display screen

The command bar

The bar at the bottom of the screen always shows the command buttons
for programming emergency parameters settings, interrogating the
pacemaker, and ending the patient session.

For complete information on these functions, see “Programming
Emergency parameters” on page 2-19, “Interrogating the pacemaker” on
page 3-16, and “Ending a patient session” on page 3-38.

Active fields

Unshaded areas, or boxes, that appear in the task area are active fields
that respond to the stylus.

Selecting a value, word, name, or phrase that appears in an active field
opens a menu or window of alternative options for whatever is
represented in that field.

Selecting an active field

opens a menu or window of

alternative options or, in

some cases, an on-screen

keyboard.

For example, touching the mode value “DDDR” in the Mode field with the
tip of the stylus opens a window of mode options. Selecting any one of
these options replaces the original DDDR value with the selected one,
which becomes a pending value.

EnPulse Pacemaker Programming Guide 1-25

Setting up the programmer

The display screen

Buttons having a less

distinct shaded label are

not presently active.

Selecting some fields (those with terms ending in an ellipsis, such as
“Rate Response...”) opens a window displaying additional fields. Some
fields that require entry of information, such as patient data, open an on­screen keyboard. How to use this keyboard is described later in this
section.

Buttons

Buttons like those shown below allow you to operate the programmer
using the stylus. You can “press” a button by touching it with the tip of the
stylus.

Buttons may directly execute a command, such as the [Program] button,
or they may open a window that prompts another action. Usually such
buttons have a label ending with an ellipsis, such as the [Save...] or
[Get...] buttons shown above.

A procedure may instruct you to “press and hold” a button. In such cases
you should touch the tip of the stylus to the button and continue to
maintain pressure against the button until it is time to “release” the button.

1-26 EnPulse Pacemaker Programming Guide

Buttons

Icons

Setting up the programmer

The display screen

The tool palette

The collection of buttons and icons along the edge of the screen is
referred to as the tool palette. These are the controls you use to choose
the task or function screen you want displayed. Once you have started a
patient session, the tool palette is always displayed, making it quick and
easy to move to the desired task or function.

Each of the icons acts like a button. To select an icon, touch the icon with
the stylus. The “<” symbol adjacent to some of the icons indicates that
selecting one of these icons opens a menu of related options. The icons
without the “<“symbol directly open a task screen.

Refer to Table 3-1 on page 3-6 for a brief explanation of the purpose of
each button and icon in the tool palette.

Note: If the programmer is operating in the Demo mode, the Session icon
is replaced with the Demo icon.

EnPulse Pacemaker Programming Guide 1-27

Setting up the programmer

The display screen

Using the on-screen keyboard

Certain fields on the screen allow you to enter data, such as the patient’s
name or chart number. Selecting such a field automatically displays the
on-screen keyboard shown below. By touching the letter or character
buttons with the stylus, you can use this display feature like an actual
keyboard.

Text entry window

Space bar

Figure 1-21. Keyboard screen

The function of the on-screen keyboard buttons are very similar to the
keys on a computer keyboard or typewriter (see “Keyboard buttons” on
page 1-29).

Note: The Model 2090 programmer includes a built-in keyboard, which is
active only when the on-screen keyboard is displayed.

Cursor position keys

1-28 EnPulse Pacemaker Programming Guide

Tab le 1-1 . Keyboard buttons

Button or feature Function

Text entry window

(See Figure 1-21)

Shows the text as you enter it using the keyboard.
You can enter only as many characters as can fit in
the selected field.

Clears all characters from the text entry window.

Closes the keyboard screen without changing the
selected field.

Deletes the character to the left of the cursor in the
text entry window.

Not intended for use.

Setting up the programmer

The display screen

Space Bar

(See Figure 1-21)

Locks all characters into upper case until the
key is selected again. While the

[Shift] and [Shift Lock] keys operate as

the
described below except that characters will shift to
lower case.

Shifts all of the characters into upper case and
replaces the top row of numbers with commonly used
symbols. This shift cancels automatically after you
select a character or symbol.

Locks all of the characters into upper case and
replaces the top row of numbers with commonly used
symbols. Press this key again to return to number
keys and lower case.

Shifts the keyboard to a limited set of characters.
Selecting a character or symbol cancels

Inserts a blank space.

Moves the cursor one space to the left or the right.

Closes the keyboard screen and enters the text in the
text entry window into the selected field.

[Caps] key is down,

[Caps]

[Alt] key.

EnPulse Pacemaker Programming Guide 1-29

Using the programmer

This chapter guides you through setting your programmer
preferences, connecting the programmer to skin electrodes,
using the programming head, programming emergency
parameters, recording an ECG strip, and using the on-line
help feature.

This chapter also describes how you can use the Checklist
feature to streamline a standardized follow-up routine or
protocol.

2

Setting programmer
preferences 2-2

About the Checklist feature 2-7

Using Checklist 2-8

Creating a custom checklist 2-9

Connecting the programmer to skin
electrodes 2-13

Positioning and using the
programming head 2-14

Programming Emergency
parameters 2-19

Recording an ECG strip 2-21

Using the On-line Help feature 2-24

EnPulse Pacemaker Programming Guide 2-1

Using the programmer

Setting programmer preferences

Setting programmer preferences

Adjusting programmer time and date

If the time or date displayed and printed by the programmer is incorrect,
use the following procedure to enter the correct settings.

To adjust the Time and Date

♦

1. Select Programmer > Time and Date.

Preferences

Time and Date

Artifact Detection

Software

Demonstrations

Figure 2-1. Programmer time and date adjustment

2. From the Programmer Time and Date screen, select the or
button to increase or decrease the value for the unit of time you want
to change. Press and release the button for single unit changes, or
press and hold the button to effect greater changes.

Note: Time must be entered on the basis of a 24-hour clock, with
00:00 being midnight and 12:00 being noon.

3. When all fields show the correct time and date, press the [Apply]
button. Select another tool palette icon to close the Programmer
Time and Date window.

2-2 EnPulse Pacemaker Programming Guide

Setting programmer preferences

Using the programmer

Using audible tones

Certain events in the operation of the programmer result in an audible
signal. The following tones alert the user to the success or failure of
an action.

■

A two-tone beep (low-to-high) indicates confirmation of an
Interrogate or a Program command.

■

A single low-tone beep indicates that an Interrogate, Program, or
Emergency command was not confirmed. It may also indicate that
the selected command cannot be executed.

■

A single, short beep coincides with pressing the Interrogate or the
Program button. It also occurs upon automatic identification of the
pacemaker.

To turn the audible tones on or off

♦

1. Select Programmer > Preferences.

2. From the Preferences screen, select the [Audio ON] or [Audio OFF]

button as desired.

Preferences

Time and Date

Artifact Detection

Software

Demonstrations

Figure 2-2. Preferences screen

EnPulse Pacemaker Programming Guide 2-3

Using the programmer

Setting programmer preferences

♦

Changing the language setting

The software is translated into several languages. Use the following
procedure to determine which languages are available.

To change the language setting

1. Select Programmer > Preferences.

2. From the Preferences screen, select the Language field for the

desired language.

Checking the software version

If you need to know what version of software is currently loaded on the
programmer for any of the pacemaker models, use the following
procedure.

To check the software version number

➤ Select Programmer > Software.

Preferences

Time and Date

Artifact Detection

Software

Demonstrations

Figure 2-3. Software on This Programmer screen

2-4 EnPulse Pacemaker Programming Guide

Preferences

Time and Date

Artifact Detection

Software

Demonstrations

Setting programmer preferences

For each pacemaker model with software loaded on the programmer, the
screen displays the software version number next to the model number.

Note: If the model that interests you is not displayed, the software to
support that model is not currently loaded on the programmer.

Using the programmer

Starting the Demonstrations option

The Demonstrations option allows you to run a demonstration program on
the programmer.

To start a Demonstration program

♦

1. Select Programmer > Demonstrations.

Figure 2-4. Demonstrations Model Selection screen

2. Insert the demonstration diskette into the disk drive.

3. From the Demonstration Model Selection screen, select the desired

View option to list the available demonstration programs.

4. Select the desired demonstration program, and press the [Start]

button.

