Medtronic KSR403 Reference Guide

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KAPPA®400 SERIES AND DX2

PACEMAKERS

Model 9952

Volume II, Pacemaker Reference Guide

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Volume II - Pacemaker Reference Guide

A Guide To Understanding the Medtronic.Kappa

401, KDR403,

401, KSR403,

Pacemakers

This guide also applies to Medtronic DX2 7970 and 7972 pacemakers as described in Section I at the back of this guide.

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

Checklist, Fast Path, Kappa, Marker Channel, Medtronic, Medtronic.Kappa, Medtronic.Vision, Rate Profile Optimization, Remote Assistant, Significant Events, Sinus Preference, Quick Look, and Vision are all trademarks of Medtronic, Inc.

How To Use This Guide ix

10. Pacing Modes

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

Table of Contents

11. Rate Response

Introduction to Rate Responsive Pacing 11-2 Preset Rate Response at Implant 11-4 Automatic Sensor Initialization 11-6 Rate Profile Optimization Individualizing Rate Profile Optimization 11-13 Integrated Sensor Operation 11-15 Minute Ventilation Sensor Operation 11-18 Activity Sensor Operation 11-20 Manual Control of Optimization and MV Sensor 11-26

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Operation 11-9

iii

Table of Contents

12. Pacemaker Timing

Rates 12-2 AV Intervals 12-12 Blanking Periods 12-19 Refractory Periods 12-21 High Rate Atrial Tracking 12-31

13. Lead / Cardiac Tissue Interface

Implant Detection 13-2 Bipolar Lead Monitor 13-5 Selecting Pacing Parameters 13-9 Selecting Sensing Parameters 13-12 Transtelephonic Capture Verification with TMT 13-15

14. Special Therapy Options

Mode Switch and Diagnostic 14-2 Non-Competitive Atrial Pacing 14-6 PMT Intervention 14-9 PVC Response 14-12 Ventricular Safety Pacing 14-15 Sinus Preference

and Diagnostic 14-17 Sleep Function 14-21 Single Chamber Hysteresis 14-23 Rate Drop Response and Diagnostic 14-25

15. Telemetry Data

Parameter Summary 15-2 Patient Data 15-4 Battery and Lead Information 15-6 Marker Channel

Telemetry 15-8 Extended Markers 15-9 Intracardiac and MV Electrograms 15-10 Extended Telemetry 15-14

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

16. Miscellaneous Operations

Magnet Mode Operation 16-2 Temporary Programming 16-5 Electrical Reset 16-7 Elective Replacement Indicator (ERI) 16-9 Emergency Pacing 16-10

17. Diagnostics

Introduction to Diagnostics 17-2 Atrial and Ventricular Rate Histograms 17-8 AV Conduction Histogram 17-10 Sensor Indicated Rate Profile 17-13 Atrial and Ventricular High Rate Diagnostics 17-14 Remote Assistant

Diagnostic 17-19

Custom Rate Trend 17-21

18. Troubleshooting the Pacing System

Troubleshooting Strategy 18-2 Troubleshooting Hemodynamic Problems 18-6 Handling, Storage, and Resterilization 18-8 Pacemaker Longevity 18-9 Replacing the Pacemaker 18-11 Patient Information and Service 18-12

Table of Contents

A. Pacemaker Description

Basic Description A-2 Lead Compatibility A-3 Radiopaque Identification A-4 Mechanical Dimensions A-6 Pacemaker Connectors A-7

B. Preset Parameter Settings

Preset Parameter Values B-2

C. Longevity Projections

Longevity Projections C-2 Elective Replacement Indicator C-5 Battery Specifications C-6

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Table of Contents

D. Telemetry and Diagnostic Values

Magnet Mode Operations D-2 Telemetry Functions D-3 Automatic Diagnostics D-6 Clinician-Selectable Diagnostics D-7 Cardiac Event Counters D-9

