Medtronic KDR603 Reference Guide

KAPPA®700/600

Pacemaker Series

Pacemaker Reference Guide

Medtronic.Kappa™ 700/600 Series
Pacemaker Reference Guide

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

A guide to the
Medtronic.Kappa

™

700/600 Series
pacemakers:

DR

K

700/720/730 Series

D

K

700 Series

VDD

K

700 Series

KSR700 Series

DR

600 Series

K

Refer to the Medtronic.Kappa™
700/600 Pacemaker
Programming Guide for
information on software and
programming.

4

The following terms are trademarks of Medtronic, Inc.

Capture Management, Checklist, FAST, Fast Path, Implant Detection, Kappa, Key Parameter History, Marker Channel, Medtronic,
Medtronic.Kappa, Medtronic.Vision, Rate Profile Optimization, Remote Assistant, Auto-PVARP, Quick Look, Search AV, Sensing
Assurance, Significant Events, Sinus Preference, and Vision.

How to Use This Guide

Information is Contained in Two Guides

Product information about Medtronic.Kappa 700/600 Series
software and pacemakers is presented in two separate guides.

The Pacemaker Reference Guide (PRG) is a supplementary guide
that provides detailed information on Medtronic.Kappa 700/600
Series pacemakers.

The Pacemaker Programming Guide (PPG) accompanies
Medtronic.Kappa 700/600 Series software and contains
instructions on how to use the programmer and the programming
software.

About this Guide

This supplementary guide describes in detail, how the pacemaker
operates and specifies the capabilities of each model.

How to Use This Guide

■

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.

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

iii

How to Use This Guide

About the Pacemaker Programming Guide

This guide presents the following information to use the 9790
programmer.

■

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.

iv

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Table of Contents

1. Pacing Modes

Table of Contents

How to Use This Guide iii

Introduction 1-2
Mode Selection Decision Tree: 1-4
Mode Pertinency Tables 1-5
Indications and Usage 1-7
Contraindications 1-8
DDDR Mode 1-9
DDD Mode 1-10
DDIR Mode 1-11
DDI Mode 1-12
DVIR Mode 1-13
DVI Mode 1-14
VDD Mode 1-15
AAIR / ADIR Modes 1-16
AAI / ADI Modes 1-17
VVIR / VDIR Modes 1-18
VVI / VDI Modes 1-19
AAT / VVT Modes 1-20
DOOR / AOOR / VOOR Modes 1-21
DOO / AOO / VOO Modes 1-22
ODO / OAO / OVO Modes 1-23

2. Rate Response

Introduction to Rate Responsive Pacing 2-2
Preset Rate Response at Implant 2-4
Rate Profile Optimization Operation 2-6
Individualizing Rate Profile Optimization 2-11
Activity Sensor Operation 2-13
Manual Control of Rate Profile Optimization 2-19

3. Pacemaker Timing

Rates 3-2
AV Intervals 3-12

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

6

v

Table of Contents

Rate Adaptive AV 3-16
Search AV and Diagnostic 3-20
Blanking Periods 3-26
Refractory Periods 3-29
High Rate Atrial Tracking 3-40

4. Lead / Cardiac Tissue Interface

Implant Detection 4-2
Automatic Polarity Configuration 4-4
Lead Monitor 4-10
Lead Impedance Data 4-13
Capture Management and Diagnostic 4-15
Sensing Assurance and Diagnostic 4-31
Manually Selecting Pacing Parameters 4-37
Manually Selecting Sensing Parameters 4-41
Transtelephonic Follow-up Features 4-46

5. Special Therapy Options

Mode Switch and Diagnostic 5-2
Non-Competitive Atrial Pacing 5-9
PMT Intervention 5-12
PVC Response 5-16
Ventricular Safety Pacing 5-19
Sinus Preference and Diagnostic 5-21
Rate Drop Response and Diagnostic 5-25
Sleep Function 5-32
Single Chamber Hysteresis 5-34

6. Telemetry Data

Establishing Telemetry 6-2
Parameter Summary 6-3
Patient Information 6-6
Battery and Lead Information 6-8
Marker Channel Telemetry 6-10
Intracardiac Electrograms 6-12
Extended Telemetry 6-15

vi

7

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

7. Miscellaneous Operations

Magnet Mode Operation 7-2
Temporary Programming 7-5
Electrical Reset 7-7
Elective Replacement Indicator (ERI) 7-9
Emergency Pacing 7-10