Note: The [Nominals] button accesses nominal parameter values
for pacemaker models that are not available for Vision software.

EnPulse Pacemaker Programming Guide 2-5

Using the programmer

Setting programmer preferences

♦

Preferences

Time and Date

Artifact Detection

Software

Demonstrations

Improving the detection of pacing artifacts

Enabling the Artifact Detection function improves the detection of pacing
artifacts when interference causes false artifacts to appear on the
patient’s ECG. Pacing artifacts are displayed on the patient’s ECG when
the artifact enhancement option (Show Artifacts) has been enabled as
described in “Enabling or disabling artifact enhancement” on page 4-13.

To access the Artifact Detection function setup screen

For information on using the Artifact Detection function on the 9790
programmer, refer to the Programming Guide Supplement supplied with
the 9886 or 9891 software previously installed in your programmer. For
information on using the Artifact Detection function on the 2090
programmer, refer to the CareLink 2090 Programmer Reference Guide.
To access the Artifact Setup screen, use the procedure described above
rather than the access instructions provided in the Programming Guide
Supplement.

2-6 EnPulse Pacemaker Programming Guide

About the Checklist feature

Checklist lets you use a predefined list of tasks to select each of the
programmer functions you use as you progress through a patient
follow-up protocol or device implantation procedure. Selecting a single
“go-to” button at the end of each task starts the function you will use for
your next task.

You can use the Master Checklist or create and save a task list that follows
your specific follow-up protocol or implantation procedure. The Checklist
screen tracks which tasks on the list have been completed by placing a
checkmark next to the task.

0

Using the programmer

About the Checklist feature

Selecting the “go-to” button
at the end of each task
steps you through the
session according to a
predetermined task list.

Figure 2-5. The Checklist feature

EnPulse Pacemaker Programming Guide 2-7

Using the programmer

Using Checklist

Using Checklist

♦

To display the available

checklists, select the

Checklist field.

Selecting a checklist

option displays the task list

tailored to that option.

The following procedure describes how to use the Checklist feature to
step through the tasks in a follow-up session or implant.

To use the Checklist feature

1. Select the Checklist icon to open the Checklist screen.

2. If the desired task list is not displayed, select the Checklist field and

then the desired option. Refer to “Creating a custom checklist” on
page 2-9 if you need to create a new task list.

Buttons select the next

function on the task list.

3. To begin the session with the first task, select the [Go To Task]
button or the [>>] button next to the Checklist icon.

4. At the completion of each task, select the [>>] button next to the
Checklist icon to start the next task function.

At any time during a session, you can manually select any function you
wish to use and then return to using Checklist.

To perform a task out of order in the tasklist, open the Checklist screen,
select the desired task, and then select the [Go To Task ] button or the

[>>] button next to the Checklist icon.

2-8 EnPulse Pacemaker Programming Guide

Figure 2-6. The Checklist screen

To review the tasks that have been completed, select the Checklist icon.
A checkmark appears by the completed tasks.

Creating a custom checklist

You can create your own checklist to show the specific tasks and the order
in which you perform them during a follow-up session. A maximum of five
checklists may be saved for use with EnPulse pacemakers. The following
sections describe the procedure for creating a custom checklist:

■

Selecting the Create/Edit... window.

■

Choosing a checklist as a source for copying tasks.

■

Building the custom checklist by copying the desired tasks.

■

Saving the custom checklist.

Selecting the Create/Edit... window

To start the procedure for creating a custom checklist, select the
[Create/Edit...] button on the Checklist screen to open the
Create/Edit... window.

Using the programmer

Creating a custom checklist

Source list for copying

Workspace for building

the custom checklist

Figure 2-7. The Create/Edit... window

EnPulse Pacemaker Programming Guide 2-9

Using the programmer

Creating a custom checklist

♦

Select the Copy From field to

display existing checklists.

This window allows you to build a checklist by copying tasks from the list
on the left (source) to the empty field (workspace) on the right. Use the
procedures described on the following pages to create a completely new
checklist that conforms to your follow-up protocol or to make changes to
refine an existing checklist.

Choosing a source for copying

Before you build a new custom checklist, select an existing checklist to act
as source for the tasks you want to copy (or use the checklist presently
displayed if it meets your needs).

To copy from a checklist source

1. Select the Copy From field to display the existing checklists.

2. From this list, select the Checklist you want to use as a source for

creating your custom checklist.

■

If you want to make changes to an existing checklist, select that
checklist.

■

If you want to use an existing checklist as a template for building
a new one, select that checklist.

■

Select the Master Checklist if you want access to all available
follow-up tasks to build a completely new checklist.

Note: The EP Studies test function is not available from the
Master Checklist.

2-10 EnPulse Pacemaker Programming Guide

To add a task to your

custom list, select the task

in the source list.

The task is automatically

copied to the custom

checklist.

Using the programmer

Creating a custom checklist

Building the custom checklist

From the list that appears on the left in the Create/Edit window, you can
build a custom checklist by using the create and edit options described
below.

To copy all tasks from the left list
to your custom list, select the

[Copy All >>] button.

■

To copy all the tasks listed on the left to your custom list on the right,

To delete a task from your custom
list, select the task and then select

[Delete Item] button.

the

select the [Copy All >>] button.

■

To build your custom checklist one task at a time, select each desired
task from the source field on the left. Select the tasks in the order you
want them to appear in the custom checklist.

■

To insert a task in the middle of your custom checklist, highlight
(select) the task that is just above where you want the new task to
appear in the custom checklist. Then select the desired task from the
source list on the left.

■

To eliminate a task that you do not want in your custom list, select the
task in the custom checklist and then select the [Delete Item] button.

Note: You can select a different checklist (source) at any time while you
are building your custom checklist.

EnPulse Pacemaker Programming Guide 2-11

Using the programmer

Creating a custom checklist

♦

The “New” options will be used

up once five different custom

checklists have been saved.

You can revise or copy over
any of these five checklists.

Saving the custom checklist

To save your custom checklist, complete the following procedure.

To save a custom checklist

1. Select the [Save As... ] button to open the Save window.

2. Select “New” from the field of options, or select an existing checklist

if you want to overwrite it with the new checklist.

The Save As field shows the name that will be used to identify the
new checklist.

3. If you want to change the name, select the Save As field to open the
on-screen keyboard; otherwise, skip to step 5. Do not change the
name if you are replacing or updating an existing checklist.

Selecting the Save As

field opens the on-screen

keyboard, which allows

you to enter your own

checklist name.

4. To change the name, clear the original name ([Clear] button), and
enter the desired name using the on-screen keyboard. Then press
the keyboard [ENTER] button.

5. To save the custom checklist, select the [Save] button. Then select
the [Close] button to complete this procedure, and return to the
Checklist window.

The new custom checklist will be available as a Checklist option until it is
replaced by a new custom checklist.

2-12 EnPulse Pacemaker Programming Guide

Connecting the programmer to skin electrodes

Using the programmer

Connecting the programmer to skin electrodes

At the start of a patient session, the programmer must be connected to
skin electrodes on the patient. The ECG display and measurement
functions will not operate without detection of the surface ECG signal.

Use an electrode lead to connect each skin electrode to the appropriate
port on the ECG cable. Typical electrode placement is shown below.
Use standard procedures for attaching disposable skin electrodes to
the patient.

RA (R)

RL (N)

1

Labeled C on some cables

LA (L)

1

(C)

V

LL (F)

() = IEC coding

Figure 2-8. Connecting the programmer to skin electrodes

Refer to your programmer manual for more details on this procedure.

EnPulse Pacemaker Programming Guide 2-13

Using the programmer

Positioning and using the programming head

Positioning and using the programming head

In many of the procedures described in the following chapters, you will
be directed to position the programming head over the patient’s
implanted device.

When to position the programming head

During a patient session, properly position the programming head over
the implanted device before any of the following actions:

■

Selection of any command that initiates a programming transmission.
The programming head must be held in position until completion
of the transmission, which is usually indicated by a confirmation
message.

■

Selection of any command that initiates data transmission from the
implantable device. The programming head should be held steady
until data reception is complete, which is usually indicated by a
confirmation message.

■

Selection of a measurement function that requires the implantable
device to be operating asynchronously as a result of the
programming head magnet.

