Medtronic KDR603 Programming Guide
KAPPA 700/600 SERIES
PACEMAKERS
Software Model 9953A
Vision™ Programmer Software
Pacemaker Programming Guide for EP Studies Function
Using the EP Studies Function
with Medtronic.Kappa™ 700/600
Series Pacemakers
Caution: Federal law (USA) restricts this device to
sale by or on the order of a physician.
Software
TM
Supplement to the
Medtronic.Kappa
700/600 Series
Pacemaker
Programming Guide
™
4
Medtronic, Medtronic.Kappa, Medtronic.Vision, and Marker Channel are all trademarks of
Medtronic, Inc.
5
About this Supplement
This booklet covers using the EP (electrophysiologic) Studies
function of the 9790 series programmer with Medtronic.Kappa™
700/600 Series pacemakers. This booklet is a supplement to the
Pacemaker Programming Guide
Refer to the Pacemaker Programming Guide for instructions on
setting up and operating your 9790 series programmer.
About this Supplement
for these pacemakers.
For information about using
the 9790 programmer with
Medtronic.Kappa™ 700/600
Series pacemakers, refer to
the
Pacemaker Programming
.
Guide
KAPPA®700/600 SERIES
PACEMAKERS
Model 9953 1.3
Pacemaker Programming Guide
EP Studies Supplement
iii
6
Additional Information
Additional Information
Instructions in this booklet reference certain procedures and
functions that are described in the
for the Medtronic.Kappa™ 700/600 Series pacemakers. The table
below lists this information and its location.
Adjusting the live rhythm display Chapter 4
Interrogating the pacemaker Chapter 2
Clinician-selected diagnostic data collection Chapter 5
Printing reports Chapter 2
Resetting an ERI or Electrical Reset Chapter 7
Programming the pacing mode Chapter 7
Viewing saved ECG strips Chapter 4
Pacemaker Programming Guide
iv
7
EP Studies Supplement
Table of Contents
1. About the EP Studies Function
2. Starting the EP Studies Function
Table of Contents
About this Supplement iii
Additional Information iv
Intended Use and General Warning 1-2
Intended Use 1-2
General Warning 1-2
Precautions and Considerations 1-3
EP Studies Access and Protocol Options 1-6
EP Studies Access 1-6
Protocol Options 1-6
The PES Protocol 1-7
The Burst Protocol 1-8
The VOO Burst Protocol 1-9
Using VOO Backup Pacing 1-10
What VOO Backup Pacing Does 1-10
Requirements for Starting EP Studies 2-2
Start-up Procedure 2-3
Before You Proceed 2-6
Protocol Timing Limitations 2-6
Viewing Information About Achievable Stimulus
Amplitudes 2-7
Adjusting the Live Rhythm Display 2-8
Protocol ECG Strip and Printed Report 2-8
3. Setting Up and Executing a PES Protocol
Setting Up a PES Protocol 3-2
A. Selecting the PES Protocol Option 3-2
B. Setting Up the Stimulation Sequence 3-3
C. Setting Up Additional Test Values 3-4
Executing the PES Protocol 3-6
EP Studies Supplement
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v
Table of Contents
4. Setting Up and Executing a Burst Protocol
Setting Up a Burst Protocol 4-2
A. Selecting the Burst Protocol Option 4-2
B. Setting Up the Burst Parameters 4-3
C. Setting Up Additional Test Values 4-3
Executing the Burst Protocol 4-5
Setting Up and Executing a VOO Burst 4-6
Setup Procedure 4-6
Executing a VOO Burst 4-7
5. Programmable Parameter Definitions and Values
PES Parameter Information 5-2
PES Parameter Definitions 5-2
PES Parameter Values 5-5
Burst Parameter Information 5-6
Burst Parameter Definitions 5-6
Burst Parameter Values 5-8
Index
vi
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EP Studies Supplement
About the EP Studies
Function
This chapter introduces the EP Studies function with
important Intended Use, General Warning, and
Precaution statements. Included is a description of
each of the stimulation protocols and the backup
ventricular pacing option.