8. Diagnostics

Introduction to Diagnostics 8-2
Atrial and Ventricular Rate Histograms 8-9
AV Conduction Histograms 8-12
Sensor Indicated Rate Profile 8-15
Atrial and Ventricular High Rate Diagnostics 8-17
Remote Assistant Diagnostics 8-22
Custom Rate Trend 8-25
Key Parameter History 8-27

9. Troubleshooting the Pacing System

Troubleshooting Strategy 9-2
Troubleshooting Electrical Problems 9-3
Troubleshooting Hemodynamic Problems 9-6
Handling, Storage, and Resterilization 9-9
Pacemaker Longevity 9-10
Replacing the Pacemaker 9-12
Patient Information and Service 9-13

Table of Contents

A. Pacemaker Description

Model Number Designator A-2
Radiopaque Codes A-3
Physical Dimensions A-5
Connector Dimensions A-6

B. Preset Parameter Settings

Shipping Settings B-2
Nominal Settings B-8
Electrical Reset Settings B-14
Emergency Settings B-22

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

8

vii

Table of Contents

C. Longevity Projections

Longevity Projections (Normal Operating Life) C-2
Longevity Projections (After ERI) C-8
Elective Replacement Indicator (ERI) C-11
Battery Specifications C-12

D. Telemetry and Diagnostic Values

Magnet Mode Operations D-2
Telemetry Functions D-3
Automatic Diagnostics D-7
Clinician-Selectable Diagnostics D-9
Cardiac Event Counters D-12

E. Parameter Values and Restrictions

Programmable Modes and Parameters E-2
Rate Response Programming Guidelines E-13
Timing Reference E-14

F. Warnings and Precautions

Special Notice F-2
Warnings F-4
Precautions F-6
Potential Complications F-11

G. Environmental Interference

Hospital or Medical Environment Interference G-2
Home and Job Environment Interference G-6

H. Glossary

I. Index

viii

9

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Understanding
Pacemaker Operation

Chapters 1 - 9 provide detailed
information about the operation of
the Kappa 700/600 Series
pacemakers.

Pacing Modes
Rate Response

Pacemaker Timing

Lead/Cardiac Tissue Interface

Special Therapy Options

Telemetry Data

Miscellaneous Operations

Diagnostics

Troubleshooting The
Pacing System

Pacing Modes

This chapter provides information about the modes
available with the pacemaker.

1

1

Introduction

Mode Selection
Decision Tree:

Mode Pertinency Tables

Indications and Usage

Contraindications

DDDR Mode

DDD Mode

DDIR Mode

DDI Mode

DVIR Mode

DVI Mode

1-2

1-4

1-8

1-9

1-10

1-11

1-12

1-13

1-14

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1-7

1-5

VDD Mode

AAIR / ADIR Modes

AAI / ADI Modes

VVIR / VDIR Modes

VVI / VDI Modes

AAT / VVT Modes

DOOR / AOOR / VOOR
Modes

DOO / AOO / VOO Modes

ODO / OAO / OVO Modes

1-15

1-16

1-17

1-18

1-19

1-20

1-21

1-22

1-23

1-1

10

Pacing Modes

Introduction

Introduction

Pacing Mode Selection

This chapter provides an introduction to pacemaker modes as an
aid to pacing mode selection. The chapter is organized as follows:

Mode Selection Decision Tree – This decision tree, based on the
1991 ACC/AHA guidelines for pacemaker implantation,

1

provides a simple means of identifying pacing modes appropriate
for given indications.

Mode Pertinency Tables – These tables show which features and
parameters apply to each commonly used pacing mode.

Mode Descriptions – These descriptions provide indications and
contraindications for modes available with the pacemaker and
brief descriptions of how these modes operate.

NBG Pacing Codes

The pacemaker modes are defined in NBG Code.2 Each five-letter
NBG code describes a specific type of operation for implantable
pacemakers. For simplicity, this manual uses only the first three or
four letters, such as DDD, DDIR, DVIR, and so forth. Figure 1-1
describes the first four letters of the NBG code.