For any temporarily programmed state or function or for reception of
continuous data such as Marker Channel telemetry or EGM waveforms,
the programming head must be held in place over the implantable device
for the duration of the function or until termination is desired. Lifting the
programming head cancels a temporary program and terminates
continuous telemetry. The implantable device reverts to permanently
programmed values.

#

2-14 EnPulse Pacemaker Programming Guide

Caution: Do not position the programming head over an implanted

pacemaker during electrocautery or defibrillation procedures.

♦

To position the programming head

The programming head must be properly positioned as described below.
An incorrectly positioned programming head can result in the failure of a
transmitted command and the loss of telemetry.

1. Hold the programming head directly against the patient’s skin with
the face of the programming head parallel to the implanted device.

Positioning and using the programming head

Using the programmer

Figure 2-9. Positioning the programming head

2. Position the programming head so that the amber light in the light

array goes out and one or more of the green lights come on. Move
the head a little in each direction to find the position that lights the
greatest number of green lights. This is the optimum position.

Light array

Green

Amber/green

Figure 2-10. Light array indicator

EnPulse Pacemaker Programming Guide 2-15

Using the programmer

Positioning and using the programming head

Effect of the programming head on pacemaker operation

If model selection and application (software) loading are complete,
positioning the programming head over an EnPulse pacemaker does not
put the pacemaker in the magnet mode of operation. The programmer
automatically sends a Cancel Magnet command to the pacemaker, which
causes it to continue to operate as programmed.

An exception to this operation can occur if the programming head does
not establish a telemetry link with the pacemaker (because of strong
electrical interference or because the programming head is improperly
positioned). In such cases, positioning the programming head would
result in magnet mode operation until a telemetry link is established. You
can easily verify the present pacing mode by observing the Status Line at
the top of the screen.

The present pacing mode

shows in the status bar at the

top of the screen.

Pacemaker operation returns to its programmed state about two seconds
after you remove the programming head from its position over
the pacemaker.

Observing magnet mode operation

To observe magnet mode operation during a patient session, you must
conduct the Magnet test described on page 3-28. Initiating the Magnet
test results in a Threshold Margin Test (TMT) and causes the pacemaker
to operate in the magnet mode.

Note: Before you select the pacemaker model, positioning the
programming head over an EnPulse pacemaker results in magnet
mode operation.

2-16 EnPulse Pacemaker Programming Guide

Positioning and using the programming head

Using the programmer

Alternative PROGRAM and
INTERROGATE buttons

To initiate the Program and Interrogate commands, you have the option to
use the on-screen [Program] and [Interrogate] buttons or the Program
[P] and Interrogate [I] buttons on the programming head.

Light array

[Interrogate] Button

Figure 2-11. Alternative Program and Interrogate

programming head buttons

Note: The [P] or [I] button on the programming head is active only when
its counterpart is displayed as an active button on the display screen.

[Program] Button

EnPulse Pacemaker Programming Guide 2-17

Using the programmer

Positioning and using the programming head

Automatic interrogation at the start of a session

At the start of a session when you select [Start] or [Auto Identify], the
programmer automatically interrogates the patient’s pacemaker for most
of the data stored in the pacemaker. For this process, you must position
the programming head and hold it steady in place until the interrogation is
complete.

At the bottom center of the screen you will see an indicator showing the
progress of the interrogation. Because this interrogation retrieves most of
the data stored in the pacemaker, the process may take about a minute.

2-18 EnPulse Pacemaker Programming Guide

Programming Emergency parameters

Programming Emergency parameters

The Emergency programming command is a safety feature that overrides
all other functions and immediately programs the pacemaker to preset
emergency values intended to provide pacing support under a variety of
conditions. This programming cancels any temporary function in effect
and restores Magnet mode operation.

Note: Use of the Emergency command clears the Ventricular Chronic
Lead Trend and Capture Management Trend diagnostic data collected by
the pacemaker. If “Collected Data” has been interrogated previously
during the session, this data will be available for viewing and printing until
the session ends. Collection of new trend data starts after you end the
session.

To program Emergency parameters with the 9790/C

♦

programmer

1. Position the programming head over the pacemaker.

2. Take either of the following actions:

■

Press the square red button on the left side of the display panel.

■

Or select the on-screen [Emergency] button in the lower left
corner of the screen.

Using the programmer

Emergency values are programmed
settings that provide higher-than-normal
energy output. It is not intended that
the pacemaker be left at these settings.
Refer to the EnPulse Pacemaker
Reference Guide for a list of Emergency
parameters settings for EnPulse
pacemakers.

3. Hold the programming head steady until a confirmation message

Red button

Emergency button

Emergency

appears. If programming is not confirmed, verify that the
programming head is properly positioned, and then reselect the
[Emergency] button or the square red button.

EnPulse Pacemaker Programming Guide 2-19

Using the programmer

Programming Emergency parameters

To program Emergency parameters with the 2090

♦

programmer

1. Position the programming head over the pacemaker.

2. Take either of the following actions:

■

■

3. Hold the programming head steady until a confirmation message
appears. If programming is not confirmed, verify that the
programming head is properly positioned, and then reselect the
[Emergency] button or the Emergency VVI hard key.

Press the Emergency VVI hard key on the left side of the
programmer display panel.

Or select the on-screen [Emergency] button in the lower left
corner of the screen.

VVI

w

2-20 EnPulse Pacemaker Programming Guide

Recording an ECG strip

At any time during a patient session, you can initiate a continuous, real­time ECG recording as described below.

To start an ECG recording

♦

➤ Press the desired paper speed button.

.

25 mm/sec

12.5 mm/sec

Paper advance

Using the programmer

Recording an ECG strip

Figure 2-12. ECG chart recorder control buttons on 9790/C programmer

1
2
3

4

1 50 mm/sec

2 25 mm/sec

Figure 2-13. Printer buttons on 2090 programmer

EnPulse Pacemaker Programming Guide 2-21

3 12.5 mm/sec

4 Paper advance

Using the programmer

Recording an ECG strip

50, 25, or 12.5 mm/s – Three buttons allow for selection of a desired
paper speed for ECG, Marker Channel telemetry, and EGM recording.
Pressing a button selects the printer speed and turns on the adjacent
indicator light. Pressing a lit button stops the printout. The selected paper
speed is printed once along the top edge of the chart recording. Paper
speed for text printing is not affected by these buttons.

PAPER ADVANCE – Pressing PAPER ADVANCE advances the printer
paper to its next perforation for tearing off.

To stop the recording

♦

➤ Press the same paper speed button again.

Before you tear off the ECG strip, press the [Paper Advance] button
to advance the strip to a perforation.

About the ECG recording

Because the printed recording provides a higher resolution, it may show
artifacts and events that do not appear on the display.

Annotation of executed commands – Information on the ECG printout
includes an indication of when certain commands to the pacemaker
occurred. When confirmation of the command is received, the command
name is printed at the appropriate point in the margin above the waveform
grid. A recording made during the use of the following test functions
shows the programmed test values as they are programmed: Magnet,
Underlying Rhythm, Threshold, Sensing, EP Studies, and Temporary.

2-22 EnPulse Pacemaker Programming Guide

Annotations

ECG Trace

Marker Telemetry

EGM Telemetry

Using the programmer

Recording an ECG strip

Figure 2-14. Example ECG printout with Marker and EGM telemetry

Marker Channel and EGM telemetry – If the programming head is
positioned over the patient’s pacemaker, the recording includes a trace or
traces of the telemetry being received from the pacemaker. In this
example, the patient’s ECG is accompanied by Marker and EGM
telemetry.

ECG and EGM trace adjustment – The ECG and EGM are recorded
according to control settings accessible from the live rhythm monitor
window on the programmer screen (see “Adjusting and arranging the
waveform traces” on page 4-7). The ECG source (Lead I, II, or III) and the
EGM source are each selected using the button bars appearing with each
waveform trace.

Missing markers – A programming command or interrogation
momentarily interrupts the transmission of Marker Channel telemetry.
This interruption may result in missing markers. The point at which the
command occurred is marked above the ECG trace by a “down” or “up”
arrow. The down arrow (▼) indicates a transmitted command from the
programmer; the up arrow (▲) indicates a telemetry response from the
pacemaker.

