1
PROGRAMMERS
/C/TEMP/197442001C_view.pdf
Programming
Guide
Supplement
9886P-EN
Software
Topics in this supplement:
The 9886P-EN software
and operation of your
updated 9790 programmer.
Adjusting artifact detection.
Expanded temporary
programming for
Legend Plus
Prevail
Premier
®
Pacemakers.
™
Pacemakers.
™
Pacemakers.
1
9790 PROGRAMMERS
Programming Guide Supplement
9886P-EN Software
Supplement to the technical
literature supplied with the
9877E Software
.
4
Created by Cardiovascular Technical Communications
The 9886P-EN software contains licensed program materials which are the property of IBM Corporation, Copyright© 1987, 1994
International Business Machines Corporation. All rights reserved. IBM is a registered trademark of the International Business Machines
Corporation.
Medtronic, Inc. 1998
All Rights Reserved
5
About This Programming Guide Supplement
About This Programming Guide Supplement
This programming guide supplement covers some new features
and programming capabilities available in the 9886P-EN
software.
Note: 9886P-EN software requires an upgraded 9790
programmer. Upgraded programmers have a label on the back of
the display with Medtronic 9790C Programmer in white lettering
on a blue background.
The information in this programming guide supplement covers
only the enhancements added by the 9886P-EN software. This
information is intended as a supplement to the information
contained in the technical literature supplied with the 9877E and
9879E software.
Part 1: Refer to Part 1 of this supplement for an overview of the
new features, device applications, and programming capabilities
and for more information about the technical literature that covers
operation of your 9790 series programmer.
Part 2: Refer to Part 2 for information and instructions on using
the artifact detection adjustment feature included in the 9886P-EN
software.
Part 3: Refer to Part 3 for information about the expanded
temporary programming capability for Legend Plus®
pacemakers.
Part 4: Refer to Part 4 for information programming for Prevail™
pacemakers.
Part 5: Refer to Part 5 for information programming for Premier™
pacemakers.
9886P-EN Technical Manual iii
6
About This Programming Guide Supplement
iv 9886P-EN Technical Manual
7
Table of Contents
About This Programming Guide Supplement iii
Part 1 - New Features and Programming Capabilities
About the 9886P-EN Software Update 1-2
Device Applications 1-4
Part 2 - Improving the Detection of Pacing Artifacts
About the Artifact Detection Function 2-2
Part 3 - Software Update for Legend Plus® Pacemakers
Expanded Temporary Programming 3-2
Part 4 - Prevail™ 8084, 8085, 8086
General Information 4-2
Programming Pacing Parameters 4-12
Programming Temporary Parameters 4-14
Measure ECG Function Accuracy 4-16
Displaying the Patient’s ECG 4-17
Table of Contents
Pacemaker Reference Information
Part 5 - Premier™ 8081
Pacemaker Reference Information
General Information 5-2
Programming Pacing Parameters 5-12
Programming Temporary Parameters 5-14
Measure ECG Function Accuracy 5-15
9886P-EN Technical Manual v
8
9
New Features and Programming Capabilities
Part 1
New Features and Programming
Capabilities
In this Part:
About the 9886P-EN Software Update page 1-2
Artifact Detection Adjustment page 1-2
Software Update for Legend Plus® Models page 1-2
Display Enhancements page 1-2
Device Applications page 1-4
Existing Applications page 1-5
1
10
9886P-EN Technical Manual 1-1
New Features and Programming Capabilities
About the 9886P-EN Software Update
About the 9886P-EN Software Update
The 9886P-EN software adds the device applications listed in
Table 1-1 in addition to the device applications and features
supplied by the 9886E software described below to your 9790
series programmer.
Artifact Detection Adjustment
Artifact Setup is a function included in the 9886P-EN and the
9886E software update. This function lets you make adjustments
to improve pacing artifact detection when interference causes
“false” artifacts to appear on the patient’s ECG. You can access the
Artifact Detection function via the Programmer icon on the Model
Select screen.
Refer to Part II of this supplement for a complete description of
Artifact Detection and instructions on how to use this function.
Software Update for Legend Plus® Models
A
1-2 9886P-EN Technical Manual
11
Installation of the 9886P-EN or 9886E software provides an
expanded temporary programming capability for use with the
Legend Plus® 8446 and 8448 pacemakers. Refer to Part 3.
Display Enhancements
As a result of certain software enhancements, you will see minor
changes in the way some graphical elements appear on the screen
after the 9886P-EN or 9886E is installed. For example, the onscreen control buttons appear more three-dimensional as shown
below. Another example as shown, is the indication of a restricted
parameter interaction. These graphical enhancements apply only
to screens operating in the color mode and do not change the way
you operate the programmer.