11

1-2

1

Dreifus LS, Fisch C, Griffin JC, et al. Guidelines for implantation of cardiac
pacemakers and antiarrhythmia devices. A report of the American College of
Cardiology/American Heart Association Task Force on Assessment of
Diagnostic and Therapeutic Cardiovascular Procedures (Committee on
Pacemaker Implantation).
18: 1-13.

2

Bernstein A., et al., “The NASPE/BPEG Pacemaker Code,” PACE, 10(4), Jul-Aug

1987. (“NBG” stands for The North American Society of Pacing and
Electrophysiology [NASPE] and the British Pacing and Electrophysiology
Group [BPEG] Generic. NBG’s five-letter code supersedes the ICHD Code.

Journal of the American College of Cardiology.

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1991;

Pacing Modes

Introduction

CHAMBER PACED

V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None

CHAMBER SENSED

V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None

Figure 1-1.

DDDR

NBG Pacing Codes

MODE OF RESPONSE

T = Triggered
I = Inhibited
D = Double (Both)
O = None

PROGRAMMABLE/
RATE RESPONSE

P = Programmable
M = Multiprogrammable
C = Communicating
R = Rate Responsive
O = None

Further Information

The mode descriptions in this chapter provide only a basic
overview of each mode. For further details on the rate response,
timing, and therapy capabilities refer to “Rate Response” on
page 2-1, “Pacemaker Timing” on page 3-1, and “Special Therapy
Options” on page 5-1, respectively.

12

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1-3

Pacing Modes

Mode Selection Decision Tree:

Mode Selection Decision Tree:

Figure 1-2 shows a basic decision tree used to select the pacing mode. In the shaded boxes the
preferred mode(s) is listed and the alternate mode(s) appears below the dashed line.

Symptomatic

Bradycardia

(e.g., persistent

atrial fibrillation,

inexcitable atrium)

Is SA node conduction

presently adequate?

Ye s NoNo

AAI

DDD
AAIR

DDDR

VVIR

VVI

No

Ye s

Can the atrium be sensed

and/or paced reliably?

Is AV conduction

presently adequate?

AAIR

DDDR

Figure 1-2.

Ye s

DDD

DDDR

VDD

Mode Selection Tree

No

(e.g., complete or
transient AV block)

Is SA node conduction

presently adequate?

Ye s

DDDR

DDIR

13

1-4

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Pacing Modes

Mode Pertinency Tables

black

✓

es.

e

✓ ✓

✓✓✓ ✓✓

✓✓✓✓ ✓

✓✓✓✓

. Automatic PVARP is available in the DDDR, DDD, and VDD mod

14

Mode Pertinency Tables

Pacing Parameters Available for Each Mode

Table 1-1.

DDDR DDD DDIR DDI DVIR DVI VDD VVIR VDIR VVI VDI VVT AAIR ADIR AAI ADI AAT

a

Pacing Parameter

Lower Rate ✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓

Upper Tracking Rate ✓✓ ✓

Upper Sensor Rate ✓ – ✓ – ✓ ––✓✓–––✓✓–––

Paced AV Interval ✓✓✓✓✓✓

Table 1-1 and Table 1-2 show which pacing parameters and features apply to each pacing mode as indicated by

check marks. Dashes indicate parameters that are programmable when mode switch, RAAV, or sensor-varied PVARP

are active or when rate response is operative but not pertinent to basic mode operation. These parameters ar

programmable. Note that certain features are not available in Kappa 600 Series pacemakers for certain pacing modes;

see Section E for specific details. Also, asynchronous modes are not shown in these tables.

Sensed AV Interval ✓✓ ✓

✓✓✓✓ ✓

b

Rate Adaptive AV ✓✓✓✓✓

PVARP

PVAB ✓✓✓✓ ✓ ✓ ✓

Atrial Refractory Period

Atrial Blanking

✓✓✓✓✓✓✓✓✓✓✓✓

✓✓✓✓✓✓

Ventricular Refractory

Period

Ventricular Blanking

(after AP)

Sensing Assurance ✓✓✓✓✓✓✓✓✓✓✓

See Chapter 3 for descriptions of these timing parameters. Sensing Assurance and Capture Management are described in Chapter 4.

Capture Management ✓✓✓✓✓✓✓✓✓✓✓

a

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Sensor-varied PVARP available in the DDDR, DDD, DDIR, and VDD modes

b

1-5

Pacing Modes

Mode Pertinency Tables

Features Available for Each Mode

✓✓

✓✓✓ ✓✓ ✓

15

Tabl e 1- 2.