E. Parameter Values and Restrictions

Programmable Modes and Parameters E-2 Nonprogrammable Parameters E-8 Temporary Modes and Parameters E-9 Rate Response Programming Guidelines E-10 Programming Restrictions and Requirements E-12 Timing Reference E-15

F. Warnings and Precautions

Special Notice F-2 Warnings F-3 Precautions F-5 Potential Complications F-9

G. Environmental Interference

Hospital or Medical Environment Interference G-2 Home and Job Environment Interference G-7

H. Pacing Indications

Indications in Acquired Atrioventricular Block in Adults H-2 Indications After Myocardial Infarction H-4 Indications in Bifascicular and Trifascicular Block H-5 Indications in Sinus Node Dysfunction H-6 Indications in Hypersensitive Carotid Sinus Syndrome and Neurovas-

cular Syndromes H-7 Indications in Children H-8

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

I. Supplement: DX2 Models 7970 and 7972

How To Use This Supplement I-2 Pacemaker Differences I-3 Low MV Monitor I-5 Radiopaque Identification I-6 Pacemaker Connectors I-7 Longevity Projections I-8 Battery Specifications I-10 Lead Compatibility I-10 Mechanical Dimensions I-10

J. Glossary

K. Index

Table of Contents

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

vii

How To Use This Guide

Guide Is Organized Into Two Volume Set

Product information about Medtronic.Kappa® 400 Series pacemakers and Vision software is organized into a two-volume set:

■

Volume I, which contains programming information is comprised of Chapters 1 through 9.

■

Volume II, which contains pacemaker information includes Chapters 10 through 18 and Sections A through J.

Note that implant information is also provided in the product information manual that is packaged with each Kappa pacemaker.

What Is Contained In This Guide - Volume II

How To Use This Guide

This guide describes how the pacemaker operates and specifies the capabilities of each model.

■

Chapters 10 through 17 describe the pacing modes, rate response options, special therapy features, telemetry types, and data collection options. In some cases, guidelines are given of how to configure these pacemaker operations.

■

Chapter 18 contains troubleshooting information for electrical and hemodynamic problems.

■

Sections A through E specify parameter and data collection capabilities, longevity projections, and mechanical and electrical specifications.

■

Sections F through H provide general warnings and cautions, potential interference with the pacemaker, and general indications for pacing. A supplement covering the clinical DX2 pacemakers, a glossary, and an index follow section H.

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

How To Use This Guide

What Is Contained In The Programming Guide - Volume I

Volume I instructs the clinician on the Model 9790/C Programmer and managing Kappa pacemaker patients. Chapters 1 through 9 cover the following topics:

■

how to setup, configure, and operate the programmer and accessing on-line help

■

using programmer features to conduct patient follow-up sessions

■

viewing patient ECGs and electrocardiograms

■

retrieving pacemaker collected data and configuring new data collection options

■

evaluating pacemaker parameter settings and programming new settings, if necessary

■

initializing the minute ventilation sensor and verifying rate response operation

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Understanding Pacemaker Operation

Chapters 10 - 18 provide detailed information about the operation of the Kappa 400 series pacemakers.

Pacing Modes

Rate Response

Pacemaker Timing

Lead/Cardiac Tissue Interface

Special Therapy Options

Telemetry Data

Miscellaneous Operations

Diagnostics

Troubleshooting The Pacing System

Pacing Modes

General Desciption

This chapter provides information about the modes available with the pacemaker. The sections are as follows:

Introduction

Mode Selection Decision Tree:

Mode Pertinency Tables

Indications/Intended Use

Contraindications

DDDR Mode

DDD Mode

DDIR Mode

DDI Mode

DVIR Mode

DVI Mode

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

10-2

10-4

10-5

10-7

10-8

10-9

10-10

10-11

10-12

10-13

10-14

VDD Mode

AAIR / ADIR Modes

AAI / ADI Modes

VVIR / VDIR Modes

VVI / VDI Modes

AAT / VVT Modes

DOOR / AOOR / VOOR Modes

DOO / AOO / VOO Modes

ODO / OAO / OVO Modes

10-15

10-16

10-17

10-18

10-19

10-20

10-21

10-22

10-23

10-1

Pacing Modes

Introduction

Pacing Mode Selection

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

Mode Selection Decision Tree – This decision tree, based on the

■

1991 ACC/AHA guidelines for pacemaker implantation, provides a simple means of identifying pacing modes appropriate for given indications. More specific indications for bradycardia-related pacing are described in Section H.