1
Intended Use and General
Warning
Precautions and
Considerations
EP Studies Access and Protocol
Options
The PES Protocol
The Burst Protocol
1-2
1-3
1-6
1-7
1-8
10
The VOO Burst Protocol
Using VOO Backup Pacing
EP Studies Supplement
1-9
1-10
1-1
About the EP Studies Function
Intended Use and General Warning
Intended Use and General Warning
EP (Electrophysiologic) Studies is a special function of the
Medtronic® 9790 series programmer that allows you to use the
patient’s implanted pacemaker to noninvasively deliver high-rate
cardiac stimulation. Programmable mode, interval, and delay
parameters allow you to set up protocols for delivering either
programmed electrical stimulation (PES) or burst stimulation.
Intended Use
The EP Studies function is intended for use in measuring or
assessing conduction properties of the heart and inducing or
terminating tachyarrhythmias. The EP Studies function covered
in this supplement applies only to the pacemakers listed below.
Table 1-1.
Medtronic.Kappa™ 700 Series KDR700/720/730 Series
Medtronic.Kappa™ 600 Series K
Applicable Pacemaker Models
KD700 Series
VDD
K
700 Series
SR
K
700 Series
DR
600 Series
General Warning
The EP Studies function is intended for use only by those trained
in electrophysiologic studies. The stimulation options of this
function should be applied only under conditions of careful
patient monitoring and control. High-rate stimulation of the
ventricles can result in ventricular fibrillation. An external
defibrillator should be placed on standby and be kept
immediately available during the use of the EP Studies function.
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1-2
EP Studies Supplement
About the EP Studies Function
Precautions and Considerations
The following precautions and important considerations apply to
using the EP Studies function.
Loss of Diagnostic EGM Collection
Starting EP Studies disables EGM collection if it applies to a
programmed clinician-selected diagnostic and clears the EGM
from the pacemaker memory.
If diagnostic data is interrogated prior to starting EP Studies, the
collected EGM is available on the programmer throughout the
patient session, but is lost when you end the session. You should
view and print the collected data before ending the session.
EGM collection remains off until it is reprogrammed to the
desired type (see “Ending the Patient Session” on page 1-5).
Using EP Studies does not affect automatic (non-selectable)
diagnostic data collection functions.
Precautions and Considerations
12
Using VOO Backup Ventricular Pacing
The VOO Backup option delivers
ventricles during atrial stimulation. These pacing stimuli may
compete with intrinsic ventricular activity. Refer to page 1-10 for
information about using the VOO Backup pacing option.
asynchronous
pacing to the
Pacemaker Battery Condition
At reduced pacemaker battery capacity, execution of a PES or
burst protocol can result in a significant temporary decrease in
pacemaker battery voltage. See “Viewing Information About
Achievable Stimulus Amplitudes” on page 2-7).
EP Studies Supplement
1-3
About the EP Studies Function
Precautions and Considerations
Selecting an Appropriate Amplitude Setting
Selecting an amplitude setting of 7.5 volts for high-rate
stimulation is not recommended. While this setting can provide
the maximum available output, its use can result in a significant
temporary decline in output voltage. An output setting of 6.0 volts
or less, as shown in the Achievable Amplitudes window (see
below), will reduce battery drain and can provide a more constant
output during protocol delivery.
Pulse amplitude information based on battery and lead
measurements interrogated from the pacemaker can be displayed
by selecting the button labeled “Amplitudes” on the protocol
setup screen. The chart listing achievable amplitudes versus rate
is intended as a guide for selecting stimulus amplitude settings
(see “Viewing Information About Achievable Stimulus
Amplitudes” on page 2-7).
Positioning the Programming Head
During delivery of a PES protocol or burst stimulation, the
programming head must be held steady in its proper position
over the patient’s pacemaker. Movement of the programming
head can result in abrupt termination of the stimulation sequence.
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EP Studies Supplement
Lifting the programming head at any time during the use of an EP
Studies function causes the pacemaker to return to its
permanently programmed state.
Interruption of Marker Telemetry
The communication between the programmer and pacemaker
momentarily interrupts the transmission of marker telemetry.
This interruption can result in missing markers on the trace
display and the chart recording.
Symbols appearing on the recording above the ECG trace indicate
the point at which communication occurred.