1-6

DDDR DDD DDIR DDI DVIR DVI VDD VVIR VDIR VVI VDI VVT AAIR ADIR AAI ADI AAT

Managing Atrial

RhythmaMode Switch ✓✓ ✓

✓✓

Non-Competitive Atrial

Pacing

Managing Ventricular

RhythmaPMT Intervention ✓✓ ✓

a

PVC Response ✓✓✓✓ ✓

Ventricular Safety Pacing ✓✓✓✓✓✓

Special Pacing

Operations

Rate Drop Response ✓✓

Search AV ✓✓✓✓✓✓✓

Single Chamber

Hysteresis

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

b

See Chapter 5 for operational descriptions of special therapy options. Search AV is described in Chapter 3.

Sinus Preference ✓

Sleep Function ✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓

Rate Response

ADL Rate ✓ – ✓ – ✓ ––✓✓–––✓✓–––

Rate Profile Optimization ✓ – ✓ – ✓ ––✓✓–––✓✓–––

Activity Threshold ✓ – ✓ – ✓ ––✓✓–––✓✓–––

Activity Acceleration ✓ – ✓ – ✓ ––✓✓–––✓✓–––

See Chapter 2 for operational descriptions of rate response features.

Activity Deceleration ✓ – ✓ – ✓ ––✓✓ –––✓✓–––

a

b

Indications and Usage

Medtronic.Kappa 700/600 Series pacemakers are indicated for the
following:

■

Rate adaptive pacing in patients who may benefit from
increased pacing rates concurrent with increases in activity.

■

Accepted patient conditions warranting chronic cardiac
pacing which include:

– Symptomatic paroxysmal or permanent second or third-

degree AV block.

– Symptomatic bilateral bundle branch block.

– Symptomatic paroxysmal or transient sinus node

dysfunctions with or without associated AV conduction
disorders.

– Bradycardia-tachycardia syndrome to prevent

symptomatic bradycardia or some forms of symptomatic
tachyarrhythmias.

Pacing Modes

Indications and Usage

16

– Vasovagal syndromes or hypersensitive carotid sinus

syndromes.

Medtronic.Kappa 700/600 Series pacemakers are also indicated
for dual chamber and atrial tracking modes in patients who may
benefit from maintenance of AV synchrony. Dual chamber modes
are specifically indicated for treatment of conduction disorders
that require restoration of both rate and AV synchrony, which
include:

■

Various degrees of AV block to maintain the atrial
contribution to cardiac output.

■

VVI intolerance (e.g., pacemaker syndrome) in the presence of
persistent sinus rhythm.

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1-7

Pacing Modes

Contraindications

Contraindications

Medtronic.Kappa 700/600 Series pacemakers are contraindicated
for the following applications:

■

Dual chamber atrial pacing in patients with chronic refractory
atrial tachyarrhythmias.

■

Asynchronous pacing in the presence (or likelihood) of
competitive paced and intrinsic rhythms.

■

Unipolar pacing for patients with an implanted cardioverter­defibrillator (ICD) because it may cause unwanted delivery or
inhibition of ICD therapy.

17

1-8

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

DDDR Mode

Pacing Modes

DDDR Mode

In the DDDR mode, the pacemaker tracks the faster of the intrinsic
atrial rate or the sensor-indicated rate. If the intrinsic rate is faster,
the DDDR mode provides atrial synchronous pacing; otherwise,
AV sequential pacing occurs at the sensor-indicated rate.

■

Rate limits for atrial tracking (Upper Tracking Rate)1 and
sensor tracking (Upper Sensor Rate) are separately
programmable.

■

The AV intervals that follow sensed atrial events (SAV) and
paced atrial events (PAV) are separately programmable, and
they can be programmed to shorten with increasing rates
(Rate Adaptive AV) or to change with intrinsic conduction
times (Search AV).

■

A nonrefractory sensed event in either chamber inhibits
pacing in that chamber. A ventricular nonrefractory sensed
event in the VA interval that is not preceded by an atrial sense
(AS or AR) is a pacemaker-defined PVC, and starts a new VA
interval.

18

Sensor-indicated

Interval

A
P

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms PVARP = 280 ms
Sensor-indicated Rate = 90 ppm (667 ms) SAV Interval = 170 ms

A
P

V
S

Figure 1-3.