On-screen Button Example →
Parameter Interaction →
New Features and Programming Capabilities
About the 9886P-EN Software Update
Original Appearance After Software Update
12
9886P-EN Technical Manual 1-3
New Features and Programming Capabilities
Device Applications
Device Applications
Installation of the 9886P-EN software adds the new device
applications listed in Table 1-1 as part of the programming and
follow-up capabilities of your programmer. Table 1-2 and
Table 1-3 show the device applications that continue to be
available. Refer to the appropriate user guide for information
about these models and using the programmer.
Note: If you do not have a complete set of these manuals, use the
order form included with this supplement to order by fax or
contact your Medtronic representative.
Note: You must reinstall the EP Study function after installing
9886P-EN software. Since operation of the EPS function has not
changed, you can continue to use the programming guide
supplement you previously received with the EPS software.
Table 1-1. New 9886P-EN Applications
New Applications
Kappa® KDR401, KDR403,
KSR401, KSR403
DX2 7970. 7972
a
User Reference Guide Software Model
Pacemaker Information and
Programming Guide
a
9952E
Micro Jewel® 7221
Jewel® PCD® 7219/DISD 5358
CD 7201
PCD 7216/7217
Jewel® PCD® 7219
Jewel® CD 7202
Jewel Plus® 7220
Micro Jewel® II 7223
a
For identification, the front cover of each user guide lists the applicable devices and a software model number.
System Reference Guide
Programming Guide
System Reference Guide
Table 1-2 shows the device applications that were supplied by the
9886E software and were not removed from your programmer.
Refer to the appropriate user guide for information about these
models and using the programmer.
1-4 9886P-EN Technical Manual
13
9894E
9895E
9955E
New Applications
New Features and Programming Capabilities
Device Applications
Table 1-2. 9886E Applications
a
User Reference Guide Software Model
a
Prevail™ 8084, 8085, 8086
Programming Guide Supplement
9886P-EN
Premier™ 8081
a
For identification, the front cover of each user guide lists the applicable devices and a software model number.
Existing Applications
The models listed in Table 1-3 are not removed from your
programmer by the installation of the 9886P-EN software. Except
for the few enhancements covered in this supplement, using the
programmer with these models does not change. Refer to the
appropriate user guide for information about these models and
using the programmer.
.
14
9886P-EN Technical Manual 1-5
New Features and Programming Capabilities
Device Applications
Table 1-3. Existing Application
Activitrax 8400, 8402, 8403, 8403M
Activitrax® E 8300, 8301
Activitrax® II 8412, 8413, 8413M, 8414
Classix™ 8436, 8437, 8438
Elite ® 7074, 7075, 7076, 7077
Elite II ® 7084, 7085, 7086
Legend ® 8416, 8417, 8418, 8419
Legend II ® 8424, 8426, 8427
Legend Plus® 8446, 8448
Minix ® 8340, 8341, 8341M, 8342
Minix ® ST 8330, 8331, 8331M
Micro Minix ® 8360
Software Reference Guide:
9790/9760 Programming Guide —
9877E Software
Thera® DR 7850, 7851, 7852
7940, 7941, 7942
7950, 7951, 7952,
7960
i
, 7961i, 7962i
Minuet ® 7107, 7108
Pasys® 8320, 8322, 8329
Pasys® ST 8316, 8317, 8318
Spectrax® S 5940, 5940LP, 5941, 5941M
Spectrax® SX 5984, 5984LP, 5985
Spectrax® SX-HT 5976, 5977
Spectrax® SXT 8420, 8422, 8423, 8423M
Symbios® 7005, 7005C, 7006, 7008
Synergyst ® 7026, 7027, 7027M
Synergyst ® II 7070, 7071, 7071A, 7071M
(No name) Model 7001
Thera® VDD 8948, 8968
Thera® SR 8940, 8941, 8942
8960
i
i
, 8961i, 8962
i
Thera® D 7944, 7945, 7946
7964i, 7965i, 7966
Software Reference Guide:
9790/9760 Pacemaker Information and
Programming Guide — 9879E Software
Prodigy™ DR 7860, 7861, 7862
Prodigy™ D 7864, 7865, 7866
Software Reference Guide:
9790/9760 Pacemaker Information and
Programming Guide — 9879E Software
1-6 9886P-EN Technical Manual
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Thera® S 8944, 8945, 8946
i
Prodigy™ VDD 8168
Prodigy™ SR 8158, 8160, 8161, 8162
Prodigy™ S 8164, 8165, 8166
8964
i
, 8965i, 8966
i
Improving the Detection of Pacing Artifacts
Part 2
Improving the Detection of Pacing
Artifacts
In this Part:
About the Artifact Detection Function page 2-2
Pulse Artifact Detection Versus ECG Detection page 2-2
Limitations of Artifact Measurement page 2-3
Accessing the Artifact Detection Screen page 2-4
Features of the Artifact Detection Screen page 2-5
Optimizing Artifact Detection page 2-8
Setting Up the Programmer page 2-8
Selecting Artifact Detection Settings page 2-8
Using Measure ECG to Verify Artifact Detection page 2-12
Closing the Artifact Detection Screen page 2-13
2
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9886P-EN Technical Manual 2-1
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
About the Artifact Detection Function
Installation of the 9886P-EN software in your 9790 programmer
gives you access to a new function referred to as Artifact
Detection. The Artifact Detection function allows you to change
the lead configuration and signal level settings used by the
programmer to detect pacing artifacts.
This function is intended for use to improve the detection of
pacing artifacts in situations where interference results in the
display of false artifacts on the patient’s ECG.
You can access the Artifact Detection function by selecting the
Programmer icon on the Model Select screen (available before you
select the patient’s device model). Installation of the 9886P-EN
software replaces the existing [
the [ARTIFACT DETECTION] option.
Pulse Artifact Detection Versus ECG Detection
ARTIFACT DISPLAY] option with
2-2 9886P-EN Technical Manual
17
It is important to note that the adjustments made using the
Artifact Detection function affect only the detection and display of
the pacing artifacts appearing on the patient’s ECG. These
adjustments do not affect the detection and display of the ECG
itself.
The pulse signals generated by the delivery of pacing stimuli are
generally too weak and too narrow to be clearly visible on the
patient’s ECG. For this reason, Medtronic programmers process
these pulse signals separately from the patient’s ECG signal. Each
pulse artifact signal is enhanced and then recombined with the
ECG signal to be displayed as a larger, standardized artifact that
clearly marks each pacing stimulus.
Under certain conditions, however, interference signals that
mimic pacing stimuli may undergo the same enhancement
process and thus appear as “false” artifacts on the patient’s ECG.
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
In such cases, changing the lead configuration and signal level
settings used by the artifact detection process may eliminate the
effects of the interference causing false artifacts.
Limitations of Artifact Measurement
The Artifact Detection function lets you directly measure artifact
parameters (see [MEASURE ECG] on page 2-12). This feature
provides rapid parameter measurements within 4 seconds
without using Marker Channel™ telemetry.
Depending on pacing conditions, the following limitations of this
measurement feature should be considered. In most cases,
positioning the programming head during artifact measurement
will resolve the first two. The limitations of the Measure ECG
function described in the reference guide for the device also
apply.
■
Measurement of pacing rates less than 45 ppm may not be
successful (no values are displayed). Pacing rate during the
use of the Artifact Detection function should be 45 ppm or
greater.
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■
The combination of a high pacing rate and long AV interval
may be misinterpreted by the measurement function. If the
AV interval is within 10 ms of being the same as the VA
interval, device operation is interpreted as single chamber
pacing. If the AV interval is longer than the VA interval, the
VA interval is measured as the programmed AV interval. In
this case, the measured values for atrial and ventricular pulse
width are transposed.
■
If the pacing mode is a single chamber mode, or is interpreted
as a single chamber mode, pulse width measurements always
appear as ventricular pulse width measurements, regardless
of the chamber paced.
9886P-EN Technical Manual 2-3
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
■
The rate of detected artifacts, whether the result of pacing or
interference, is measured and displayed as pacing rate. The
measurement function is capable of measuring rates well
above the pacing range. Any rate measurement that is not
consistent with the expected pacing rate is an indication that
interference is causing false artifacts.
■
This artifact measurement function cannot be used with
implantable cardioverter defibrillators (ICDs).
Accessing the Artifact Detection Screen
To display the controls for adjusting artifact detection, you must
select the Artifact Detection screen as follows:
1. Display the Model Select screen. This screen appears when
you end a patient session or after the automatic self-test
when you turn the programmer on.
2. Select the Programmer icon.
3. From the displayed window of options, select [
DETECTION]. This action displays the Artifact Detection
screen shown on the next page.
2-4 9886P-EN Technical Manual
ARTIFACT
19
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
Features of the Artifact Detection Screen
1
2
3
4
5
6
7
8
9
10
11
12
13
1 ECG Display — Displays the patient’s ECG (and pacing
artifacts) as detected via skin electrodes attached to the
patient. Note: Pacing artifacts will not be displayed if the
Artifact Display function is turned off (see item 7).
2 ARTIFACT DETECTION LEAD Buttons — Used to manually
select the lead configuration used for artifact detection.
3 ARTIFACT DETECTION LEVEL Controls — The [∧] and [∨]
buttons change the signal level at which pulse artifact
detection occurs. A setting of 5 is the highest level (least
sensitive setting), while a setting of 1 is the lowest level
(most sensitive setting).
20
4 [MEASURE ECG] Button — Initiates measurement of the
artifact signals presently being displayed. The measured
rate, interval, and pulse width values can indicate whether
or not artifact detection is being affected by interference.
9886P-EN Technical Manual 2-5
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
5 [SCAN] Button — Selecting this button causes the
programmer to automatically activate each Artifact
Detection Lead option, one by one, for four seconds each.
The highlighted button indicates which setting is active. The
programmer will continue to cycle through the lead settings
until a lead button is manually selected.
Note: A Lead button cannot be selected while it is
highlighted.
6 Message Box — Displays procedural prompts and status
information during use of the Artifact Detection function.
7 [ARTIFACT DISPLAY] Button — Turns the artifact display
function on or off. The button will indicate that the function
IS ON” or “IS OFF.” This function must be on during use of
“
the Artifact Detection screen.
8 [AUTO SINGLE] Button — Initiates an automatic scan feature
that can be used with devices operating in a single chamber
pacing mode.
9 [AUTO DUAL] Button — Initiates the automatic scan feature
10 [MV FILTER] Button — Turns the MV Filter function on or
11 [SAVE NOMINAL AND EXIT] Button — Saves the nominal
2-6 9886P-EN Technical Manual
This feature automatically determines the appropriate
Artifact Detection Lead and Level settings by testing all lead
configurations with each Level setting starting at level 5. The
scanning process can be stopped at any time by selecting the
[STOP AUTO SCAN] button, which appears once the scan is
initiated.
described in the paragraph above, but is used when the
device is operating in a dual chamber pacing mode.
off. The button will indicate that the filter “IS ON” or “IS
OFF.” This function should be turned off unless the patient
has a Legend Plus® or a Kappa® 400 series pacemaker.
settings for Artifact Detection Lead and Artifact Detection
Level and closes the Artifact Detection screen. Nominal
settings are Lead II and Level 2, respectively.
21
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
12 [SAVE CURRENT AND EXIT] Button — Saves the presently
selected settings for Artifact Detection Lead and Artifact
Detection Level and closes the setup screen.
13 [EXIT - NOTHING SAVED] Button — Closes the Artifact
Setup screen without saving any changes to the Artifact
Detection Lead and Artifact Detection Level settings in
effect when the setup screen was opened.
22
9886P-EN Technical Manual 2-7
Improving the Detection of Pacing Artifacts
About the Artifact Detection Function
Optimizing Artifact Detection
The procedures below describe how to use the Artifact Setup
screen to optimize pacing artifact detection when interference
results in false artifacts on the patient’s ECG.
Setting Up the Programmer
1. Display the Artifact Setup screen as described under
Accessing the Artifact Detection Screen on page 2-4.
2. Verify that the Artifact Display function is on. The button in
the upper- right corner of the screen should show as
ARTIFACT DISPLAY IS ON]. If the button indicates that the
[
function “IS OFF,” press the button once.
3. Unless the patient has a Legend Plus® or Kappa® 400 series
pacemaker, the MV Filter function should be off (button
shows as [MV FILTER IS OFF]). If the patient has a Legend
Plus® or a Kappa® 400 series pacemaker, press the button
once so that it shows as [MV FILTER IS ON].
2-8 9886P-EN Technical Manual
23
4. Confirm that the ECG display at the top of the setup screen
clearly shows the patient’s ECG and pacing artifacts.
Note: If the patient’s device is inhibited, position the
programming head to obtain magnet mode operation.
Selecting Artifact Detection Settings
The purpose of this procedure is to determine the combination of
Artifact Detection Lead and Artifact Detection Level that will
improve the detection and display of pacing artifacts in the
presence of interference. You can determine these settings either
manually or automatically.
The initial Artifact Detection Lead and Level settings determined
by using either of the procedures below may not be settings that
will work for all patients. Settings that work for one patient may
not work for another. However, over a number of sessions, it
should be possible to determine the settings that will provide
good pacing artifact detection most of the time. Characteristics of
the interference will affect the outcome.
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