EnPulse Pacemaker Programming Guide 2-23

Using the programmer

Using the On-line Help feature

Using the On-line Help feature

The On-line Help system provides on-screen information about many of
the features and operations of the programmer. When you request help,
a Help window opens, temporarily covering much of the workspace. If the
initial Help window does not have the information you are seeking, you
can find another one that does by using the buttons and icons listed
in Table 2-1.

When you are ready to leave the On-line Help system, simply close the
Help window. You will return to the workspace that was in view before you
requested help.

Tab le 2-1 . Getting around in the Help system

Button or icon What It does

(underlined phrase

Scroll bar Use this if a help topic extends beyond the window

) Definition available — Select the phrase to see a pop-

Specific Help — If this icon is displayed within a
screen or window, select it to get specific help related
to that screen or window.

This icon is displayed only if specific help is available.

General Help — Select this button at any time to enter
Help, starting with a topics list.

Displays the Help window last viewed or closes the
Help window first opened.

Closes the Help window.

Displays a list of terms discussed in Help. From this
list, you can select a help topic to learn about one of
the terms.

Displays a list of all available help topics. From this list
you can select any topic.

Link icon — Indicates that more help is available.
Select this symbol to jump to a related topic.

Some pictures may have links also.

up window that defines the phrase. Select
to close the pop-up window or tap the stylus outside
the pop-up window to close the window.

size.

[Previous]

2-24 EnPulse Pacemaker Programming Guide

Using the programmer

Using the On-line Help feature

Entering the Help system

Figure 2-15 shows ways to enter the Help system:

■

If the [?] icon is present, select it for specific help about the screen or
window in which it appears. This icon appears near the window’s title
bar when specific help is available.

■

Select the [Help…] button, which is always present. This leads you
directly to a topics list so that you can search for information. You can
also search by using a Help index.

Once you have entered the Help system, you can use the built-in links to
jump from the current Help window to other related Help windows.

[Help…] button for

general help

[?] icon for

specific help

Title bar for window

having specific help

Figure 2-15. Entering On-line Help

EnPulse Pacemaker Programming Guide 2-25

Using the programmer

Using the On-line Help feature

Pop-up definition window Link to definition window Scroll bar

Using the links in Help

Figure 2-16 shows the links that allow you to see additional Help windows:

■

The basic link, whose icon is shown to the left, indicates that more
help is available. Select it to jump to a related topic.

■

The definition link, whose symbol is an underlined phrase, indicates
that there is a pop-up window to define the phrase. Select the phrase
to open the pop-up window. Select outside the pop-up window (or
select [Previous]) to close it.

Note: Some pictures may have links also. Each of these pictures has
instructions on how to select the links and where they lead.

If you have viewed a series of topics and wish to return to a topic viewed
earlier in that series, you can use the [Previous] button to go backward
through the series of topics one at a time.

Topic window

Help push buttons Link to another Help topic

Figure 2-16. Typical Help windows (topic and definition)

2-26 EnPulse Pacemaker Programming Guide

Using the programmer

Using the On-line Help feature

Exiting the Help system

When you are ready to leave Help and return to the programmer
workspace, select the [Close] button. The Help window closes, and the
programmer screen displays the same information that it did when you
entered Help.

Note: Except for the [Emergency] button, no other functions on the
programmer screen are usable when Help is open. To use other
programmer functions, you must first exit the Help system.

Searching for information in Help

If you do not find the information you were looking for in the current Help
screen, there are several methods for searching for it:

■

Topics List — Select the [Topic s] push button to open a window
having two columns. The column on the left lists categories of help
topics. One of these categories is always selected, and the topics for
that category are listed in the right-hand column. You can view

– Any of the topics listed (on the right) by selecting the link icon

next to its name

– Another category by selecting its name (on the left)

Figure 2-17 shows what happens when you select a different
category. In this example, the category “Initial Help” is selected first.
The right-hand column lists topics included in this category. Suppose
that you are searching for Help on one of the pacing therapies. If you
select “Pacemaker Features” as a new category, notice that the right­hand column changes. You can then select a link icon for the specific
topic you would like to view.

■

Help Index — Select the [Index] button to open a window that lists
indexed terms in alphabetical order. Like a book index, the terms are
not limited to titles in Help. You can go to a Help window that explains
any of the indexed terms by selecting the link icon next to that term.

Figure 2-18 shows some typical index entries.

EnPulse Pacemaker Programming Guide 2-27

Using the programmer

Using the On-line Help feature

Unexpanded Help

categories

To open a

Help topic,

select its

link icon

To expand a new Help category,

select its name

Figure 2-17. Topics List for Help

Expanded Help category
(list of available topics)

To open a Help topic,

select the link icon for its

Index listing.

2-28 EnPulse Pacemaker Programming Guide

Figure 2-18. Help Index

Conducting a
patient session

This chapter describes how to begin a patient session and
how to execute some of the typical tasks you might use to
evaluate operation of the patient’s pacing system.

Included is information about printing, saving, and
transferring the data accumulated during the session. This
chapter concludes with a description of how to properly end
a patient session.

Programmer features 3-2

Automatically adapting
parameters 3-2

Starting a patient session 3-4

Proceeding with session tasks 3-11

Interrogating the pacemaker 3-16

Taking a quick look at pacemaker
operation 3-17

Viewing Battery and Lead
Measurements 3-22

Checking the present parameter
settings 3-25

3

Viewing and programming patient
information stored in the
pacemaker 3-26

Recording an ECG Strip of magnet
operation 3-27

Checking the patient’s Underlying
Rhythm 3-30

Printing reports 3-33

Saving session data on a
diskette 3-36

Ending a patient session 3-38

EnPulse Pacemaker Programming Guide 3-1

Conducting a patient session

Programmer features

Programmer features

Auto cancel magnet – Cancels the magnet automatically when you

place the programmer head over the pacemaker. With Magnet Test, you
can view and record magnet operation.

Auto-interrogation – Occurs automatically at the start of a session. The
programmer automatically prints a report of the interrogated information
unless this feature is turned off.

Checklist feature – You can advance quickly to the next task to be done
in a patient session. Clinicians can create custom checklists that
streamline task selection in follow-up and implant sessions.

Full page-size reports – You can choose to connect an external printer
for printing full page-size reports.

Live rhythm waveform display – You can quickly tailor a multiple-trace
display of the patient’s ECG, atrial and ventricular EGMs, and Marker
Channel signals.

Saved session data – You can save data from a session on a diskette,
which allows you to import session data into a data base or review it using
Read From Disk in Demo mode.

Automatically adapting parameters

This section lists some of the automatically adapting parameters:

■

Rate Profile Optimization

■

Automatic Implant Detection

■

Capture Management

■

Sensing Assurance

■

Lead Monitor

■

Search AV+

■

Automatic PVARP

3-2 EnPulse Pacemaker Programming Guide

Conducting a patient session

Automatically adapting parameters

Rate Profile Optimization

When Rate Profile Optimization is programmed On, the pacemaker can
adapt submaximal and maximal rate response levels once each day by
comparing the patient’s current sensor rate profiles against a nominal or
clinician prescribed target rate profile. This feature is intended to provide
automatic and independent monitoring of rate response at both
submaximal rates for daily patient activities, such as walking and daily
chores, and at maximal rates for vigorous patient activities.

Automatic Implant Detection

The Automatic Implant Detection feature:

■

Determines that the pacemaker has been implanted and that its
leads are stable and sets lead polarities.

■

At implant initializes Sensing Assurance, Capture Management, rate
response, and diagnostic data collection.

Capture Management

The Atrial Capture Management and Ventricular Capture Management
features check the patient’s pacing thresholds at regular intervals. Using
these threshold measurements, the pacemaker can determine whether
pacing pulses in that chamber are capturing the heart’s rhythm.
Optionally, it makes adjustments to the amplitude and pulse width
parameters based on these measurements.

Sensing Assurance

The Sensing Assurance feature, when active for a specific chamber,
allows the pacemaker to change the sensitivity threshold for that chamber
to track changes in the sensed amplitude.