= Programming or interrogation command to the pacemaker.
▼
= Telemetry response from the pacemaker.
▲
Communication
Symbols
Missing Marker
About the EP Studies Function
Precautions and Considerations
Figure 1-1.
ECG Recording Example Showing a Missing Marker
Ending the Patient Session
Reprogramming the Pacing Mode –
pacemaker from a rate responsive mode as required to access the
EP Studies function, reprogram the pacemaker to the desired
mode and parameter settings prior to ending the session.
Reprogramming Diagnostic Data Collection –
stated, using EP Studies disables
collection, if programmed on (see “Loss of Diagnostic EGM
Collection” on page 1-3). EGM collection will remain off unless
you reprogram the desired EGM collection type option.
Reprogram this option
you finish using EP Studies, but
after
you end the patient session.
If you programmed the
As previously
clinician-selected
diagnostic EGM
before
14
EP Studies Supplement
1-5
About the EP Studies Function
EP Studies Access and Protocol Options
EP Studies Access and Protocol Options
EP Studies Access
The EP Studies function is available for the applicable pacemakers
(Table 1-1) only if 9953A software has been installed on your
programmer.
To verify whether or not this software has been installed, select
the Tests icon in the tool palette (during a session). If the software
has been installed, “EP Studies” appears on the Tests menu.
Tests Icon
EP Studies
Option
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1-6
If the 9953A software has not been installed, contact your
Medtronic representative.
Protocol Options
The EP Studies function provides three protocol options for
delivering cardiac stimulation.
PES Protocol
Burst Protocol
VOO Burst
Protocol
Sections on the following pages describe each of these protocols.
Refer to Chapter 5 for a complete list of the programmable
parameters and value options.
EP Studies Supplement
The PES Protocol
Selecting the PES protocol displays parameter options for setting
up a programmed stimulation sequence that includes:
■
■
■
■
■
About the EP Studies Function
The PES Protocol
A drive train of up to 30 stimuli (S1).
Up to three premature stimuli (S2, S3, and S4).
An optional delay period with or without pacing stimuli.
A “Scan” option that causes the PES sequence (and delay
period) to automatically repeat. You can set the interval of the
last premature stimulus to decrease with each repetition.
Optional asynchronous backup ventricular pacing during
atrial stimulation (dual chamber models).
S1 drive train
(2 to 30 events)*
Start of the PES sequence is
synchronized to a paced or
sensed event.
Figure 1-2.
Premature stimuli
(up to three)
*In this example, the S1 drive train is delivered in
a dual chamber mode.
Elements of the PES Protocol
Optional delay period (1 to 20 sec)
with or without pacing
S2 S3 S4
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EP Studies Supplement
1-7
About the EP Studies Function
The Burst Protocol
The Burst Protocol
Selecting the Burst protocol displays options for setting up a
manually-delivered asynchronous burst. Options include:
■
An adjustable burst interval of 148 to 1945 ms (30 to 400 ppm).
■
Chamber selection (AOO or VOO mode) for dual chamber
models.
■
An optional delay period with or without pacing stimuli.
■
Optional asynchronous backup ventricular pacing during
atrial stimulation (dual chamber models).
Manually delivered burst
(press and hold button)*
The burst is synchronized to
a paced or sensed event.
Figure 1-3.
Optional delay period (1 to 20 sec)
with or without pacing
Adjustable interval
(148 - 1945 ms)
*With dual chamber models, stimuli
can be delivered to the atrial chamber
or the ventricular chamber.
Elements of the Burst Protocol
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EP Studies Supplement
The VOO Burst Protocol
The VOO Burst option applies only to dual chamber models and
provides for quick setup of a basic stimulation protocol for the
ventricles.
■
The burst interval is adjustable from 148 to 1945 ms (30 to
400 ppm).
■
No chamber selection. The burst mode is fixed as VOO.
■
The option to select a delay period does not apply.
Manually delivered burst to the ventricles
only (via press and hold button)
About the EP Studies Function
The VOO Burst Protocol
18
The burst is synchronized to
a paced or sensed event.
Figure 1-4.
Elements of the VOO Burst Protocol
Adjustable interval
(148 - 1945 ms)
EP Studies Supplement
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