Mode Pertinency Tables – These tables show which features and

■

parameters apply to each commonly used pacing mode.

Mode Descriptions – These descriptions provide indications

■

and contraindications for modes available with the pacemaker and brief descriptions of how these modes operate.

10-2

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

Journal of the American College of Cardiology.

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

1991;

Pacing Modes

Introduction

NBG Pacing Codes

The pacemaker modes are defined in NBG Code.1 Each five-letter NBG code describes a specific type of operation for implantable pacemakers. For simplicity, this manual uses only the first three or four letters, such as DDD, DDIR, DVIR, and so forth. Figure 10-1 describes the first four letters of the NBG code.

CHAMBER PACED

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

CHAMBER SENSED

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

Figure 10-1.

DDDR

NBG Pacing Codes

MODE OF RESPONSE

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

PROGRAMMABLE/ RATE RESPONSE

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

Further Information

The mode descriptions in this chapter provide only a basic overview of each mode. For further details on the rate response, timing, and therapy capabilities refer to Chapter 11, Chapter 12, and Chapter 14, respectively.

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

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

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

10-3

Pacing Modes

Mode Selection Decision Tree:

Figure 10-2 shows a basic decision tree used to select the pacing mode. In the shaded boxes the preferred mode(s) are listed and the alternate mode(s) appears below the dashed line.

Symptomatic

Bradycardia

(e.g., persistent

atrial fibrillation,

inexcitable atrium)

is SA node conduction

Ye s NoNo Yes

AAI

DDD AAIR

DDDR

VVIR

VVI

presently adequate?

Can the atrium be sensed

and/or paced reliably?

presently adequate?

AAIR

DDDR

Figure 10-2.

Ye s

is AV conduction

Mode Selection Tree

is SA node conduction

presently adequate?

DDD

DDDR

VDD

NoYe s

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

DDDR

DDIR

10-4

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Pacing Modes

Mode Pertinency Tables

✓

–––

✓✓

–––

✓✓

––

✓

✓ ✓ ✓ ✓✓

✓✓✓✓ ✓

Mode Pertinency Tables

–

Pacing Parameters Available For Each Mode

Table 10-1.

Table 10-1 and Table 10-2 indicate which pacing parameters and features apply to each commonly used pacing mode

by black check marks. Dashes indicate parameters that are programmable but not pertinent to basic mode operation.

These parameters are programmable when mode switch, RAAV, or sensor-varied PVARP are active or when

background rate response is operative.

Basic Operation Parameters

✓ ✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓

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

Lower Rate

✓

–

✓✓ ✓

Upper Tracking Rate

✓ ✓✓✓✓✓

✓

Sensed AV Interval

Paced AV Interval

Upper Sensor Rate

✓✓✓ ✓ ✓

✓ ✓✓✓ ✓

†

PVARP

Rate Adaptive AV

✓ ✓✓✓ ✓ ✓ ✓

PVAB

Atrial Blanking

Atrial Refractory Period

✓ ✓✓✓✓✓ ✓ ✓

✓ ✓✓✓✓✓✓✓✓✓✓✓

Ventricular Blanking (After AP)

Ventricular Refractory Period

* See Chapter 12 for operational descriptions of these timing parameters.

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

Standard pacing and sensing parameters (amplitude, pulse width, sensitivity, and pace/sense polarities) are

Note:

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

not shown here but are found in Section E. Also, asynchronous modes are not shown.