Lead Monitor

This feature monitors lead integrity by measuring and recording lead
impedance. Optionally, it can switch either lead (or both leads) from
bipolar to unipolar polarity if lead impedance is out of range.

EnPulse Pacemaker Programming Guide 3-3

Conducting a patient session

Starting a patient session

Search AV+

The Search AV+ feature is intended to promote intrinsic ventricular
activation in patients with intact or intermittent AV conduction and prevent
inappropriate therapy in patients without conduction. Search AV+ is
available in the DDDR, DDD, DDIR, DDI, DVIR, DVI, and VDD modes for
dual chamber EnPulse pacemakers. The pacemaker searches for the
patient’s intrinsic AV conduction time and adjusts the SAV and PAV
intervals to be longer or shorter to promote intrinsic activation of the
ventricles. When Rate Adaptive AV is active, the pacemaker also adjusts
the SAV and PAV intervals relative to the rate adaptive values. If the
pacemaker does not observe intrinsic ventricular activation during its
periodic searches over the course of a week, it turns off the Search AV+
feature.

Automatic PVARP

When automatic PVARP is programmed, the pacemaker determines a
value for the PVARP based on the mean atrial rate (which is an average
of all A-A intervals except those starting with an atrial sense or atrial
refractory sense and ending with an atrial pace). In the DDDR, DDD, and
VDD modes, automatic PVARP is intended to provide a higher 2:1 block
rate by shortening the PVARP and SAV (if necessary) at higher
tracking rates and protect against PMTs at lower rates by providing a
longer PVARP.

Starting a patient session

Because the programmer collects and stores data on a session-by­session basis, it is important to correctly start and end each session. This
section describes how to start a patient session. To end a session, refer
to “Ending a patient session” on page 3-38.

The starting point of a patient session

A patient session always begins at the Select Model screen. See
“Procedure for starting a patient session” on page 3-9. If you are between
patient sessions, you can access other screens by using the icons and
buttons described in Table 3-1 on page 3-6.

3-4 EnPulse Pacemaker Programming Guide

Conducting a patient session

Starting a patient session

The Select Model screen appears:

■

Upon completion of the self test when you turn the programmer on.

■

After you end a patient session.

Figure 3-1. Select Model screen

Notes:

■

If the Select Model screen does not look like this example and you
see a button, select the button to display this screen.

■

The [Nominals] button does not apply to EnPulse pacemakers. This
button allows you to set up Site Nominals if you select a pacemaker
with this feature.

EnPulse Pacemaker Programming Guide 3-5

Conducting a patient session

Starting a patient session

The tool palette between sessions

Tab le 3-1 .

Tool palette Tool Selecting the tool (button or icon)… Reference

Freezes a segment of the live rhythm display.

Tool palette between patient sessions

page 4-16

Note: A frozen strip can be viewed and printed (but not saved)

between patient sessions. Markers and EGM traces are not present
between patient sessions.

Accesses the rhythm strips saved during a patient session.

page 4-24

Note: No saved strips are available between patient sessions.

Opens a window of options for adjusting the live rhythm display.

page 4-7

Note: Additional adjustment options are present during a patient

session.

Displays the screen for selecting a pacemaker model and starting a
patient session.

Displays a queue of print requests from previous sessions as well as
frozen waveform reports requested between sessions.

Displays the programmer setup options.

Preferences
Time and Date
Artifact Detection
Software
Demonstrations
Programmer Profile (2090 programmer only)

a

For more information on the Programmer Profile feature, refer to the 2090 Carelink Programmer Reference Guide.

a

page 3-4

page 3-35

page 2-2
page 2-2
page 2-6
page 2-4
page 2-5

Note: When some functions are active on the display, selecting a tool button or icon will have no effect.
Closing the active window restores operation of the tool palette.

3-6 EnPulse Pacemaker Programming Guide

Conducting a patient session

Starting a patient session

About automatic interrogation

At the start of a patient session when you select the [Auto-Identify]
button or the [Start] button (see “Procedure for starting a patient session”
on page 3-9), the programmer automatically attempts to interrogate the
patient’s pacemaker to retrieve most of the data that might be needed
during the session.

Note: To take advantage of this automatic interrogation, you must position
the programming head over the pacemaker and continue to hold it in place
until the interrogation is complete.

Clinician-selected diagnostic data is not included in the initial
interrogation. The programmer interrogates that data when you choose to
view the clinician-selected data on-screen or when you select the
[Interrogate...] button.

Interrogation may take about a minute because of the amount of
information stored in the pacemaker. A status gauge at the bottom of the
screen shows progress of the interrogation. The [Stop] button lets you
cancel the interrogation once it has started.

Note: Except for use of the [Emergency] button or the [Stop] button, you
cannot proceed with session activities until the interrogation is 100%
complete.

You can choose to stop interrogation and continue with other activities
(not using the automatic interrogation feature). To do this, select the
[Stop] button or lift the programming head before the process is
complete. In this case, when data is needed, the programmer will display
a message prompting you to interrogate the pacemaker.

You also can manually interrogate the pacemaker at any time during the
patient session (see “Interrogating the pacemaker” on page 3-16).

Warning messages – As a result of an interrogation, a warning message
box may be displayed. Examples of these include:

■

ERI (Elective Replacement Indicator)

■

POR (Power On Reset) or Full Electrical Reset

■

Interrogation interrupted or unsuccessful

■

Lead warnings

EnPulse Pacemaker Programming Guide 3-7

Conducting a patient session

Starting a patient session

You must acknowledge the message before proceeding with other
activities. For an ERI, POR, or a lead message, you can attempt to clear
them by following the instructions in the message. Otherwise, you can
close the message box and clear the condition later. See “Resetting ERI
or electrical reset” on page 7-12.

Initial Interrogation Report

Following a successful interrogation, a report based on this interrogation
is printed automatically. Session preferences allow you to turn this
function on or off (see “Verifying or changing session preferences” on
page 3-13). If the function is on, the same preferences allow you to
choose whether or not to include the Arrhythmia Summary and
Permanent Parameters sections in the report. Depending on the
programmed status of the implanted pacemaker, this report can include
the following:

■

Patient/Pacemaker Information

■

Pacemaker Status

■

Last Measured Threshold

■

P and R-Wave Measurements

■

Threshold Trend

■

Impedance Trend

■

Parameter Summary

■

Clinical Status

■

Long Term Heart Rate Histograms

■

Pacing % counters

■

Event counters

■

High Rate Episodes Summaries

■

Arrhythmia Summary, including:

– High Rate Episodes Summaries

– V. Rate During Atrial Arrhythmias

– Atrial Arrhythmia Durations

– Atrial Arrhythmia Trend

■

All Permanent Parameters

3-8 EnPulse Pacemaker Programming Guide

Conducting a patient session

Starting a patient session

Procedure for starting a patient session

From the Select Model screen, you can start a patient session by either of
two methods:

■

By selecting the [Auto-Identify] button, which automatically
identifies and selects the patient’s pacemaker model.

■

By selecting the appropriate pacemaker model and then the [Start]
button yourself.

Note: To review software screens without interrogating the pacemaker,
use the demonstrations option (See “Starting the Demonstrations option”
on page 2-5). Starting a session without an interrogation provides only a
limited number of screens for review.

To start a session using Auto-Identify

♦

1. Display the Select Model screen:

– If the programmer is not operating, turn it on. The power switch

is on the left side and near the back. The Select Model screen
appears after a short, self-test sequence. (Select the

button if it appears on the screen.)

– If the programmer is operating, but the Select Model screen is

not displayed, choose the Select Model icon from the tool palette
at the side of the screen.

– If the Select Model icon is not in the tool palette, the steps to

properly end the previous patient session have not been
executed. Refer to “Ending a patient session” on page 3-38.

2. Position the programming head over the patient’s pacemaker and

continue to hold it steady.

3. Select the [Auto-Identify] button at the bottom of the screen.

After 40 to 50 seconds of internal software loading, the programmer
displays the first task screen. Continue to hold the programming head
in place until the initial interrogation process is 100% complete.

Refer to “Proceeding with session tasks” on page 3-11 for information on
selecting the functions or tasks you have planned for the session.

