Medtronic KDR603 Programming Guide

KAPPA® 700/600 SERIES

197907002A_view.pdf

PA C E M A K E R S

Model 9953 1.3

Pacemaker Programming Guide

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

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

A guide to using the 9790 Series programmer for Medtronic Kappa 700/600 Series pacemakers

Refer to the Medtronic Kappa 700/600 Series Pacemaker Reference Guide for information on the pacemakers.

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

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

About this 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.

How to Use This Guide

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide v

How to Use This Guide

About the Pacemaker Reference Guide

This supplementary 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 warning and cautions, potential interference sources, and general indications for pacing.

■

Contains a glossary of terms.

vi Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

1. Programmer Basics

2. Conducting a Patient Session

Table of Contents

How to Use This Guide v

Setting Up the 9790 Programmer 2 Connecting the Programmer to Skin Electrodes 6 Positioning and Using the Programming Head 7 About the Display Screen 12 Programming Emergency Parameters 19 Recording an ECG Strip 20 Using the On-line Help Feature 22

Important Reminders About Medtronic Kappa 700/600 Series Pacemakers 2

Starting a Patient Session 5 Proceeding with Task Selection 11 Interrogating the Pacemaker 13 Taking a Quick Look at Pacemaker Operation 14 Viewing Battery and Lead Measurements 18 Checking the Present Parameter Settings 22 Viewing Patient Information Stored in the Pacemaker 23 Recording an ECG Strip of Magnet Operation 24 Checking the Patient’s Underlying Rhythm 27 Printing Data Reports 31 Ending a Patient Session 36

3. Streamlining Follow-up with Checklist

About the Checklist Feature 2 Using Checklist to Streamline a Follow-up Session 3 Creating a Custom Checklist 6

4. Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms 2 Adjusting and Configuring the Display 7 Freezing and Analyzing a Waveform Strip 17 Recalling and Viewing Waveform Strips 25

5. Collecting Diagnostic Data

About Data Collected by the Pacemaker 2 Displaying Collected Data 9 Choosing Clinician-Selected Detailed Data Collection 25 Lead Impedance Detail 42

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide vii

Table of Contents

Programming Data Collection 44 Clearing Data From the Pacemaker 47

6. Evaluating Parameter Settings

Measuring Stimulation Thresholds 2 Determining a Sensitivity Setting 23 Using Temporary Programming to Evaluate Parameter Settings 31

7. Programming Pacemaker Parameters

Programming Parameters 2 Saving/Retrieving a Set of Parameter Values 14

8. Rate Response Setup

Using Exercise Test to Verify Rate Response 2

9. Miscellaneous Setup Options - Programmer and Pacemaker

Selecting System Operating Preferences 2 Adjusting Programmer Time and Date 4 Improving the Detection of Pacing Artifacts 5 Checking the Software Version 6 Starting the Demonstrations Option 7 Programming Patient Data into Pacemaker Memory 8 Retrieving Key Parameter History Information 10 Connecting an External Printer 11

A. Appendix: Parameter Values and Restrictions

Programmable Modes and Parameters 2 Automatic and Clinician-Selectable Diagnostics 12 Programming Restrictions 16

I. Index

viii Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Programmer Basics

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 information includes such things as using the programming head and stylus, programming Emergency parameters, and recording an ECG strip. Sections include an introduction to features of the display screen and use of the on-line Help system.

For more detailed information on setting up your programmer, refer to Programmer Description and Setup, a guide supplied with your 9790 series programmer.

Setting Up the 9790 Programmer 1-2

Connecting the Programmer to Skin Electrodes 1-6

Positioning and Using the Programming Head 1-7

About the Display Screen 1-12

Programming Emergency Parameters 1-19

Recording an ECG Strip 1-20

Using the On-line Help Feature 1-22

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-1

Programmer Basics

Setting Up the 9790 Programmer

The following topics summarize the basic steps for setting up your 9790 series programmer. For more complete information on setting up your programmer, refer to the guide, Programmer Description and Setup, supplied with your programmer.

Programmer Setup Check List

Verify that the components illustrated below are properly connected to the programmer.

Selector Pen

(Stylus)

Note: Do not disconnect the

Programming Head

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stylus.

ECG Cable

Figure 1-1. The Programmer

Setting Up the 9790 Programmer

Figure 1-2. Power Cord

Programmer Basics

Figure 1-3. Programming Head

Figure 1-4. ECG Cable

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-3

Programmer Basics

Setting Up the 9790 Programmer

Calibrate Button

Connecting an External Monitor/Recorder

To connect an external monitor or recorder to your programmer, you need the optional adaptor shown below. Connect the adaptor to the analog output port on the right side of the programmer.

Connector Type: BNC Output Signal: ± 1 Volt or ± 5 mV (switchable)

Signal Output Adaptor

A B C D

± 1V ± 5mV

Connecting Optional Adaptor to the Analog Output

Port on the Programmer.

Figure 1-5. Connecting the Optional External Adaptor

Adaptor Output Signals

(after model selection):

A - Patient’s ECG (upper most ECG on display) B - Telemetered EGM (uppermost EGM on display) C - Telemetered EGM (other EGM if programmed) D - Marker Channel Telemetry

1-4 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Setting Up the 9790 Programmer

Programmer Basics

Using the Calibrate Button

Selecting the Calibrate button located next to the analog output port adds a reference signal (as shown in Figure 1-6 and Figure 1-7) 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.

Atrial Pace (AP)

Atrial Sense (AS)

Atrial Refractory Sense (AR)

Vent. Refractory Sense (VR)

Vent. Sense (VS)

Vent. Pace (VP)

Figure 1-6. Marker Channel Signals

5 mV

1 mV

Figure 1-7. EGM Calibration Signals

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-5

Programmer Basics

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)

Figure 1-8. Connecting the Programmer to Skin Electrodes

Refer to the guide, Programmer Description and Setup, supplied with your 9790 programmer for more details on this procedure.

LA (L)

C (C)

LL (F)

( ) = IEC Coding

1-6 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Positioning and Using the Programming Head

Programmer Basics

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 pacemaker.

When to Position the Programming Head

You must position the programming head over the patient’s pacemaker whenever a procedure initiates communication between the programmer and pacemaker. Examples are:

■

At the start of a patient session when you select the [Auto-Identify] or [Start] button. The programmer automatically initiates an interrogation that takes a number of seconds to complete.

■

Prior to executing any command that results in a telemetry or programming transmission.

■

To view or record Marker Channel or EGM telemetry.

Caution: Do not position the programming head over an implanted pacemaker during electrocautery or defibrillation procedures.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-7

Programmer Basics

Positioning and Using the Programming Head

How 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 pacemaker.

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.

Figure 1-9. Positioning the Programming Head

Light Array

Figure 1-10. Light Array Indicator

1-8 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Green

Amber/Green

The present pacing mode

shows in the status bar at the

top of the screen.

Positioning and Using the Programming Head

Programmer Basics

Effect of the Programming Head on Pacemaker Operation

If model selection and application (software) loading are complete, positioning the programming head over a Medtronic Kappa 700/600 Series pacemaker does not put the pacemaker in the magnet mode of operation, as is the case with previous pacemaker models. 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.

Pacemaker operation returns to its programmed state about 2 seconds after you remove the programming head from its position over the pacemaker.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-9

Programmer Basics

Positioning and Using the Programming Head

Observing Magnet Mode Operation

To observe Magnet mode operation during a patient session, you must conduct the Magnet test described in Chapter 2. Initiating the Magnet test results in a Threshold Margin Test (TMT) and causes the pacemaker to operate in the Magnet mode.

Note: Between patient sessions before you select the pacemaker model, positioning the programming head over a MedtronicKappa 700/600 Series pacemaker will result in magnet mode operation.

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 1-11. 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.

1-10 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

[Program] Button

Positioning and Using the Programming Head

Programmer Basics

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 contained within 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 a number of seconds.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-11

Programmer Basics

About 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 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

Task area

Active Field Button Tool PaletteCommand Bar

Figure 1-12. Main Elements of a Display Screen Example

1-12 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Status Bar

Programmer Basics

About the Display Screen

Note: For information on changing the language in the screens (for example, from English to German), see “Selecting System Operating Preferences” on page 9-2.

The Status Bar

The status bar at the top of the screen shows:

■

The present pacing mode.

■

When any one of a number of test conditions is occurring.

■

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 ECG and Other Rhythm Waveforms” on page 4-2 for information about the live rhythm monitor.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-13

Programmer Basics

About the Display Screen

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 1-12 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.

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 1-19, “Interrogating the Pacemaker” on page 2-13, and “Ending a Patient Session” on page 2-36.

Active Fields

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

Active fields show as

unshaded areas on

the screen.

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.

1-14 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Programmer Basics

About the Display Screen

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.

Selecting an active field opens

a menu or window of

alternative options, or in some

cases, an

on-screen keyboard.

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 on-screen keyboard. How to use this keyboard is described later in this section.

Buttons

Buttons like those shown below let you 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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-15

Programmer Basics

About the Display Screen

Buttons

Icons

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 will 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 four 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 2-1 on page 2-6 for a brief explanation of the purpose of each button and icon in the tool palette.

Note: The Demo icon is available only when the programmer is operating in the Demo mode.

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 1-13. Keyboard Screen

The function of the on-screen keyboard buttons are very similar to the keys on a computer keyboard or typewriter.

1-16 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Cursor

Position Keys

Table 1 -1. Keyboard Buttons

Button or Feature Function

Text Entry Window

(See Figure 1-13)

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.

Has no effect.

Programmer Basics

About the Display Screen

Space Bar

(See Figure 1-13)

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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-17

Programmer Basics

About the Display Screen

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 can 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.

1-18 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

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 will clear 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

♦

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.

Programmer Basics

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

Medtronic.Kappa 700/600 Series Pacemaker Reference Guide for a

list of Emergency parameters settings for Kappa 700/600 Series pacemakers.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-19

Red Button

Emergency Button

Emergency

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 square red button.

Programmer Basics

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 or

12.5 mm/sec).

Paper Advance

25 mm/sec

12.5 mm/sec

Figure 1-14. ECG Chart Recorder Control Buttons

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.

1-20 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Annotations

ECG Trace

Marker Telemetry

Programmer Basics

Recording an ECG Strip

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 use of the following test functions will show the programmed test values as they are programmed: Magnet, Underlying Rhythm, Threshold, Sensing, and Temporary.

EGM Telemetry

Figure 1-15. 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 will include 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 Adjust window (see “Adjusting and Configuring the Display” on page 4-7). The ECG source (Lead I, II, or III) printed is the ECG trace appearing first in the live rhythm monitor window on the programmer screen.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-21

Programmer Basics

Using the On-line Help Feature

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

Using the On-line Help Feature

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

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.

Table 1 -2.

Button or Icon What It Does

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.

[Previous] button Displays the Help window last viewed or closes the

Help window first opened.

[Close] button Closes the Help window.

[Index] button Displays a list of terms discussed in Help. From this

list, you can select a Help topic to learn about one of the terms.

[Topics] button 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.

Getting Around in the Help System

1-22 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Using the On-line Help Feature

Programmer Basics

Table 1 -2. Getting Around in the Help System

Button or Icon What It Does

(underlined phrase) Definition available — Select the phrase to see a

pop-up window that defines the phrase. Select

[Previous] to close the pop-up window.

Scroll bar Use this if a Help topic extends beyond the

window size.

Entering the Help System

Figure 1-16 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 1-16. Entering On-line Help

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-23

Programmer Basics

Using the On-line Help Feature

Pop-up definition window Link to definition window Scroll Bar

Using the Links in Help

Figure 1-17 shows the links that allow you to see additional Help windows:

■

The basic link, whose icon 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 1-17. Typical Help Windows (Topic and Definition)

1-24 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Using the On-line Help Feature

Programmer Basics

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 [Topics] 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, or

– another category by selecting its name (on the left).

Figure 1-18 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 explaining any of the indexed terms by selecting the link icon next to that term.

Figure 1-19 shows some typical index entries.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 1-25

Programmer Basics

Using the On-line Help Feature

Unexpanded Help

New 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.

Full Auto-Interrogation – Occurs automatically at the start of a session.

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-size Reports – You can choose to connect an external printer for printing full-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.

2-2 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Important Reminders About Medtronic Kappa 700/600 Series Pacemakers

Conducting a Patient Session

Automated Rate Response

Rate Profile Optimization – Adjusts rate response levels daily to a

prescribed target profile.

Activity Sensor – Converts detected patient motion into electrical signals.

New Parameters – ADL Response sets the target profile for moderate rates; Exertion Response sets the target profile for high rates.

Automated Monitoring and Collection of Patient Diagnostic Data

Diagnostic monitors collect data automatically in the background:

■

Rate, AV Conduction, and Search AV Histograms

■

Sensor Indicated Rate Profile

■

Atrial and Ventricular High Rate Episodes

■

Mode Switch, Rate Drop Response, and Sinus Preference Episodes

■

Lead Monitor Counters

■

Chronic Lead Impedance Trend

■

Capture Management Trend

■

Sensitivity Trend

Remote Assistant

This feature allows the patient to activate data collection when symptoms are present. The collected data can be used for analysis of the patient’s rate recorded during symptoms.

Sinus Preference

Promotes tracking of intrinsic atrial activity to increase cardiac output and extend system longevity.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-3

Conducting a Patient Session

Important Reminders About Medtronic Kappa 700/600 Series Pacemakers

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.

■

Initializes a group of features at implant. These include Sensing Assurance, Capture Management, rate response, and diagnostic data collection.

Capture Management

The Capture Management feature checks the patient’s ventricular pacing thresholds at regular intervals. Using these threshold measurements, the IPG can determine whether ventricular pacing pulse are capturing the heart. Optionally, it makes adjustments to the ventricular amplitude and pulse width parameters based on these measurements.

Sensing Assurance

The Sensing Assurance feature, when active for a specific chamber, allows the IPG 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.

2-4 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

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 2-36.

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 2-8. If you are between patient sessions, you can access other screens by using the icons and buttons described in Table 2-1.

The Select Model screen appears:

■

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

■

After you end a patient session.

Conducting a Patient Session

Starting a Patient Session

Figure 2-1. Select Model Screen

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-5

Conducting a Patient Session

Starting a Patient Session

Notes:

■

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

■

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

The Tool Palette Between Sessions

Tabl e 2 -1. Tool Palette Between Patient Sessions

Tool Palette Tool Selecting the Tool (Button or Icon)… Reference

Freezes a segment of the live rhythm display. 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. Note: No saved strips are available between patient sessions.

Opens a window of options for adjusting the live rhythm display. Note: Additional adjustment options are present during a patient

session.

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

page 4-17

page 4-25

page 4-7

page 2-5

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

page 2-34

page 9-2 page 9-4 page 9-5 page 9-6 page 9-7

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.

2-6 Medtronic Kappa™ 700/600 Series 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 2-8), the programmer automatically attempts to interrogate the patient’s pacemaker to retrieve all 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.

The interrogation time may extend to 55 seconds 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 2-13).

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-7

Conducting a Patient Session

Starting a Patient Session

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

■

High threshold measurements

You must acknowledge the message before proceeding with other activities. For an ERI, POR, lead, or threshold 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.

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.

2-8 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Conducting a Patient Session

Starting a Patient Session

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 [Medtronic] 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 2-36.

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 Task Selection” on page 2-11 for information on selecting the functions or tasks you have planned for the session.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-9

Conducting a Patient Session

Starting a Patient Session

♦

Proceeding with Task Selection

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 screen. Refer to “Taking a Quick Look at Pacemaker Operation” on page 2-14 for information about the Quick Look 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 2-2 on page 2-12). 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 Task Selection

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

Select the Checklist icon to display the Checklist task screen.

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 your session tasks. Refer to “Streamlining Follow-up with Checklist” on page 3-1 for information about using Checklist.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-11

Conducting a Patient Session

Proceeding with Task Selection

Tab le 2 -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 4-17

Accesses the rhythm strips saved since the start of the session. page 4-25

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

Accesses the available Help topics Chapter 1

Displays the screen for setting up and using the Checklist function. page 3-3

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

Displays the parameter programming screen. page 7-2

page 2-14 page 5-9 page 2-18 page 5-44

Displays the pacing system test options.

Magnet Underlying Rhythm Threshold Exercise Sensing Temporary

Displays the following session report options:

Available Reports Print Queue

Displays patient information:

Patient Information Key Parameter History

Displays case studies in Demo mode Note: Demo diskette is needed for Demo mode. Otherwise, icon is

not visible.

2-12 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

page 2-24 page 2-27 page 6-2 page 8-2 page 6-23 page 6-31

page 2-33 page 2-34

page 2-23 page 9-10

page 9-7

Interrogating the Pacemaker

At the start of the patient session (as described in “Procedure for Starting a Patient Session” on page 2-8) 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.

Conducting a Patient Session

Interrogating the Pacemaker

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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-13

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

Quick Look 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. It includes some of the data accumulated by the pacemaker since the last patient session.

The Quick Look Screen

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

Quick Look - Initial Interrogation

Graphs and Tables

Battery and Lead Measurements

Data Collection Setup/Clear

Figure 2-2. Pacemaker Information on the Quick Look Screen

2-14 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Taking a Quick Look at Pacemaker Operation

Conducting a Patient Session

Viewing Data on the Quick Look Screen

The Quick Look screen displays the following data and data access options.

Remaining Longevity – This is an estimate of the time in 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 next to the displayed estimate.

Note: The symbol appearing next to a value on the Quick Look screen indicates that the programmed value can be changed automatically by the pacemaker. For example, this symbol appears next to each sensitivity value in Figure 2-2 because Sensing Assurance is On. Refer to “Adaptive Parameter Values” on page 7-4 for more information.

Atrial Lead – The data under this heading include programmed values for atrial amplitude, pulse width, and sensitivity. The measured impedance of the atrial pacing lead appears also.

Ventricul ar Le ad – Data under this heading include programmed values for ventricular amplitude, pulse width, capture management parameters, and sensitivity. The measured impedance of the ventricular pacing lead appears also.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-15

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

Mode/Rates – Under this heading are listed the programmed values for the pacing mode, lower rate, and upper rate.

(Number of) Total Events – This heading includes the number of heart beats (events) recorded since the last patient session. The data lists the percentage of these recorded beats that fall into each of the applicable event sequence categories (see Table 2-3).

To see Rate Histograms, select the Histogram icon next to the data. For more information on these histograms, refer to “Heart Rate Histograms” on page 5-11.

Note: The data under the Total Events and Significant Events headings show data 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.

Significant Events – 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 2-4).

To view a graph or table showing the details associated with a significant event, select the event and then select the [Open Data] button. Refer to “Displaying Collected Data” on page 5-9 for information about viewing the data recorded by the various monitoring functions.

2-16 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Taking a Quick Look at Pacemaker Operation

Conducting a Patient Session

Tab le 2 -3. Event Sequence Categories

Dual Chamber Pacing Modes (and ADI, ADIR, VDI, VDIR)

AS-VS Atrial Sense - Ventricular Sense

AS-VP Atrial Sense - Ventricular Pace

AP-VS Atrial Pace - Ventricular Sense

AP-VP Atrial Pace - Ventricular Pace

VDD Pacing Mode

AS-VS Atrial Sense - Ventricular Sense

AS-VP Atrial Sense - Ventricular Pace

Single Chamber Pacing Modes

Paced Atrial or ventricular chamber Pace

Sensed Atrial or ventricular chamber Sense

Tabl e 2 -4. Significant Event Monitoring Functions

Functions and Criteria Used for Significant Event 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.

Mode Switch Episodes One or more episodes detected.

Rate Drop Response Episodes One or more episodes detected.

PMT Intervention Episodes One or more episodes detected.

Sinus Preference Episodes One or more episodes detected.

Remote Assistant Monitor Symptom.

ERI Monitor Occurrence of ERI conditions.

Electrical Reset Monitor Occurrence of reset conditions.

Custom Rate Trend Listed if programmed to collect data.

Capture Management High ventricular threshold measurement.

Abort threshold searches prior to ERI.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-17

Conducting a Patient Session

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 - Initial Interrogation

Graphs and Tables

Battery and Lead Measurements

Data Collection Setup/Clear

Figure 2-3. 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.

2-18 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing Battery and Lead Measurements

Conducting a Patient Session

Pacemaker Battery Measurements

Battery Status – Displays an “OK” or “Replace Pacer” message based

on battery voltage and internal impedance measurements.

Date of Implant – From data programmed into the pacemaker at the time of implantation.

Remaining Longevity – Calculated estimate of the time (in months) 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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-19

Conducting a Patient Session

Viewing Battery and Lead Measurements

Voltag e – The battery voltage obtained during the previous ERI measurement.

Current – Present current drain on the pacemaker battery averaged over a pacing cycle.

Impedance – Internal electrical impedance of the pacemaker battery.

Lead System Measurements

Amplitude – Present programmed amplitude of a pacing pulse.

Pulse Width – Present programmed pulse width setting.

Output Energy – The output energy contained in a single pacing pulse.

Measured Current – Current in the pacing lead during delivery of a

pacing pulse.

Measured Impedance – Electrical impedance presented by the pacing lead and electrode/tissue interface.

Pace Polarity – The present lead electrode configuration (unipolar or bipolar) used for pacing.

2-20 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing Battery and Lead Measurements

Conducting a Patient Session

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.

2. Select the [Measure Again] button.

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

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-21

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 2-4. 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 7-2” on page 7-1. Table 7-1 lists subordinate therapy parameters.

2-22 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing Patient Information Stored in the Pacemaker

Conducting a Patient Session

Viewing Patient Information Stored in the Pacemaker

The Medtronic Kappa 700/600 Series 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 (see “Programming Patient Data into Pacemaker Memory” on page 9-8).

Patient Information

Key Parameter History

Figure 2-5. Viewing the Patient Information Screen

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-23

Conducting a Patient Session

Recording an ECG Strip of Magnet Operation

With the Medtronic Kappa 700/600 Series pacemakers, positioning the programming head does not cause the pacemaker to operate in its magnet mode as has been the rule with previous Medtronic pacemakers (see “New Programmer Features” on page 2-2). To record or view magnet operation for Kappa 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

Figure 2-6. Magnet Test Setup Screen

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.

2-24 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Recording an ECG Strip of Magnet Operation

Conducting a Patient Session

Procedure for Conducting a Magnet Test

To Conduct a Magnet Test

♦

1. Display the Magnet Test Setup screen (see Figure 2-6 on

page 2-24).

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 FAST Indicators had been programmed On, the pacemaker displays activated FAST indicators.

If you have chosen to collect an ECG strip (see “Collecting an ECG Strip” on page 2-26), 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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-25

Conducting a Patient Session

Recording an ECG Strip of Magnet Operation

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 NonMagnet 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 4-25 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 4-24 for information about printing waveform strips and reports.

2-26 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Checking the Patient’s Underlying Rhythm

Conducting a Patient Session

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.

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.

Magnet

Underlying Rhythm

Threshold

Exercise

Sensing

Tem por ary

Figure 2-7. 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 2 seconds will restore normal pacemaker operation. In the event of a programmer malfunction or loss of power, lift the programming head immediately.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-27

Conducting a Patient Session

Checking the Patient’s Underlying Rhythm

Procedure for Checking the Patient’s Underlying Rhythm

Note: The Inhibit mode basically shuts the pacemaker off for the duration

of the test.

To Check Underlying Rhythm Using Inhibit

♦

1. Display the Underlying Rhythm Test screen (see Figure 2-7 on page 2-27).

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.

2-28 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Checking the Patient’s Underlying Rhythm

To Check Underlying Rhythm Using Manual Rate

♦

Conducting a Patient Session

Decrease

1. Display the Underlying Rhythm Test screen (see Figure 2-7 on

page 2-27).

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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-29

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 4-25 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 4-24 for information about printing waveform strips and reports.

2-30 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Printing Data Reports

You can print the data generated during a patient session using either of the following methods.

Using the Print Button – On most task screens, the [Print…] button is available when there is a report available to print. Selecting this [Print…] button allows you to print a formatted data report associated with the current task screen.

Activating the “Trace Mode” – If you select the Trace printing mode, data is automatically printed as soon as the task data is available. This data is not printed in a report format.

Additional reports are available for printing from the Available Reports window. This window lists reports that are not associated with a specific task.

As described in this section, you have the option to print full-page-sized reports. For this, the programmer must be connected to a compatible external printer. Refer to “Connecting an External Printer” on page 9-11 for instructions on connecting an external full-page printer.

Conducting a Patient Session

Printing Data Reports

[Print…] button appears or

becomes active when

task-related data has been

generated.

Using the Print Button

The [Print…] button appears or becomes active as soon as the execution of a task or function generates the data needed for the associated report. The [Print…] button appears near the bottom of the task screen.

Selecting this button displays options for printing only the report associated with the current task screen.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-31

Conducting a Patient Session

Printing Data Reports

♦

To Print a Report Using the Print Button

1. Select the [Print…] button.

2. From the Print Options window, make the following selections:

a. Select the Number of Copies field if you want to change the

number of copies to be printed. You can print from 1 to 4 copies.

b. Select the desired paper size. Full Size requires that a

compatible, external printer be connected to the programmer (see “Connecting an External Printer” on page 9-11). Programmer Strip will print the report on the programmer’s strip chart printer.

Note: You can choose Full Size now but delay the printing until another time when the external printer is connected.

c. To print on an externally connected printer, the printer type or

“driver” listed in the Printer field must be compatible with the input requirements of the connected printer. Verify that the correct printer is selected.

3. Select the desire print command:

– To print the report immediately, select the [Print Now] button.

– To print the report later from the Print Queue window,

select [Print Later]. See “Printing Reports Held in the Print Queue” on page 2-34.

2-32 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Available Reports

Print Queue

Conducting a Patient Session

Printing Data Reports

Printing Additional Reports

During a patient session, the programmer automatically accumulates data not associated with a specific task.

At any time during the session, you can view the list of additional reports that are available for printing and select the ones you want to print immediately or save in the print queue for printing later in the session or after the session has ended.

To Print From the List of Available Reports

♦

1. Select Reports > Available Reports.

Note: Device Memory Report is intended for use only by Medtronic

technical support personnel.

2. From the displayed list of available reports, select the report you

want to print.

3. Select the [Print…] button.

4. From the Print Options window, choose the desired print options

(see “Using the Print Button” on page 2-31).

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-33

Conducting a Patient Session

Printing Data Reports

♦

Check Box

Using the Continuous Print “Trace” Mode

If you want data to be printed as it becomes available during the patient session, you can activate the Trace printing mode. With this mode activated, data is printed as it is generated.

To Print Data Automatically Using the Trace Mode

1. Select Reports > Available Reports to display the Available Reports window.

2. From the Available Reports window, select the Print Continuously check box near the bottom of the window.

Appearance of a check mark (✔) indicates that the Trace printing mode is active.

3. To turn off the Trace printing mode, select the check box again to clear the check mark.

Printing Reports Held in the Print Queue

Whenever you make a report print request by selecting the [Print Now] button or the [Print Later] button, control of the print job is passed on to the print queue.

By displaying the Print Queue window, you can check the status of any print job and either print or delete those print jobs that are being held. All print jobs held for printing are displayed and up to 25 print jobs printed already are reported.

Note: The print queue is still available after you end the patient session.

2-34 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Available Reports

Print Queue

Conducting a Patient Session

To Print or Delete Reports From the Print Queue

♦

1. Select Reports > Print Queue.

2. From the list of reports, select the report you want to print or delete.

Caution: Once deleted, a report cannot be recovered.

3. Select the button for the desired action:

–Select [Print] to print the report.

–Select [Delete] to delete the report from the print queue

Report list.

Printing Data Reports

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-35

Conducting a Patient Session

Ending a Patient Session

Because the programmer collects and stores data on a session-bysession basis, it is important to correctly end a session when you finish. You should not begin using the programmer with a different patient until you have completed the procedure described in this section.

Note: If the programmer detects a serial number that is different from the one acquired during the initial interrogation, it will automatically end the current session.

Once you end a session, you can still access the Print Queue window to print reports from the session. Prior to ending the session, you have the options to:

■

Save the session data on a diskette.

■

Change the way the pacemaker clears collected data.

To End a Patient Session

♦

1. Select the [End Session] button in the command bar at the bottom of the screen.

2-36 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Conducting a Patient Session

Ending a Patient Session

2. Note the “Warnings!” field at the top of the End Session window. It

informs you of any action you should take or any information you should know before you end the session. To return to the session, select the [Cancel] button.

3. Before ending the session, consider the options available from the

End Session window.

■

To save the session data on a diskette, see “Saving a Session on Diskette” below.

■

To change the settings for how collected data is cleared from the pacemaker when you end the session, see “Options for Clearing Pacemaker Data” on page 2-39.

To accomplish either of these tasks, proceed to its appropriate procedure. Do not select the [End Now] button in step 4.

4. To end the session now and return to the Select Model screen,

select the [End Now] button.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-37

Conducting a Patient Session

Ending a Patient Session

Saving a Session on Diskette

Before you end a patient session, you can save data from the session on a diskette. Table 2-5 lists the data saved. Data is saved as a text file that can be imported into a word processing or data base program.

Tabl e 2 -5. Saved Session Data

Feature Name Information Exported

Therapy Parameters

Patient Information Final programmed values

Battery and Lead Measurements Last measured values

Threshold Tests Last results for each test type conducted

Sensing Tests Last results for each test type conducted

Exercise Test Last results for each test type conducted

Automatic Diagnostics

Initial interrogated values Final programmed values

(for each chamber tested)

Event Counters Atrial High Rate Episodes Ventricular High Rate Episodes Mode Switch Episodes Sinus Preference Episodes

To Save Session Data on a Diskette

♦

1. Insert a 3.5-inch computer diskette into the disk drive on the right side of the programmer.

Use a formatted diskette that is IBM-compatible. It can have a capacity of either 720 Kb (DS, DD) or 1.44 Mb (DS, HD).

2. From the End Session window (see step 1 on page 2-36), select the [Save Session] button.

Note: If the diskette is full, the programmer will notify you that you

need to insert a different diskette.

2-38 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Conducting a Patient Session

Ending a Patient Session

3. In the pop-up window, select the [Start] button.

This starts the transfer of data to the diskette. This process takes a few seconds as indicated by a progress gauge on the screen.

Note: After session data has been saved, you can change the options for clearing data (see “Options for Clearing Pacemaker Data” below). However, you cannot cancel the End Session sequence and return to the session.

4. When the transfer of data is complete, select the [End Now] button

to end the patient session. Remove the diskette from the programmer.

Note: The programmer automatically assigns a unique file name so that it cannot overwrite any existing session file. To determine which file was saved for a particular session, use an IBM-compatible computer to view the diskette file directory. The directory lists the date and time each file was created.

Options for Clearing Pacemaker Data

All diagnostic data collected in the pacemaker except Sensor Indicated Rate Profile and Chronic Lead Impedance Trend is cleared one hour after you end a patient session. Collection of new data then starts. The End Session window provides access to options that let you make the following changes:

■

You can choose to have the Chronic Lead Trend data also cleared when you end the session.

Note: Chronic lead trend data typically should not be cleared unless the pacing lead has been replaced.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-39

Conducting a Patient Session

Ending a Patient Session

♦

Atrial Lead Trend Field

■

You can choose to clear collected data immediately when you end the session. New data collection starts when you lift the programming head.

With the default setting (“1 hr after session end”), you can restart a session within one hour of ending it and still retrieve the collected data. Selecting the “Now” option causes the pacemaker to clear the collected data and start collection of new data immediately when you end the session.

To Change a Clear Data Setting

1. From the End Session window (see step 1 on page 2-36), select the field labeled “Clear Data in Pacemaker and Restart Collection.” This action opens the Clear Data window.

2. To change the setting for clearing Chronic Lead Trend data, complete a, b, and c, below. Otherwise, skip to step 3.

a. Select the appropriate Lead Trend field.

Ventricular Lead

Trend Field

b. From the option window, select the “Clear” option.

Selecting “Clear” results in a message window. Select the [OK] button to continue.

c. If applicable, repeat steps 2a and 2b for the other Lead

Trend setting.

3. To change when the pacemaker data is cleared and collection restarts, complete a, b, and c, below. Otherwise, skip to step 4.

a. From the Clear Data window, select the Pacemaker Data field.

2-40 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Pacemaker

Data Field

Conducting a Patient Session

Ending a Patient Session

b. From the option window, select the “Now” option.

c. From the pop-up window, select [Continue] to proceed.

4. To end the patient session, position the programming head and

execute one of the following two procedures.

Procedure a — If you performed step 3, the End Session screen displays the [Clear and End] button. Select the [Clear and End] button to program the selected options and end the session.

Diagnostic data collection starts when you lift the programming head.

Procedure b — If you did not perform step 3, proceed as follows:

a. Select the [PROGRAM] button to program the selected options.

(Selecting the [Undo Pending] button cancels the selected options.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 2-41

Conducting a Patient Session

Ending a Patient Session

)

The selected Chronic Lead Trend data is now cleared from pacemaker memory. It can no longer be retrieved.

b. Select the [Close] button.

c. Select the [End Now] button to end the patient session.

2-42 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Streamlining Follow-up with Checklist

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

About the Checklist Feature 3-2

Using Checklist to Streamline a Follow-up Session 3-3

Creating a Custom Checklist 3-6

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 3-1

Streamlining Follow-up with Checklist

About the Checklist Feature

Selecting the Checklist icon displays a list of tasks done with the programmer. implantation.

Tasks may be accessed from the Checklist screen or by using the Fast Path option to quickly advance to the next task on the list.

Checklist tracks which tasks on the list have been completed by placing a checkmark next to the task.

Typical lists are for follow-up visits and pacemaker

Figure 3-1. Checklist Screen

3-2 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Using Checklist to Streamline a Follow-up Session

Streamlining Follow-up with Checklist

Using Checklist to Streamline a Follow-up Session

Selecting a Checklist

By selecting the Checklist field, you can display the available checklist options. Each checklist option provides a different task list that you can use to structure your follow-up session.

To display the available

checklists, select the Checklist

field.

To Select a Desired Checklist

♦

1. Select the Checklist field to display the list of the available

checklist options.

2. Select the desired option.

Selecting an option displays the task list tailored to that option.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 3-3

Streamlining Follow-up with Checklist

Using Checklist to Streamline a Follow-up Session

Conducting a Session with Fast Path OFF

When the Fast Path switch is Off, the “go-to” Task button that starts the next task (the highlighted task) appears beneath the task list.

In this example, the Fast Path switch is set to Off.

Fast Path

ON/OFF Switch

Go-To Task Button

To Use Checklist with Fast Path OFF

♦

1. If the Fast Path switch icon is labeled On, select it to change the setting to Off.

2. Select the desired task from the list (if it is other than the one presently highlighted).

3. Select the [>>Task] button.

4. Complete the task and select the Checklist icon to return to this

screen.

A checkmark appears by each completed task. The task highlighter automatically moves to the next task.

5. Repeat steps 2, 3, and 4 to complete the desired tasks.

To repeat a task, select it and then select the [>>Task] button.

3-4 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Fast Pa th

ON/OFF Switch

Go-To Task Button

♦

Using Checklist to Streamline a Follow-up Session

Streamlining Follow-up with Checklist

Completing a Checklist with Fast Path ON

When the Fast Path switch is On, the “go-to” Task button that starts the next task (according to the order of the listed tasks) appears next to the Checklist icon.

In this example, the Fast Path switch is set to On.

To Use Checklist with Fast Path ON

1. If the Fast Path switch icon is labeled Off, select it to change the

setting to On.

The first task in the task list should be highlighted if you want to complete all the tasks. However, you can select another task on the list as the starting point.

2. Select the [>>] button.

3. After you complete the task, select the [>>] button again to start the

next task.

4. Repeat step 3 to complete all the tasks listed in the checklist.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 3-5

Streamlining Follow-up with Checklist

Creating a Custom Checklist

To go to a task out of the list order, select the Checklist icon, select the task, and then select the [>>] button.

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

The [>>] button may not be selectable when the last task in the list has been completed.

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 Medtronic Kappa 700/600 Series pacemakers. The following sections describe the procedure for creating a custom checklist:

■

Select the Create/Edit window.

■

Choose a checklist as a source for coping tasks.

■

Build the custom checklist by copying the desired tasks.

■

Save 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.

3-6 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Source list for copying

Streamlining Follow-up with Checklist

Creating a Custom Checklist

Workspace for building the

custom checklist

♦

Select the Copy From field to

display existing checklists.

This window lets you 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 proceed to build a 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).

Procedure to Copy 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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 3-7

Streamlining Follow-up with Checklist

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 add a task to your custom

list, select the task in the

source list.

The task is automatically

copied to the custom checklist.

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

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 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 anytime while you are building your custom checklist.

3-8 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

♦

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 checklist.

Streamlining Follow-up with Checklist

Creating a Custom Checklist

Saving the Custom Checklist

To save your custom checklist complete the following procedure.

Procedure to Save Your 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.

Selecting the Save As field

opens the on-screen

keyboard, which allows

you to enter your own

checklist name.

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.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 3-9

Streamlining Follow-up with Checklist

Creating a Custom Checklist

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.

3-10 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

This chapter describes how to use the features of the live rhythm window to view the patient’s cardiac signals and monitor pacemaker operation. Also covered is the waveform Freeze feature, which lets you freeze a 15-second strip of the patient’s rhythm signals.

For instructions on using the programmer’s ECG chart printer, refer to“Recording an ECG Strip” on page 1-20.

Viewing the ECG and Other Rhythm Waveforms 4-2

Adjusting and Configuring the Display 4-7

Freezing and Analyzing a Waveform Strip 4-17

Recalling and Viewing Waveform Strips 4-25

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-1

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

During a patient session, the programmer continuously displays the patient’s ECG (or other selected waveform trace) in the live rhythm monitor window at the top of the screen.

The size of the window automatically changes between the single-trace size shown above and the dual-trace size shown below, depending on the selected task screen. The dual-trace window is displayed for test functions, in which case, the traces displayed are the patient’s ECG and the EGM in the chamber being tested.

The instructions on the following pages describe how you can:

■

Expand the monitor window to its full-screen size.

■

Adjust the size, position, and color (programmers with color display panels) of the waveform traces.

■

Choose a different sweep speed, display pacing artifacts or turn them off, engage an interference filter.

■

Program pacemaker telemetry to a different EGM mode.

4-2 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

Expanding the Live Rhythm Monitor Window

To view all of the available waveform traces, you can expand the ECG window to its full size with the touch of a button. The expanded screen covers the task area of the current screen.

To Expand the Monitor Window to Its Full Size

♦

➤ Select the square button in the upper-right corner of the partial-view

window.

This action expands the live rhythm monitor window to its maximum size.

Figure 4-1. Live Rhythm Monitor Window - Expanded View

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-3

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

To Return to the Partial-View Window

♦

➤ Select the minimize button in the upper-right corner of the full-view

window.

This action collapses the monitor window to its previous size and displays the task screen as it was prior to expanding the monitor window.

Figure 4-2. Live Rhythm Monitor Window - Partial View

About the Waveform Traces

The programmer can display traces from up to six signal sources. The ECG Leads (I, II, and III) are always available if the ECG leads are connected. Marker Annotation and Marker Intervals are displayed if the programming head is positioned over the pacemaker. These signal sources are labeled 1 - 5 in Figure 4-3.

The source of the sixth trace, also shown in Figure 4-3 as Ventricular EGM, is programmable to any one of four different telemetry options. (See “Programming a Different Telemetry Mode” on page 4-12.)

4-4 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

ECG signals detected via

skin electrodes attached to

the patient.

Sense and pace markers

received via telemetry from

the pacemaker.

Intervals measured

between the sense and

pace markers.

Programmable source.

Presently set to

Ventricular EGM.

Figure 4-3. Waveform Trace Breakdown

The traces in Figure 4-3 are shown in a separated fashion for the purpose of explanation. Typically, the Marker Annotation and Marker Intervals traces are superimposed on an ECG or EGM trace to facilitate interpretation. Instructions on how to arrange the traces are covered on page 4-9 and page 4-15.

Note: A programming command or interrogation momentarily interrupts the transmission of marker annotations. This interruption can result in missing markers on the trace display.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-5

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

Tabl e 4 -1. Waveform Trace Information

Trace Description

ECG Lead I ECG Lead II ECG Lead III

Marker Annotation

ECG signals are detected via skin electrodes attached to the patient. The programmer must be connected to these electrodes with the ECG cable as described in “Connecting the Programmer to Skin Electrodes” on page 1-6.

Marker annotations depict pacemaker operation by showing events as they occur within the pacemaker. These annotations, which are coded as shown below, are intended to facilitate ECG interpretation. The typical position of the Marker Annotation trace is superimposed on an ECG trace.

Dual Chamber Modes AP - Atrial pace AS - Atrial sense AR - Atrial sense during refractory

Single Chamber Models P -Pace S -Sense

SR - Sense during refractory VP - Ventricular pace VS - Ventricular sense VR - Ventricular sense during refractory

Other Markers TP - Triggered pace (AAT or VVT pacing mode) MS - Mode Switch episode (marks the beginning and end) ER - Error marker (indicates a marker signal that could not be decoded)

Marker Intervals

The programmer automatically measures the interval between pace and sense markers and displays these intervals (in milliseconds) as one of the traces. For dual chamber and ADI, ADIR, VDI, VDIR modes, the trace displays the A–V interval and the V–V interval. For single chamber modes, the trace displays the A–A or V–V interval depending on the chamber being paced.

Programmable Trace

(Telemetry Mode)

The Telemetry Mode feature described on page 4-12 lets you program the pacemaker to transmit any one of four types of EGM signals to be displayed in the live rhythm monitor window. Refer to the instructions on page 4-12 for a description of each of these four EGM options.

- Atrial EGM

- Ventricular EGM

-Dual EGM

-Summed EGM Note: The Telemetry Mode feature is not available when the pacemaker is at elective

replacement indicator. Also, the Telemetry Mode feature can be programmed Off.

Since these traces depend on telemetry received from the pacemaker, they are not displayed unless the programming head is positioned over the pacemaker.

4-6 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

The Adjust window contains controls that let you tailor the live rhythm display to your specific needs.

To open the Adjust window, select the [Adjust] button near the top of the tool palette. This action expands the live rhythm display window (if it is not already expanded) and displays the Adjust window.

Figure 4-4. Live Rhythm Display Adjust Window

Refer to the pages that follow for instructions on using each of the controls in the Adjust window.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-7

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Adjust Size Select this button to adjust the amplitude of the

Adjust Source Select this button if you want to change the source of a

Adjust Color Select this button if you want to change the color of one

Sweep speed Select the Sweep speed field to display the sweep

Telemetry Mode Select the Telemetry Mode field to display the options

ECG Filter Select this checkbox to turn the ECG filter on or off. A

Show Artifacts Select this checkbox to enable or disable the pacing

Cleanup Select this button to equalize the spacing between the

Normalize Select this button to equalize the trace spacing and to

OK Select this button to close the Adjust window.

Tab le 4 -2. The Adjust Window Options

waveforms (see “Adjusting Waveform Size” on page 4-9).

particular trace (see “Selecting a Trace Source” on page 4-9).

or more of the waveform traces (see “Color Coding the Waveform Traces” on page 4-11). Option is only available on programmers with color display panels.

speed options (12.5, 25, 50, and 100 mm/sec). To change the sweep speed, select the desired option (see “Selecting a Different Sweep Speed” on page 4-12).

for programming the type of waveform telemetry transmitted by the pacemaker (see “Programming a Different Telemetry Mode” on page 4-12).

checkmark (✓ ) indicates that the filter is turned on. The filter may improve clarity of the ECG in the presence of interference (see “Selecting the ECG Filter” on page 4-13).

artifact enhancement function. A checkmark (✓ ) indicates that the function is enabled (see “Enabling Artifact Enhancement” on page 4-15).

traces

adjust the size of each trace to the default setting.

4-8 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

♦

[Size] button

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Adjusting Waveform Size

To Adjust the Size or (Amplitude) of a Waveform

1. Select the [Size] button in the Adjust window.

2. For the trace you want to adjust, alternately press and release the

increase button or decrease button to change the waveform size.

To return to the default setting, press the [Normalize] button. This action resets the size of all traces to the default setting and equalizes the spacing between traces.

Selecting a Trace Source

You can change the order in which traces appear in the monitor window. One method is by changing the “source” of one or more of the traces as described below. Also, you can use the stylus to “drag” a trace to the desired location as described on page 4-15.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-9

Viewing the Patient’s ECG and EGM Traces

]

Adjusting and Configuring the Display

To Change the Source of a Trace

♦

1. Select the [Source] button in the Adjust window.

ource

button

Note that traces may be superimposed on one another. In this example above, both the Lead II ECG and Marker Annotation signal make up the first trace. Also note that the name of only one of the trace sources appears at the left edge of the screen.

To display the name of the other trace source, “tap” the trace (source) name at the left edge of the screen. It will change to show the source of the other trace.

If you want to change the position of a superimposed trace, the source of the trace you want to move must show at the left edge of the screen. If it does not, alternate the source names as described in the paragraph above.

2. Select the source field for the trace you want to change. A drop-down list appears displaying source options.

Source field

3. From the drop-down menu of Source options, select the desired source.

Selecting a source option causes the source of the trace presently displayed to change positions with the trace source you selected.

4-10 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

♦

[Color] button

Color field

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Color Coding the Waveform Traces

To Change the Color of a Waveform Trace

1. Select the [Color] button in the Adjust window.

2. Select the color field for the trace you want to change.

3. From the drop-down menu of Color options, select the desired color.

Note: The option to color code trace waveforms is available only on

programmers with color displays.

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-11

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Selecting a Different Sweep Speed

From the Adjust window, you can set the trace sweep speed to one of four settings: 12.5, 25, 50, and 100 mm/sec. The default setting is 25 mm/sec.

To Change the Trace Display Sweep Speed

♦

1. Select the Sweep Speed field in the Adjust window.

2. From the drop-down menu of choices, select the desired speed.

Programming a Different Telemetry Mode

In contrast to the traces that automatically appear in the live rhythm monitor window (the ECG, Marker Annotation, and Marker Intervals traces), the EGM trace can be programmed to any one of four Telemetry Mode options from the Adjust window.

Sweep Speed field

Menu of choices

To Program a Different Telemetry Mode

♦

1. Ensure that the programming head is positioned over the patient’s pacemaker. Observe that marker annotations are appearing on the screen.

2. Select the Telemetry Mode field in the Adjust window.

Telemetry Mode field

Menu of options

3. From the drop-down menu of options, select the desired Telemetry Mode.

4-12 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

The Telemetry Mode options are as follows:

Atrial EGM – The intracardiac signal detected in the atria by the atrial pacing lead.

Ventricul ar EGM – The intracardiac signal detected in the ventricles by the ventricular pacing lead.

Dual EGM – Display of both the atrial and ventricular EGM traces. Since the pacemaker transmits both EGMs over a single telemetry channel in a “time sharing” fashion, resolution of the EGM signals in this case is reduced.

Summed EGM – The atrial and ventricular EGM signals combined (added together) into a single trace.

Off – No EGM trace is displayed.

Adjusting and Configuring the Display

Selecting the ECG Filter

➤ Select the ECG Filter checkbox to turn the ECG filter on or off. A

checkmark (✓) indicates that the filter is turned on.

The filter may improve clarity of both the displayed and printed ECG in the presence of interference. The filter affects the ECG detection bandwidth as follows:

Filter Off (no checkmark) – Bandwidth = 0.05 to 100 Hz Filter On (checkmark) – Bandwidth = 0.5 to 40 Hz

Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide 4-13

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

ECG Filter

checkbox

Show Artifacts

checkbox

4-14 Medtronic Kappa™ 700/600 Series Pacemaker Programming Guide

Medtronic KDR603 Programming Guide

Specifications and Main Features

Frequently Asked Questions

User Manual

How to Use This Guide

Information is Contained in Two Guides

About this Guide

About the Pacemaker Reference Guide

Table of Contents

Programmer Basics

Setting Up the 9790 Programmer

Programmer Setup Check List

Connecting an External Monitor/Recorder

Connecting the Programmer to Skin Electrodes

Positioning and Using the Programming Head

When to Position the Programming Head

Effect of the Programming Head on Pacemaker Operation

Observing Magnet Mode Operation

About the Display Screen

Using the On-Screen Keyboard

Audible Tones

Programming Emergency Parameters

Recording an ECG Strip

About the ECG Recording

Using the On-line Help Feature

Entering the Help System

Using the Links in Help

Exiting the Help System

Searching for Information in Help

New Programmer Features

Automated Rate Response

Automated Monitoring and Collection of Patient Diagnostic Data

Remote Assistant

Sinus Preference

Automatic Implant Detection

Capture Management

Sensing Assurance

Lead Monitor

Starting a Patient Session

The Starting Point of a Patient Session

The Tool Palette Between Sessions

About Automatic Interrogation

Procedure for Starting a Patient Session

Proceeding with Task Selection

The First Task Screen

Selecting Another Task or Function

Consider Using Checklist

Interrogating the Pacemaker

Taking a Quick Look at Pacemaker Operation

The Quick Look Screen

Viewing Data on the Quick Look Screen

Viewing Battery and Lead Measurements

Battery and Lead Measurements Screen

Pacemaker Battery Measurements

Lead System Measurements

Updating the Displayed Data

Checking the Present Parameter Settings

The Therapy Parameters Screen

Viewing Patient Information Stored in the Pacemaker

Recording an ECG Strip of Magnet Operation

The Magnet Test Setup Screen

Procedure for Conducting a Magnet Test

Collecting an ECG Strip

About the Collected ECG Strips

Checking the Patient’s Underlying Rhythm

The Underlying Rhythm Test Screen

Procedure for Checking the Patient’s Underlying Rhythm

Collected ECG Strips

Printing Data Reports

Using the Print Button

Printing Additional Reports

Using the Continuous Print “Trace” Mode

Printing Reports Held in the Print Queue

Ending a Patient Session

Saving a Session on Diskette

Options for Clearing Pacemaker Data

About the Checklist Feature

Selecting a Checklist

Creating a Custom Checklist

Selecting the Create/Edit Window