1

Example of DDDR Mode Operation

The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser

Sensor-indicated

Interval

A
S

V
S

A
P

V
P

value.

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

A
S

V
P

200 ms

1-9

Pacing Modes

DDD Mode

DDD Mode

The DDD mode provides atrial synchronous pacing in the
presence of intrinsic atrial activity; otherwise, AV sequential
pacing occurs at the Lower Rate.

■

Each atrial paced or nonrefractory atrial sensed event starts an
AV interval and a lower rate interval. The AV intervals that
follow sensed atrial events (SAV) and paced atrial events
(PAV) are separately programmable, and the SAV may be
optionally programmed to shorten with increasing rate (Rate
Adaptive AV) or to change with intrinsic conduction times
(Search AV).

■

A ventricular paced events may track atrial sensed events up
to the programmed Upper Tracking Rate.

■

A ventricular nonrefractory sensed event in the VA interval

1

that is not preceded by an atrial sense (AS or AR) is a
pacemaker-defined PVC, and starts a new VA interval.

19

1-10

Lower Rate Interval

A
P

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms

Figure 1-4.

A
P

V
S

SAV Interval = 170 ms

Example of DDD Mode Operation

1

The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value.

A
S

V
S

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Lower Rate Interval

200 ms

A
P

DDIR Mode

Pacing Modes

DDIR Mode

The DDIR mode provides dual chamber, sensor-driven,
atrioventricular (AV) sequential pacing for heart rate variation
without atrial tracking.

■

Atrial pacing occurs at the sensor-indicated rate, with
ventricular pacing at the end of the PAV interval unless
inhibited.

■

An atrial event sensed outside the PVARP will inhibit a
scheduled atrial stimulus but will not start an AV interval.
That is, ventricular paced events after such sensed atrial
events occur at the sensor-indicated rate. The following
ventriculoatrial (VA) interval may be extended slightly to
avoid an increasing atrial paced rate.

■

A ventricular nonrefractory sensed event in the VA interval
starts a new VA interval.

Sensor-indicated

Interval

A
P

V

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms
Sensor-indicated Rate = 90 ppm (667 ms)

P

A
P

Figure 1-5.

Sensor-indicated

Interval

A
S

V
P

Example of DDIR Mode Operation

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

Sensor-indicated

VA Interval

V
P

Sensor-indicated

A

A
P

P

V
P

Interval

200 ms

A
P

1-11

20

Pacing Modes

DDI Mode

DDI Mode

Lower Rate Interval

The DDI mode provides dual chamber atrioventricular (AV)
sequential pacing with atrial sensing but without atrial tracking.

■

Atrial pacing occurs at the Lower Rate, with ventricular
pacing at the end of the PAV interval unless inhibited.

■

An atrial event sensed outside the PVARP will inhibit a
scheduled atrial stimulus but will not start an AV interval.
Ventricular paced events after such sensed atrial events occur
at the Lower Rate.

■

A ventricular nonrefractory sensed event in the
ventriculoatrial (VA) interval starts a new VA interval.

Lower Rate

Lower Rate Interval

VA Interval

21

A
P

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms

A
P

Figure 1-6.

1-12

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

A
S

V
P

V
P

Example of DDI Mode Operation

200 ms

A
P

DVIR Mode

Pacing Modes

DVIR Mode

The DVIR mode provides AV sequential pacing at the sensor­indicated rate unless inhibited by ventricular sensed events.

■

Atrial pacing occurs at the sensor-indicated rate, with
ventricular pacing at the end of the PAV interval unless
inhibited.

■

The DVIR mode ignores intrinsic atrial events. Sensing occurs
only in the ventricle. A ventricular nonrefractory sensed event
during the ventriculoatrial (VA) interval starts a new VA
interval.

Sensor-indicated

Interval

A
P

V

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms
Sensor-indicated Rate = 90 ppm (667 ms)

P

A
P

V
S

Figure 1-7.

Example of DVIR Mode Operation

Sensor-indicated

V
S

VA Interval

Sensor-indicated

A
P

V
P

Interval

A
P

200 ms

22

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1-13

Pacing Modes

DVI Mode

DVI Mode

The DVI mode provides dual chamber AV sequential pacing
without atrial sensing/tracking.

■

Atrial pacing occurs at the Lower Rate, with ventricular
pacing at the end of the PAV interval unless inhibited.