EnPulse Pacemaker Programming Guide 3-9

Conducting a patient session

Starting a patient session

♦

Categories

Models

[Start] button

To start a session by selecting the pacemaker model

1. Display the Select Model screen. (Refer to the previous procedure.)

2. Select the appropriate category to view pacemaker models.

3. Select the desired pacemaker model from the list of models. (During

the patient session, the specific model number will appear on the
status bar at the top of the display screen.)

4. If you want the programmer to automatically interrogate the patient’s
pacemaker, position the programming head.

5. Select the [Start] button.

6. After loading the internal software, the programmer displays the first

task screen. Continue to hold the programming head in place until
the initial interrogation process is 100% complete.

Refer to the next topic for information on selecting the functions or tasks
you have planned for the session.

3-10 EnPulse Pacemaker Programming Guide

Proceeding with session tasks

After you select the [Auto-Identify] or [Start] button to begin a patient
session, a short period of internal software loading occurs before the first
task screen appears.

The first task screen

The first task screen to appear is the Quick Look II screen. Refer to
“Taking a quick look at pacemaker operation” on page 3-17 for information
about the Quick Look II screen.

Selecting another task or function

To proceed with the session, select the desired task or function from the
button and icon options grouped along the edge of the screen (see
Table 3-2 on page 3-12). This group of buttons and icons is referred to as
the “tool palette.” It is always available (except during the execution of
certain functions) so that you can quickly and easily display a desired task
or function screen.

Conducting a patient session

Proceeding with session tasks

Note: When some functions are active on the display, selecting a tool
button or icon will have no effect. Closing the active window restores
operation of the tool palette.

Consider using Checklist

During a follow-up session, you can use the tool palette to select tasks or
functions in any order as you proceed through the session. However, if
you use a particular follow-up routine or protocol, you can configure and
use the Checklist feature to streamline the session. For more information,
see “Using Checklist” on page 2-8.

With Checklist, you can advance quickly to each successive task in a
follow-up session. You also can create custom checklists that can be used
for task selection during an implant procedure.

EnPulse Pacemaker Programming Guide 3-11

Conducting a patient session

Proceeding with session tasks

Tabl e 3-2 . Tool palette during a patient session

Tool palette Tool Selecting the tool (button or icon)… Reference

Freezes a segment of the live rhythm display. page 4-16

Accesses the rhythm strips saved since the start of the session. page 4-24

Opens a window of options for adjusting the live rhythm display. page 4-7

Accesses the available Help topics

Selecting the icon displays a screen for setting up and viewing the
Checklist function. Selecting the [>>] button starts the next function
on the follow-up task list.

Displays the options for retrieving information about the patient’s
pacemaker and its operation and for setting up or clearing the data
collection functions:

Quick Look II - Initial Interrogation
Graphs and Tables
Battery and Lead Measurements
Data Collection Setup/Clear

Displays the parameter programming screen. page 7-2

Displays the pacing system test options:

Magnet
Underlying Rhythm
Threshold
Exercise
Sensing
Temporary
EP Studies

Displays the following session report options:

Available Reports
Print Queue

Displays patient information:

Patient Information
Key Parameter History

Displays options for setting session preferences and saving session
data to a diskette:

Preferences
Save To Disk…

This icon is replaced by the Demo icon during the Demo mode

Displays case study options in the Demo mode (use of a
demonstration diskette). This icon otherwise is not displayed.

.. page 2-24

page 2-7

page 3-17
page 5-8
page 3-22
page 5-45

page 3-27
page 3-30
page 6-2
page 8-2
page 6-22
page 6-30
page 9-10

page 3-34
page 3-35

page 3-26
page 7-18

page 3-13
page 3-39

page 2-5

3-12 EnPulse Pacemaker Programming Guide

Conducting a patient session

Proceeding with session tasks

Verifying or changing session preferences

At the start of a patient session, or anytime during the session, you can
select the Session icon to access preference settings that apply to printing
reports and viewing waveform traces during test procedures. Preference
settings are saved and will not be canceled when the session ends.

Printing preferences

Printing preferences let you set up how reports are printed when you
select the [Print...] button. You can choose to have the setup window
show each time you select the [Print...] button or have the [Print...] button
immediately print the report or send it to the print queue. You can also
enable or disable the printer Trace Mode. With the Trace Mode enabled,
the programmer prints programmed variables and their values.

To set up printing preferences

♦

1. Select Session > Preferences.

Preferences

Save To Disk...

2. Select the check box for “Pop up these options when any Print

button is selected” as follows:

– If a check mark (✔) appears, the print setup window will appear

each time you select the [Print...] button.

– If there is no check mark, the [Print...] button immediately prints

the report or transfers it to the print queue.

3. Select the Number of copies field to change the number of report

copies to be printed. Options are 1 to 4 copies.

EnPulse Pacemaker Programming Guide 3-13

Conducting a patient session

Proceeding with session tasks

4. Select the desired Printer.

– Full Size requires that a compatible, external printer be

connected to the programmer (see “Connecting an external
printer” on page 1-15).

Important: Select the printer field and choose the appropriate
printer. The selected printer type must be compatible with the
input requirements of the connected printer.

– Programmer Strip prints reports on the programmer’s strip

chart printer.

5. Select the desired Print report option.

– Now: The report prints immediately when you select the

[Print...] button.

– Later from Print Queue: Selecting the [Print...] button sends the

report to the print queue. See “Printing reports held in the Print
Queue” on page 3-35.

6. Select the check box for “Print continuously (Trace Mode)” as
follows:

–If a check mark (✔) appears, the programmer prints

programmed variables and their values. The data in this case is
not printed in a report format.

– If there is no check mark, the programmer does not print

automatically.

Initial report preference

The Initial Report preference lets you choose whether or not an initial
interrogation report is automatically printed at the start of each patient
session following a successful interrogation.

To select your initial report preference

♦

1. Select the Initial Report option in the Preferences window.

Initial Report option

3-14 EnPulse Pacemaker Programming Guide

Conducting a patient session

Proceeding with session tasks

2. Select the check box for “Always print at session start” as follows:

–If a check mark (✔) appears, the programmer automatically

prints the initial interrogation repor t.

– If there is no check mark, the programmer does not

automatically print the initial interrogation report.

3. Use the additional check boxes to select whether the initial report

will include an Arrhythmia Summary or Permanent Parameters or
both.

Tests preference

The Tests preference lets you choose how waveform traces are displayed
during a selected follow-up test. You can choose whether the live rhythm
display automatically displays the EGM for the heart chamber being
tested (atrium or ventricle) or does not change the arrangement of the
rhythm traces.

To select your preference for the trace display

♦

1. Select the Tests option in the Preferences window.

Tests option

2. Choose the desired option (“Switch EGM to match selected test

chamber” or “Do not change waveform arrangement”).

EnPulse Pacemaker Programming Guide 3-15

Conducting a patient session

Interrogating the pacemaker

Interrogating the pacemaker

At the start of the patient session (as described in “Procedure for starting
a patient session” on page 3-9) the programmer performs an automatic
interrogation to retrieve most of the information stored in the pacemaker.

You can also manually interrogate the pacemaker at any time during
the patient session. In some cases, a pop-up window may request that
you do so.

To interrogate the pacemaker

♦

1. Select the [Interrogate] button at the bottom center of the screen or
press the Interrogate [I] button on the programming head.

2. From the window of options, select the type of information you want
to retrieve. You can select more than one option.

Collected data can

be interrogated only

once during a patient

session.

Figure 3-2. Interrogate How Much? screen

The word “(AGAIN)” indicates that a previous interrogation has
already retrieved this data.

3. Position the programming head and select the [Start] button or
press the programming head Interrogate [I] button.

Hold the programming head steady until the interrogation is 100%
complete as shown by the status gauge at the bottom of the screen.
The [Stop] button lets you cancel the interrogation.

3-16 EnPulse Pacemaker Programming Guide

Taking a quick look at pacemaker operation

Conducting a patient session

Taking a quick look at pacemaker operation

Quick Look II provides a summary or overview of pacemaker operation by
displaying the essential information on one screen. This data was
retrieved during the initial interrogation of the session.

The Quick Look II screen

The Quick Look II screen appears automatically when you start a patient
session or when you choose to display it.

Quick Look II - Initial Interrogation

Graphs and Tables

Battery and Lead Measurements

Data Collection Setup/Clear

Figure 3-3. Pacemaker information on the Quick Look II screen

Note: Each QuickLink [>>] button on the screen provides a direct link to

diagnostic data related to information displayed next to the button.

EnPulse Pacemaker Programming Guide 3-17

Conducting a patient session

Taking a quick look at pacemaker operation

Viewing data on the Quick Look II screen

The Quick Look II screen displays the following information and
information access options.

Remaining Longevity – This is an estimate of the time in years or
months remaining until pacemaker replacement is required. This estimate
is based on the programmed parameter settings and events recorded by
the pacemaker since the last patient session. Note the following
explanation of the longevity estimates, which you can view by selecting
the symbol after the “Remaining Longevity” heading.

Figure 3-4. Remaining Longevity screen

Threshold Trend – The graph shows the average weekly ventricular

pacing thresholds over the last year. If Capture Management is enabled,
the last measured threshold is shown in the box to the right of the graph
(see Figure 3-5 on page 3-19). To view detailed Automatic Capture
Management data, select the QuickLink [>>] button. Refer to “Capture
Management Trend” on page 5-25 for more information.

Impedance Trend – The graph shows the average weekly atrial and
ventricular measured impedances over the last year. The lead
impedances measured during initial interrogation are shown in the box to
the right of the graph (see Figure 3-5 on page 3-19). To view detailed
Lead Impedance Data, select the QuickLink [>>] button. Refer to “Lead
Impedance” on page 5-29 for more information.

3-18 EnPulse Pacemaker Programming Guide

Taking a quick look at pacemaker operation

Figure 3-5. Last measured values

P Wave – If Atrial Sensing Assurance is on, this shows the current P

Wave amplitude range measured by the pacemaker within the last week.
To view detailed P Wave Amplitude trend data, select the QuickLink [>>]
button. Refer to “Sensitivity Trend” on page 5-27 for more information.

R Wave – This shows the current R Wave amplitude range if Ventricular
Sensing Assurance is on. To view detailed R Wave Amplitude trend data,
select the QuickLink [>>] button. Refer to “Sensitivity Trend” on page 5-27
for more information.

Conducting a patient session

Last measured
thresholds

Lead impedance
measured during initial
interrogation

Mode – This shows the currently programmed mode.

Lower Rate – This is the slowest rate at which pacing occurs during a

mode’s basic operation. In rate responsive modes, in the absence of
sensor-detected activity, the sensor-indicated rate is equal to the
programmed Lower Rate.

Upper Track Rate – This is the maximum rate at which the ventricle may
be paced in response to sensed atrial events in the DDDR, DDD, and
VDD modes.

AT/AF – This shows the average number of hours each day in which atrial
arrhythmia episodes are occurring and the total percentage of patient time
that is spent in atrial arrhythmias. To view the Atrial Arrhythmia Trend,
select the QuickLink [>>] button. Refer to “Atrial Arrhythmia Trend” on
page 5-22 for more information.

EnPulse Pacemaker Programming Guide 3-19

Conducting a patient session

Taking a quick look at pacemaker operation

Pacing – Listed under this heading are the pacing and sensing event
sequences applicable to the programmed pacing mode (see
Table 3-3 on page 3-20). Shown is the percent of the total number of
heart beats (recorded since the last patient session) that occurred in each
category.

To view a recorded heart rate histogram, select the QuickLink [>>] button.
Refer to “Heart Rate Histograms” on page 5-11 for information about the
histogram displays.

Note: The data shown under the Pacing and the Observations headings
was collected by the pacemaker since the last patient session. This data
is automatically cleared from pacemaker memory after the session has
ended. After the data is cleared, it cannot be recalled.

Observations – The information displayed in the field under this heading
summarizes the results of diagnostic data collection since the last patient
session. This field lists the number of significant events recorded by the
various diagnostic monitoring functions (see Table 3-4 on page 3-21).

To view a graph or table showing the details associated with an
observation, select the event and then select the QuickLink [>>] button.
Refer to “Viewing the collected data” on page 5-8 for information about
viewing the data recorded by the various monitoring functions.

Dual chamber pacing modes (and ADI, ADIR, VDI, VDIR, VDD)

AS-VS Atrial Sense - Ventricular Sense

AS-VP Atrial Sense - Ventricular Pace

AP-VS Atrial Pace - Ventricular Sense

AP-VP Atrial Pace - Ventricular Pace

3-20 EnPulse Pacemaker Programming Guide

Tabl e 3- 3. Event sequence categories

Taking a quick look at pacemaker operation

Conducting a patient session

Tabl e 3- 3. Event sequence categories

Single chamber pacing modes

Paced Atrial or Ventricular Pace

Sensed Atrial or Ventricular Sense

Tabl e 3-4 . Observation monitoring functions

Functions and criteria used for observation reporting

Atrial Lead Monitor Lead impedance outside Min/Max settings.

Vent. Lead Monitor Lead impedance outside Min/Max settings.

Atrial High Rate Episodes One or more episodes detected.

Ventricular High Rate Episodes One or more episodes detected.

Rate Drop Response Episodes One or more episodes detected.

Remote Assistant Monitor Symptom or exercise data collected.

ERI Monitor Occurrence of ERI conditions.

Electrical Reset Monitor Occurrence of reset conditions.

Capture Management High ventricular threshold measurement.

Abort threshold searches prior to ERI.
Capture Management unable to run.

EnPulse Pacemaker Programming Guide 3-21

Conducting a patient session

Viewing Battery and Lead Measurements

Viewing Battery and Lead Measurements

By selecting the Battery and Lead Measurements screen, you can view
information about the pacemaker battery and the lead system based on
real-time measurements and calculations made at the time of pacemaker
interrogation.

Battery and Lead Measurements screen

The information on this screen provides a detailed status of the
pacemaker battery and the output conditions pertaining to the pacing lead
system.

Quick Look II - Initial Interrogation

Graphs and Tables

Battery and Lead Measurements

Data Collection Setup/Clear

Figure 3-6. The Battery and Lead Measurements screen

Note: The values measured for the pacemaker battery and the lead

system can change from one measurement to the next.

3-22 EnPulse Pacemaker Programming Guide

Viewing Battery and Lead Measurements

Conducting a patient session

Pacemaker Battery and Lead Measurements

The Battery and Lead Measurements screen displays the following
information.

Battery Status – Displays an “OK” or “Replace Pacer” message based
on battery voltage and internal impedance measurements. Included
below the battery status message is the date of pacemaker implantation,
which is based on the most recent operation of the Implant Detect
function.

Remaining Longevity – This is a calculated estimate of the time
remaining until pacemaker replacement will be required. This calculated
estimate is based on the programmed parameter settings and event data
accumulated by the pacemaker since the previous patient session.

For an on-screen explanation of the longevity estimates, select the
information ( ) button appearing after the “Remaining Longevity”
heading.

#

Caution: Elective replacement should not be based on the estimated
remaining longevity. For this decision, use only the elective replacement
indicators or the “Replace Pacer” battery status message.

Battery Voltage/Current/Impedance – These values show the
measured pacemaker battery voltage, the present current drain on the
pacemaker battery averaged over a pacing cycle, and the battery’s
impedance.

EnPulse Pacemaker Programming Guide 3-23

Conducting a patient session

Viewing Battery and Lead Measurements

Atrial and Ventricular Leads – Lead information includes the following:

Amplitude The measured amplitude of a pacing pulse.

Pulse Width Present programmed pulse width setting.

Output Energy Output energy contained in a single pacing pulse.

Measured
Current

Measured
Impedance

Pace Polarity The present lead electrode configuration (unipolar or bipolar)

Updating the displayed data

You can update the data shown on the screen by the following
interrogation procedure.

To update the pacemaker Battery and Lead Data

♦

1. Position the programming head and hold it in place.

The measured current in the pacing lead during delivery of a
pacing pulse.

The measured electrical impedance presented by the pacing
lead and electrode/tissue interface.

used for pacing.

2. Select the [Measure Again] button.

As indicated by the pop-up window, the interrogation and measurement
process takes a few seconds.

3-24 EnPulse Pacemaker Programming Guide

Checking the present parameter settings

Conducting a patient session

Checking the present parameter settings

The first step to viewing the parameter settings to which the patient’s
pacemaker is presently programmed is to display the Therapy Parameters
screen shown below.

The Therapy Parameters screen

This screen is used to view permanent parameters or to program them to
the desired settings.

An ellipsis (...) appearing after

an option indicates that

selecting that option will

display additional parameters.

Figure 3-7. The Therapy Parameters screen

The parameter values displayed on this screen are the parameter settings
to which the patient’s pacemaker is presently programmed. If the field for
a parameter or option displays an ellipsis (e.g., Rate Response…), there
are subordinate parameters that are not displayed on this screen.

For more information, see “Programming parameters” on page 7-2.
Table 7-1 on page 7-10 lists subordinate therapy parameters.

EnPulse Pacemaker Programming Guide 3-25

Conducting a patient session

Viewing and programming patient information stored in the pacemaker

Viewing and programming patient information stored
in the pacemaker

The EnPulse pacemakers can store patient related information that you
can view and print during a patient session. This information typically is
programmed into the pacemaker at the time of implantation, but it can be
revised at any time.

Patient Information

Key Parameter History

Figure 3-8. Viewing the Patient Information screen

To program patient information

♦

1. On the Patient Information screen, select the data field in which you
want to enter or change the data.

This action displays selectable options or the on-screen keyboard for
entering data. Refer to “Using the on-screen keyboard” on page 1-28
for information about entering data using this keyboard.

2. Select the desired information option, or type the desired
information, and then select the [Enter] button on the on-screen
keyboard.

3. Repeat steps 1 and 2 for any field to which you want to add, delete,
or change the data.

3-26 EnPulse Pacemaker Programming Guide

Recording an ECG Strip of magnet operation

4. When you have finished, position the programming head and press

the [PROGRAM] button.

This action programs into the pacemaker all the data as it is presently
displayed on the Patient Information screen.

Conducting a patient session

Recording an ECG Strip of magnet operation

With the EnPulse pacemakers, positioning the programming head does
not cause the pacemaker to operate in its magnet mode. To record or view
magnet operation for EnPulse models, you must use the Magnet test.

The Magnet Test Setup screen

From the Magnet Test Setup screen, you can start and stop magnet
operation in the pacemaker. Options let you collect an ECG strip of
magnet operation and, if desired, non-magnet operation.

Magnet

Underlying Rhythm

Threshold

Exercise

Sensing

Tem por ary

EP Studies

Figure 3-9. Magnet Test Setup screen

EnPulse Pacemaker Programming Guide 3-27

Conducting a patient session

Recording an ECG Strip of magnet operation

Note: At any time during a Magnet test, lifting the programming head from
over the patient’s pacemaker for at least 2 seconds restores operation of
the pacemaker to its permanent status. This action should be taken in the
event of programmer malfunction, loss of power, or the absence of an
appropriate command confirmation.

Procedure for conducting a Magnet Test

To conduct a Magnet Test

♦

1. Display the Magnet Test Setup screen (see Figure 3-9 on
page 3-27).

2. To start magnet operation, position the programming head and
select the [START Magnet] button.

Observe that the live rhythm display shows the point at which magnet
operation begins (“DOO, 85 ppm” for example). At this point, the
pacemaker performs a Threshold Margin Test.

If you have chosen to collect an ECG strip (see “Collecting an ECG
strip” on page 3-29), a pop-up window shows progress during the
collection process. Select the [Stop Collection] button if you want to
stop the ECG collection before it completes. Selecting this button
does not stop magnet operation.

3. To stop magnet operation, select the [STOP Magnet] button.

A pop-up window gives you the option to collect an ECG strip of non­magnet operation. Select [Yes] to collect a non-magnet strip or select

[No] to close the window.

3-28 EnPulse Pacemaker Programming Guide

Recording an ECG Strip of magnet operation

Conducting a patient session

Collecting an ECG strip

The programmer automatically collects an ECG strip during the Magnet
test unless you cancel this option.

■

A check mark (✔) appearing in the Magnet Strip check box indicates
that a strip will be collected. This is the default status when you open
the screen.

■

To change the length of the strip, select the time field and choose the
collection time you desire.

■

If you do not want automatic strip collection, select the Magnet Strip
check box to clear the check mark.

About the collected ECG strips

If you have chosen to collect a Magnet strip or both a Magnet and
Non-Magnet strip, the strips are stored by the programmer for viewing and
printing. A Magnet Strip (and Non-Magnet Strip) icon appears at the
bottom of the screen to indicate when strips are available for viewing
and printing.

To view a collected ECG strip

♦

➤ Select the Magnet Strip or the Non-Magnet Strip icon near the

bottom of the screen. Refer to “Recalling and viewing
waveform strips” on page 4-24 for information about using the strip
viewing feature.

To print a Magnet Test report

♦

➤ Select the [Print...] button and then choose the desired printing

options. Refer to “Printing the frozen strip” on page 4-20 for
information about printing waveform strips and reports.

EnPulse Pacemaker Programming Guide 3-29

Conducting a patient session

Checking the patient’s Underlying Rhythm

Checking the patient’s Underlying Rhythm

To evaluate a patient’s underlying rhythm or determine the patient’s
intrinsic heart rate, use the Underlying Rhythm test.

Magnet

Underlying Rhythm

Threshold

Exercise

Sensing

Tem por ary

EP Studies

#

Caution: The use of this test function is intended for diagnostic and test
purposes. It should be used only under conditions of careful patient
monitoring and control.

The Underlying Rhythm Test screen

The Underlying Rhythm Test screen provides two means for evaluating
the patient’s underlying rhythm: 1) the Inhibit test and 2) the Manual Rate
Decrease test.

Figure 3-10. Underlying Rhythm Test screen

Note: At any point during use of the Underlying Rhythm test, lifting the

programming head away from the site of the patient’s pacemaker for at
least two seconds will restore normal pacemaker operation. In the event
of a programmer malfunction or loss of power, lift the programming head
immediately.

3-30 EnPulse Pacemaker Programming Guide

Checking the patient’s Underlying Rhythm

Conducting a patient session

Procedure for checking the patient’s Underlying Rhythm

Note: The Inhibit mode shuts off pacemaker output for the test duration.

To check Underlying Rhythm using Inhibit

♦

1. Display the Underlying Rhythm Test screen (see Figure 3-10 on

page 3-30).

2. To stop the output of pacing stimuli:

a. Position the programming head.

b. Press and hold the [INHIBIT Press and Hold] button.

Pacemaker blanking periods are shortened during this test to
increase the period during which cardiac events can be sensed.

3. To restore pacing, release the [INHIBIT Press and Hold] button.

To check Underlying Rhythm using manual rate

♦

decrease

1. Display the Underlying Rhythm Test screen (see Figure 3-10 on

page 3-30).

2. Choose the desired test pacing mode and the starting value for

Lower Rate:

a. Select the Mode field to display the test mode options.

b. Select the test pacing mode from the options displayed.

c. Select the or button to adjust the Test Value for Lower Rate

to a setting close to the patient’s present pacing rate.

3. Select the [START Test] button to engage the test mode and rate.

4. Select the button to gradually decrease Lower Rate until the

patient’s underlying rhythm emerges. (Select the button to
increase Lower Rate as desired.)

5. To end the test, select the [STOP and Restore] button.

EnPulse Pacemaker Programming Guide 3-31

Conducting a patient session

Checking the patient’s Underlying Rhythm

Collected ECG strips

During either type of Underlying Rhythm test, the programmer
automatically collects and saves a 10-second ECG strip. A Test Strip icon
appears near the bottom of the screen (after the test has ended) to
indicate its availability.

To view a collected ECG strip

♦

➤ Select the Test Strip icon near the bottom of the screen. Refer to

“Recalling and viewing waveform strips” on page 4-24 for
information about using the strip viewing feature.

To print an Underlying Rhythm Test report

♦

➤ Select the [Print…] button and then choose the desired printing

options. Refer to “Printing the frozen strip” on page 4-20 for
information about printing waveform strips and reports.

3-32 EnPulse Pacemaker Programming Guide