10-5

Pacing Modes

Mode Pertinency Tables

Features Available For Each Mode

Special Therapy Options

✓✓✓ ✓✓ ✓

✓✓

†

Rate Response Therapy Options

–––

✓✓

–––

✓✓

––

✓

–

✓

–––

✓✓

–––

✓✓

––

✓

–

✓

Table 10-2.

10-6

✓✓

✓

✓✓ ✓

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

Managing Atrial Rhythms

Mode Switch

Non-Competitive Atrial Pacing

✓✓ ✓

Rhythms

PMT Intervention

Managing Ventricular

✓ ✓✓✓✓✓

✓ ✓✓✓ ✓

Ventricular Safety Pacing

Special Pacing Operations

Rate Drop Response

PVC Response

Single Chamber Hysteresis

✓ ✓✓✓✓✓✓✓✓✓✓✓✓✓✓

Sinus Preference ✓Sleep Function

–

✓

Integrated Sensor

Rate Profile Optimization

ADL Rate

–

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

–

✓

Activity Threshold

Activity Sensor

Minute Ventilation Sensor

* See Chapter 14 for operational descriptions of special therapy options.

† See Chapter 11 for operational descriptions of rate response features.

Indications/Intended Use

Kappa pacemakers are indicated for the following:

Rate adaptive pacing in patients who may benefit from

■

increased pacing rates concurrent with increases in activity and/or minute ventilation.

Accepted patient conditions warranting chronic cardiac

■

pacing which include:

– Symptomatic paroxysmal or permanent second or third-

degree AV block.

– Symptomatic bilateral bundle branch block.

– Symptomatic paroxysmal or transient sinus node

dysfunctions with or without associated AV conduction disorders.

– Bradycardia-tachycardia syndrome to prevent

symptomatic bradycardia or some forms of symptomatic tachyarrhythmias.

Pacing Modes

Indications/Intended Use

– Vasovagal syndromes or hypersensitive carotid sinus

syndromes.

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

Various degrees of AV block to maintain the atrial

■

contribution to cardiac output.

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

■

persistent sinus rhythm.

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

10-7

Pacing Modes

Contraindications

Kappa pacemakers are contraindicated for the following applications:

Dual chamber atrial pacing in patients with chronic refractory

■

atrial tachyarrhythmias.

Asynchronous pacing in the presence (or likelihood) of

■

competitive paced and intrinsic rhythms.

Co-implant in a patient with an implanted cardioverter-

■

defibrillator (ICD) because it may cause unwanted delivery of ICD therapy.

10-8

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

DDDR Mode

Pacing Modes

DDDR Mode

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

Rate limits for atrial tracking (Upper Tracking Rate)1 and

■

sensor tracking (Upper Sensor Rate) are separately programmable.

The AV intervals that follow sensed atrial events (SAV) and

■

paced atrial events (PAV) are separately programmable, and they can be programmed to shorten with increasing rates (Rate Adaptive AV).

A nonrefractory sensed event in either chamber inhibits

■

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

Sensor-indicated

Interval

A P

V P

Parameters:

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

A P

V S

Figure 10-3.

Example of DDDR Mode Operation

Sensor-indicated

Interval

A S

V S

A P

V P

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

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

A S

V P

200 ms

10-9

Pacing Modes

DDD Mode

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

Each atrial paced or nonrefractory atrial sensed event starts an

■

AV interval and a lower rate interval. The AV intervals that follow sensed atrial events (SAV) and paced atrial events (PAV) are separately programmable, and the SAV may be optionally programmed to shorten with increasing rate (Rate Adaptive AV).

Ventricular paced events may track atrial sensed events up to

■

the programmed Upper Tracking Rate.

A ventricular nonrefractory sensed event in the VA interval

■

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

10-10

Lower Rate Interval

A P

V P

Parameters:

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

Figure 10-4.

A P

V S

SAV Interval = 170 ms

Example of DDD Mode Operation

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

Lower Rate Interval

A S

V S

200 ms

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

A P

DDIR Mode

Pacing Modes

DDIR Mode

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

Atrial pacing occurs at the sensor-indicated rate, with

■

ventricular pacing at the end of the PAV interval unless inhibited.

An atrial event sensed outside the PVARP will inhibit a

■

scheduled atrial stimulus but will not start an AV interval. That is, ventricular paced events after such sensed atrial events occur at the sensor-indicated rate.

A ventricular nonrefractory sensed event in the

■

ventriculoatrial (VA) interval starts a new VA interval.

Sensor-indicated

Interval

A P

V P

Parameters:

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

A P

Figure 10-5.

Sensor-indicated

Interval

A S

V P

Example of DDIR Mode Operation

Sensor-indicated

VA Interval

V P

Sensor-indicated

A P

V P

Interval

200 ms

A P

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

10-11

Pacing Modes

DDI Mode

Lower Rate Interval

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

Atrial pacing occurs at the Lower Rate, with ventricular

■

pacing at the end of the PAV interval unless inhibited.

An atrial event sensed outside the PVARP will inhibit a

■

scheduled atrial stimulus but will not start an AV interval. Ventricular paced events after such sensed atrial events occur at the Lower Rate.

A ventricular nonrefractory sensed event in the

■

ventriculoatrial (VA) interval starts a new VA interval.

Lower Rate

Lower Rate Interval

VA Interval

A P

V P

Parameters:

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

A P

Figure 10-6.

10-12

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

A S

V P

Example of DDI Mode Operation

200 ms

A P

DVIR Mode

Pacing Modes

DVIR Mode

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

Atrial pacing occurs at the sensor-indicated rate, with

■

ventricular pacing at the end of the PAV interval unless inhibited.

The DVIR mode ignores intrinsic atrial events. Sensing occurs

■

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

Sensor-indicated

Interval

A P

V P

Parameters:

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

A P

V S

Figure 10-7.

Example of DVIR Mode Operation

Sensor-indicated

V S

VA Interval

Sensor-indicated

A P

V P

Interval

A P

200 ms

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

10-13

Pacing Modes

DVI Mode

Lower Rate Interval

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

Atrial pacing occurs at the Lower Rate, with ventricular

■

pacing at the end of the PAV interval unless inhibited.

Sensing occurs only in the ventricle, and intrinsic atrial events

■

are ignored. A ventricular nonrefractory sensed event during the VA interval starts a new ventriculoatrial (VA) interval.

Lower Rate

VA Interval

10-14

A P

V P

Parameters:

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

Figure 10-8.

A P

V S

Example of DVI Mode Operation

V S

A P

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

V P

200 ms

VDD Mode

Pacing Modes

VDD Mode

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

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

To promote atrial synchronous pacing at slow rates, a sensed

■

atrial event occurring near the end of the lower rate interval will be followed by the programmed maximum SAV interval. The result is an extension of the ventricular lower rate.

A ventricular nonrefractory sensed event in the V-V interval

■

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

Lower Rate Interval

SAV

Interval

A S

V P

Parameters:

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

A S

V P

Figure 10-9.

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

value.

Example of VDD Operation

A S

V P

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

A S

200 ms

10-15

Pacing Modes

AAIR / ADIR Modes

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

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

In the AAIR and ADIR modes, atrial refractory sensed

Note:

events do not restart the upper sensor rate interval.

Sensor-indicated Interval Sensor-indicated Interval

10-16

A P

Operation

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

A R

A P

Figure 10-10.

A S

Example of AAIR Mode Operation

A P

200 ms

Medtronic.Kappa® 400 Series Pacemaker Information and Programming Guide

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Medtronic KSR403 Reference Guide

Specifications and Main Features

Frequently Asked Questions

User Manual

Table of Contents

How To Use This Guide

Understanding Pacemaker Operation