■

Sensing occurs only in the ventricle, and intrinsic atrial events
are ignored. A ventricular nonrefractory sensed event during
the VA interval starts a new ventriculoatrial (VA) interval.

Lower Rate Interval

A
P

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms

Figure 1-8.

A
P

V
S

Example of DVI Mode Operation

V
S

Lower Rate

VA Interval

A
P

V
P

200 ms

23

1-14

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

VDD Mode

Pacing Modes

VDD Mode

The VDD mode provides atrial synchronous pacing (or VVI
pacing at the Lower Rate). The ventricle is paced synchronously
up to the programmed Upper Tracking Rate.

1

Sensing occurs in
both the atrium and ventricle, but pacing occurs only in the
ventricle.

■

To promote atrial synchronous pacing at slow rates, a sensed
atrial event occurring near the end of the Lower Rate interval
will be followed by the programmed maximum SAV interval.
The result is an extension of the ventricular lower rate.

■

A ventricular nonrefractory sensed event in the V-V interval
that is not preceded by an atrial sense (AS or AR) is a
pacemaker-defined PVC, and it starts a new V-V interval.

Lower Rate Interval

SAV

Interval

24

A
S

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) SAV Interval = 200 ms
Upper Tracking Rate = 120 ppm (500 ms) PVARP = 250 ms

A
S

V
P

Figure 1-9.

1

The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value.

Example of VDD Operation

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

A
S

V
P

A
S

200 ms

1-15

Pacing Modes

AAIR / ADIR Modes

AAIR / ADIR Modes

The AAIR mode provides atrial-based rate responsive pacing in
patients with intact AV conduction. Sensing and pacing occur
only in the atrium. In the absence of sensed events, the chamber is
paced at the sensor-indicated rate.

The ADIR mode operates the same as the AAIR mode except that
events sensed in the ventricle are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the conducted
ventricular rhythm without affecting atrial pacing.

In the AAIR and ADIR modes, atrial refractory sensed

Note:

events do not restart the Upper Sensor Rate interval.

Sensor-indicated Interval Sensor-indicated Interval

25

1-16

A
P

Parameters

Sensor-indicated Rate = 75 ppm (800 ms)
Upper Sensor Rate = 100 ppm (600 ms)

A

R

:

A
P

Figure 1-10.

Example of AAIR Mode Operation

A
S

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

A
P

200 ms

AAI / ADI Modes

The AAI mode provides single chamber inhibited atrial pacing.
Sensing and pacing occur only in the atrium. Pacing occurs at the
programmed Pacing Rate unless inhibited by sensed events.

The ADI mode operates the same as the AAI mode except that
events sensed in the ventricle are recorded by the diagnostics.
When used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the conducted
ventricular rhythm without affecting atrial pacing.

Pacing Modes

AAI / ADI Modes

Pacing Rate Interval

A
P

Parameters:

Pacing Rate = 75ppm (800 ms)

A
R

Figure 1-11.

Pacing Rate Interval

A
P

A
S

Example of AAI Mode Operation

800600400200 1000

A
P

200 ms

26

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide

1-17

Pacing Modes

VVIR / VDIR Modes

VVIR / VDIR Modes

The VVIR mode provides ventricular rate responsive pacing in
patients for whom atrial-based pacing is deemed unnecessary or
inappropriate. In the absence of sensed events, the ventricle is
paced at the sensor-indicated rate.

The VDIR mode operates the same as the VVIR mode except that
events sensed in the atrium are recorded by the diagnostics. When
used in conjunction with Marker Channel recordings and
concurrent ECG, this mode may be used to observe the
underlying atrial rhythm without affecting ventricular pacing.

Note:

events restart the Upper Sensor Rate interval.

In the VVIR and VDIR modes, ventricular refractory sensed

Sensor-indicated

Interval

V
P

Parameters:

Lower Rate = 60 ppm (1000 ms) Upper Sensor Rate = 120 ppm (500 ms)
Sensor-indicated Rate = 90 ppm (667 ms) Ventricular Refractory Period = 300 ms

Figure 1-12.

Sensor-indicated

Interval

Upper Sensor

Rate Interval

V
P

V
R

V
P

Example of VVIR Mode Operation

Sensor-indicated

Interval

V
P

200 ms

27

1-18

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide