Medtronic SVDD303 Reference Guide
SIGMA™ 300/200/100
Pacemaker Series
Pacemaker Reference Guide
Medtronic.Sigma™ 300/200/100 Series
Pacemaker Reference Guide
Caution: Federal law (USA) restricts this device to sale
by or on the order of a physician.
A guide to the
Medtronic.Sigma
300/200/100 Series
pacemakers
Refer to the Medtronic.Sigma™
300/200/100 Pacemaker
Programming Guide for information
on software and programming.
™
The following terms are trademarks of Medtronic, Inc.
Auto PVARP, Marker Channel, Medtronic, Medtronic.Sigma, Medtronic.Vision, Quick Look,
Quick Secure, Sigma, Significant Events, and Vision.
How to Use This Guide
Information is Contained in Two Guides
Product information about Medtronic.Sigma 300/200/100 Series
software and pacemakers is presented in two separate guides.
The Pacemaker Reference Guide (PRG) is a supplementary guide
that provides detailed information on Medtronic.Sigma
300/200/100 Series pacemakers.
The Pacemaker Programming Guide (PPG) accompanies
Medtronic.Sigma 300/200/100 Series software and contains
instructions on how to use the programmer and the programming
software.
Note:
Refer to the technical manual supplied with the pacemaker
for information about which features are supported by a
Medtronic.Sigma pacemaker.
How to Use This Guide
About this 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 warnings and cautions, plus potential
interference sources.
■
Contains a glossary of terms.
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
iii
How to Use This Guide
About the Pacemaker Programming Guide
This guide presents the following information to use the 9790
programmer.
■
How to setup and configure the programmer and access
on-line help.
■
How to start a patient session, use the various follow-up
features during the session, and properly end the session.
■
How to view and print the patient’s ECG and EGM waveform
traces.
■
How to configure the pacemaker to collect diagnostic data
and how to retrieve and view this information.
■
How to measure stimulation thresholds and sensing levels.
■
How to program parameter values and verify rate response
parameters settings.
iv
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Table of Contents
1. Pacing Modes
Ta b l e of C on te n ts
How to Use This Guide iii
Information is Contained in Two Guides iii
About this Guide iii
About the Pacemaker Programming Guide iv
Introduction 1-2
Pacing Mode Selection 1-2
NBG Pacing Codes 1-2
Further Information 1-3
Mode Selection Decision Tree: 1-4
Mode Pertinency Tables 1-5
Indications and Usage 1-7
Contraindications 1-9
DDDR Mode 1-10
DDD Mode 1-11
DDIR Mode 1-12
DDI Mode 1-13
DVIR Mode 1-14
DVI Mode 1-15
VDD Mode 1-16
AAIR / ADIR Modes 1-17
AAI / ADI Modes 1-18
VVIR / VDIR Modes 1-19
VVI / VDI Modes 1-20
AAT / VVT Modes 1-21
DOOR / AOOR / VOOR Modes 1-22
DOO / AOO / VOO Modes 1-23
ODO / OAO / OVO Modes 1-24
2. Rate Response
Introduction to Rate Responsive Pacing 2-2
Overview 2-2
Sensor-Indicated Rate 2-3
Activity Sensor Operation 2-4
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
v
Ta b le of Co nt en ts
Overview 2-4
How Activity Threshold Influences Rate 2-5
Rate Response Operation 2-7
How Activity Acceleration and Deceleration Influence
Rate 2-10
Exercise Deceleration Operation 2-12
Adjusting Rate Response with the Exercise Test 2-13
Overview 2-13
3. Pacemaker Timing
Rates 3-2
Overview 3-2
A–A and V–V Timing 3-3
Lower Rate 3-4
Operating Lower Rate 3-5
Selecting a Lower Rate 3-5
Sensor-Indicated Rate 3-6
Sensor-Indicated Rate Effect on Other Intervals 3-7
Upper Tracking Rate 3-8
Upper Sensor Rate 3-8
Programming Considerations and Restrictions 3-9
Rate Limit 3-9
Possible Atrial Competition at High Rates 3-10
Mean Atrial Rate 3-10
AV Intervals 3-12
Overview 3-12
Selecting PAV and SAV 3-14
Rate Adaptive AV 3-16
Overview 3-16
Programming for Rate Adaptive AV 3-16
RAAV Operations 3-17
RAAV Operation in the DDDR and DDD Modes 3-19
RAAV and Sick Sinus Syndrome 3-19
Blanking Periods 3-20
Nonprogrammable Blanking Periods 3-20
Post-Ventricular Atrial Blanking 3-21
Ventricular Blanking 3-21
vi
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Single Chamber Atrial Blanking 3-22
Refractory Periods 3-23
Overview 3-23
Post-Ventricular Atrial Refractory Period 3-23
Auto PVARP (Tracking Modes) 3-25
Auto PVARP (Nontracking Modes) 3-26
Total Atrial Refractory Period (TARP) 3-27
Ventricular Refractory Period 3-28
Atrial Refractory Period (Single Chamber) 3-29
Noise Reversion 3-30
Preventing Noise Sensing 3-32
Spontaneous PVARP Extension 3-32
High Rate Atrial Tracking 3-33
Overview 3-33
2:1 Block 3-33
Pacemaker Wenckebach 3-34
High Rate Operation in the DDDR Mode 3-36
4. Lead / Cardiac Tissue Interface
Selecting Pacing Parameters 4-2
Overview 4-2
Selecting Pacing Polarity 4-2
Muscle Stimulation with Unipolar Pacing 4-3
Bipolar Pacing Polarity Confirmation 4-3
Determining Stimulation Threshold at Implant 4-3
Verifying Stimulation Threshold at Follow-up 4-4
Selecting Output Parameters 4-4
For Further Information 4-5
Selecting Sensing Parameters 4-6
Overview 4-6
Selecting Sensing Polarity 4-6
Bipolar Sensing Polarity Confirmation 4-7
Determining Sensing Threshold(s) at Implant 4-7
Verifying Sensing Threshold(s) at Follow-up 4-8
Selecting Sensitivity Settings 4-8
Effects of Myopotentials During Unipolar Pacing 4-9
For Further Information 4-10
Ta b l e of C on te n ts
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
vii
Ta b le of Co nt en ts
Lead Monitor 4-11
Overview 4-11
How Lead Monitoring Works 4-11
Lead Impedance Data 4-13
Automatic Lead Impedance
(Chronic Lead Trend) 4-13
Clinician-Selected Lead Impedance Detail 4-14
For Further Information 4-14
Transtelephonic Follow-up Features 4-15
Overview 4-15
The Threshold Margin Test (TMT) 4-15
Threshold Margin Test Operation 4-15
Enhanced Transtelephonic Monitoring 4-17
For Further Information 4-17
5. Special Therapy Options
Mode Switch and Diagnostic 5-2
Overview 5-2
How Atrial Tachyarrhythmia is Defined 5-3
How Atrial Tachyarrhythmia is Detected 5-3
Switching to Non-Atrial Tracking Mode 5-3
Switching Back to Atrial Tracking Mode 5-5
Mode Switching Interruption 5-5
Programming Restrictions 5-5
Recording Mode Switch Episode Data 5-6
Non-Competitive Atrial Pacing 5-7
Overview 5-7
How NCAP Affects Atrial Timing 5-7
How NCAP Affects Ventricular Timing 5-8
NCAP Availability 5-9
For Further Information 5-9
PMT Intervention 5-10
Overview 5-10
How the Pacemaker Defines PMT 5-10
PMT Therapy Intervention 5-10
Automatic Therapy Suspension 5-11
Interactions with Other Features 5-12
viii
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Patient Intervention for PMT 5-12
For Further Information 5-12
PVC Response 5-13
Overview 5-13
How the Pacemaker Defines a PVC 5-13
Extending PVARP 5-14
Interaction with Other Features 5-14
PVCs Automatically Counted 5-15
For Further Information 5-15
Ventricular Safety Pacing 5-16
Overview 5-16
How VSP Operates 5-17
Sleep Function 5-18
Overview 5-18
How the Sleep Function Works 5-18
Interrupting the Sleep Function 5-19
Programming Considerations 5-19
Evaluating Sleep Function Operation 5-19
Single Chamber Hysteresis 5-20
Overview 5-20
How Hysteresis Works 5-20
Programming Considerations 5-21
Interactions with Sleep Function 5-21
Ta b l e of C on te n ts
6. Telemetry Data
Establishing Telemetry 6-2
For Further Information 6-2
Parameter Summary 6-3
Overview 6-3
Parameters Reported 6-3
Possible Variation from Programmed Values 6-4
For Further Information 6-4
Patient Information 6-5
Overview 6-5
Parameters Reported 6-5
Battery and Lead Information 6-6
Overview 6-6
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
ix
Ta b le of Co nt en ts
Telemetered Data 6-6
Conditions and Variance in Measurements 6-7
Chronic Lead Impedance Trend 6-7
For Further Information 6-7
Marker Channel Telemetry 6-8
Overview 6-8
Standard Marker Channel Telemetry 6-8
Intracardiac Electrograms 6-9
Overview 6-9
Intracardiac Electrogram Recording 6-10
Uses for the Intracardiac Electrogram 6-11
For Further Information 6-11
Extended Telemetry 6-12
Overview 6-12
Additional Battery Drain 6-12
7. Miscellaneous Operations
Magnet Mode Operation 7-2
Overview 7-2
Magnet Mode Operation 7-2
Threshold Margin Test 7-3
Transtelephonic Monitor Feature 7-3
Special Operation with Extended Telemetry 7-4
For Further Information 7-4
Temporary Programming 7-5
Overview 7-5
Temporarily Programmable Parameters 7-5
Temporary Refractory Period Settings 7-6
For Further Information 7-6
Electrical Reset 7-7
Overview 7-7
Reset Parameter Values 7-7
Elective Replacement Indicator (ERI) 7-8
Overview 7-8
Basis for Setting ERI 7-8
ERI Verification 7-8
Emergency Pacing 7-9
x
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Ta b l e of C on te n ts
8. Diagnostics
Introduction to Diagnostics 8-2
Automatic Diagnostics 8-3
Clinician-Selected Diagnostics 8-4
Battery / Lead Data 8-5
Suspending and Clearing of Data 8-5
For Further Information 8-6
Atrial and Ventricular Rate Histograms 8-7
Automatic Data Collection 8-8
Retrieving the Atrial and Ventricular Rate Histograms 8-9
For Further Information 8-9
AV Conduction Histograms 8-10
Automatic Data Collection 8-11
Retrieving the AV Conduction Histogram 8-12
For Further Information 8-12
Atrial and Ventricular High Rate Diagnostics 8-13
Automatic Data Collection 8-13
Programmable Data Collection 8-14
How High Rate Episodes Are Defined 8-15
Limitation to Detect High Rate Atrial Events 8-16
Retrieving Atrial and Ventricular
High Rate Diagnostics 8-17
For Further Information 8-17
Custom Rate Trend (Rate Versus Time) 8-18
Data Collection 8-18
Programmable Data Collection Options 8-19
Retrieving Custom Rate Trend 8-19
For Further Information 8-19
9. Troubleshooting the Pacing System
Troubleshooting Strategy 9-2
Overview 9-2
Troubleshooting Electrical Problems 9-3
Defining Electrical Problems 9-3
Identifying the Cause of an Electrical Problem 9-3
Correcting an Electrical Problem 9-5
Troubleshooting Hemodynamic Problems 9-6
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
xi
Ta b le of Co nt en ts
Defining a Hemodynamic Problem 9-6
Identifying the Cause of a Hemodynamic Problem 9-6
Correcting a Hemodynamic Problem 9-8
Handling, Storage, and Resterilization 9-9
Handling and Storage 9-9
Resterilization 9-9
Pacemaker Longevity 9-10
Background 9-10
Elective Replacement Indicator 9-10
Time from ERI to Cessation of Pacing 9-10
Distinguishing ERI from Electrical Reset 9-11
For Further Information 9-11
Replacing the Pacemaker 9-12
For Further Information 9-12
Patient Information and Service 9-13
Patient Registration Information 9-13
Establishing a Patient Record 9-13
Assistance Information 9-14
For Further Information 9-14
xii
A. Pacemaker Description
Model Number Designator A-2
Radiopaque Codes A-3
Physical Dimensions A-4
Connector Dimensions A-5
B. Preset Parameter Settings
Shipping Settings B-2
Nominal Settings B-6
Electrical Reset Settings B-9
Emergency Settings B-12
C. Longevity Projections
Estimated Longevity Projections C-2
Estimated Longevity Projections for Dual
Chamber Series Pacemakers C-3
Estimated Longevity Projections for Single
Chamber Series Pacemakers C-4
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Post ERI Longevity Projections C-5
ERI Longevity Projections For Single Chamber Series
Pacemakers C-5
ERI Longevity Projections For Dual Chamber Series
Pacemakers C-6
Elective Replacement Indicator (ERI) C-7
Battery Specifications C-8
D. Telemetry and Diagnostic Values
Magnet Mode Operations D-2
Telemetry Functions D-3
Marker Channel and Extended Telemetry D-3
Electrograms (EGM) D-3
Battery and Lead Information D-4
Patient Data D-5
Automatic Diagnostics D-6
Clinician-Selectable Diagnostics D-8
E. Parameter Values and Restrictions
Programmable Modes and Parameters E-2
Temporary Parameters E-11
Timing Reference E-13
Dual Chamber Timing Summary E-17
Ta b l e of C on te n ts
F. Warnings and Precautions, and EMI
Special Notice F-2
Warnings F-4
Programming and Pacemaker Operation F-4
Pacemaker Dependent Patients F-4
Precautions F-6
Programming and Pacemaker Operation F-6
Rate Increases F-8
Unipolar Sensing F-8
Implantable Defibrillator F-9
Potential Complications F-10
Potential Events F-12
Hospital or Medical Environment Interference F-13
Therapeutic Diathermy F-13
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
xiii
Ta b le of Co nt en ts
Magnetic Resonance Imaging F-13
Electrosurgical Cautery F-13
External Defibrillation F-15
Diagnostic X-ray and Fluoroscopic Radiation F-15
Lithotripsy F-15
Radiofrequency Ablation F-16
Home and Job Environment Interference F-17
High Voltage Power Transmission Lines F-17
Communication Equipment F-17
Commercial Electrical Equipment F-17
Home Appliances F-17
Electronic Article Surveillance (EAS) F-18
Cellular Phones F-18
G. Glossary
H. Index
xiv
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Understanding
Pacemaker Operation
Chapters 1 - 9 provide detailed
information about the operation of
the Sigma 300/200/100 Series
pacemakers.
Pacing Modes
Rate Response
Pacemaker Timing
Lead/Cardiac Tissue Interface
Special Therapy Options
Telemetry Data
Miscellaneous Operations
Diagnostics
Troubleshooting The
Pacing System
Pacing Modes
This chapter provides information about the modes
available with the pacemaker.
1
1
Introduction
Mode Selection
Decision Tree:
Mode Pertinency Tables
Indications and Usage
Contraindications
DDDR Mode
DDD Mode
DDIR Mode
DDI Mode
DVIR Mode
DVI Mode
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
1-2
1-4
1-9
1-10
1-11
1-12
1-13
1-14
1-15
1-7
1-5
VDD Mode
AAIR / ADIR Modes
AAI / ADI Modes
VVIR / VDIR Modes
VVI / VDI Modes
AAT / VVT Modes
DOOR / AOOR / VOOR
Modes
DOO / AOO / VOO Modes
ODO / OAO / OVO Modes
1-16
1-17
1-18
1-19
1-20
1-21
1-22
1-23
1-24
1-1
Pacing Modes
Introduction
Introduction
Pacing Mode Selection
This chapter provides an introduction to pacemaker modes as an
aid to pacing mode selection. The chapter is organized as follows:
Mode Selection Decision Tree – This decision tree, based on the
1991 ACC/AHA guidelines for pacemaker implantation,
1
provides a simple means of identifying pacing modes appropriate
for given indications.
Mode Pertinency Tables – These tables show which features and
parameters apply to each commonly used pacing mode.
Indications and Contraindications – These sections provide the
indications, usage, and contraindications for using the
Medtronic.Sigma pacemakers.
Mode Descriptions – These descriptions indicate the modes
available with the pacemaker and how they operate.
NBG Pacing Codes
The pacemaker modes are defined in the NBG code.2 Each fiveletter 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. Figure 1-1
describes the first four letters of the NBG code.
1-2
1
Dreifus LS, Fisch C, Griffin JC, et al. Guidelines for implantation of cardiac
pacemakers and antiarrhythmia devices. A report of the American College of
Cardiology/American Heart Association Task Force on Assessment of
Diagnostic and Therapeutic Cardiovascular Procedures (Committee on
Pacemaker Implantation).
18: 1-13.
2
Bernstein A., et al., “The NASPE/BPEG Pacemaker Code,” PACE, 10(4), Jul-Aug
1987. (“NBG” stands for The North American Society of Pacing and
Electrophysiology [NASPE] and the British Pacing and Electrophysiology
Group [BPEG] Generic. NBG’s five-letter code supersedes the ICHD Code.
Journal of the American College of Cardiology.
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
1991;
Pacing Modes
Introduction
CHAMBER PACED
V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None
CHAMBER SENSED
V = Ventricle
A = Atrium
D = Dual Chamber
S = Single Chamber
O = None
Figure 1-1.
DDDR
NBG Pacing Codes
MODE OF RESPONSE
T = Triggered
I = Inhibited
D = Double (Both)
O = None
PROGRAMMABLE/
RATE RESPONSE
P = Programmable
M = Multiprogrammable
C = Communicating
R = Rate Responsive
O = None
Further Information
The mode descriptions in this chapter provide only a basic
overview of each mode. For further details on the rate response,
timing and therapy capabilities refer to “Rate Response” on
page 2-1, “Pacemaker Timing” on page 3-1, and “Special Therapy
Options” on page 5-1, respectively.
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
1-3
Pacing Modes
Mode Selection Decision Tree:
Mode Selection Decision Tree:
Figure 1-2 shows a basic decision tree used to select the pacing mode. In the shaded boxes the
preferred mode(s) is listed and the alternate mode(s) appears below the dashed line.
Symptomatic
Bradycardia
No
Complete or
transient AV
block
s
S
I
n
A
o
i
o
n
p
d
e
q
u
d
r
e
s
e
e
a
t
?
1st, 2nd, or
3rd degree
normal
f
u
n
c
t
a
No No
1st, 2nd, or
3rd degree
block, sick
sinus
syndrome
DDDR DDDR
conduction
e
n
y
l
t
block,
sinus
DDD
VDD
Is AV
intact?
Ye s
conduction,
No
tachyarrhythmias
Ye s
Normal AV
conduction
Is SA node
function presently
adequate?
Normal AV
sick sinus
syndrome
(no SVTs)
AAIR
DDDR
Are atrial
present?
Normal AV
conduction
DDD
Ye s
Ye s N o
Is AF chronic?
paroxysmal SVT
Is AV conduction
No YesYe s
Sick sinus
syndrome,
chronic AF
VVIR
VVI
Sick sinus
syndrome,
paroxysmal
SVT, 3rd
degree
block
DDDR with
mode
switching
Sick sinus
syndrome
intact?
Sick sinus
syndrome,
paroxysmal
SVT, 1st, 2nd
degree block
or normal
conduction
DDIR with
automatic
PVARP
1-4
Figure 1-2.
Mode Selection Tree
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Pacing Modes
Part# 197839001 Rev B
Mode Pertinency Tables
✓
✓✓ ✓✓
–
✓✓
✓✓✓ ✓✓
✓✓✓✓ ✓
Mode Pertinency Tables
Table 1-1 and Table 1-2 show which pacing parameters and features apply to each pacing mode as indicated by black
check marks. Dashes indicate parameters that are programmable when mode switch is active. These parameters are
programmable. Asynchronous modes are not shown in these tables.
Pacing Parameters Available for Each Mode
✓✓
Table 1-1.
–
✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
✓✓ ✓
✓
✓✓✓✓✓✓
✓✓ ✓
✓✓✓✓✓
✓✓✓✓ ✓
a
DDDR DDD DDIR DDI DVIR DVI VDD VVIR VDIR VVI VDI VVT AAIR ADIR AAI ADI AAT
Pacing Parameter
✓✓✓✓ ✓ ✓ ✓
Lower Rate
Upper Tracking Rate
Upper Sensor Rate
Paced AV Interval
Sensed AV Interval
Rate Adaptive AV
PVARP
(including Auto PVARP)
PVAB
Atrial Refractory Period
✓✓✓✓✓✓✓✓✓✓✓✓
✓✓✓✓✓✓
Atrial Blanking
Ventricular Refractory
Per iod
Ventricular Blanking
(after AP)
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
See Chapter 3 for descriptions of these timing parameters.
a
1-5
Pacing Modes
Part# 197839001 Rev B
Mode Pertinency Tables
✓✓
✓✓✓ ✓✓ ✓
✓✓ ✓✓
✓✓ ✓✓
✓✓ ✓✓
✓✓ ✓✓
–
–
–
–
Features Available for Each Mode
Table 1-2.
✓✓ ✓
RhythmaMode Switch
✓✓
Non-Competitive Atrial
Pacing
Managing Ventricular
DDDR DDD DDIR DDI DVIR DVI VDD VVIR VDIR VVI VDI VVT AAIR ADIR AAI ADI AAT
Managing Atrial
1-6
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
✓✓ ✓
RhythmaPMT Intervention
✓✓✓✓ ✓
✓✓✓✓✓✓
PVC Response
Ventricular Safety Pacing
Special Pacing
OperationsaSingle Chamber
✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
Hysteresis
Sleep Function
Rate ResponsebRate Response Curve
✓✓
✓✓
✓✓
–
–
✓
✓
Activity Threshold
✓✓
–
–
✓
✓
Activity Acceleration
See Chapter 5 for operational descriptions of special therapy options.bSee Chapter 2 for operational descriptions of rate response features.
Activity Deceleration
a
Indications and Usage
Medtronic.Sigma pacemakers are indicated for the following:
■
Rate adaptive pacing in patients who may benefit from
increased pacing rates concurrent with increases in activity.
■
Accepted patient conditions warranting chronic cardiac
pacing which include:
– Symptomatic paroxysmal or permanent second or third-
degree AV block.
– Symptomatic bilateral bundle branch block.
– Symptomatic paroxysmal or transient sinus node
dysfunctions with or without associated AV conduction
disorders.
– Bradycardia-tachycardia syndrome to prevent
symptomatic bradycardia or some forms of symptomatic
tachyarrhythmias.
Pacing Modes
Indications and Usage
Medtronic.Sigma 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.Sigma Series pacemakers are also indicated for VDD
modes in patients having adequate atrial rates and the following
indications:
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
1-7
Pacing Modes
Indications and Usage
■
Requirements for ventricular pacing when adequate atrial
rates and adequate intracavitary atrial complexes are present.
This includes the presence of complete AV block when atrial
contribution is needed for hemodynamic benefit or when
pacemaker syndrome has existed or is anticipated.
■
Normal sinus rhythm and normal AV conduction in patients
needing ventricular pacing intermittently.
1-8
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Contraindications
Medtronic.Sigma pacemakers are contraindicated for the
following applications:
■
Dual chamber atrial pacing in patients with chronic refractory
atrial tachyarrhythmias.
■
Asynchronous pacing in the presence (or likelihood) of
competitive paced and intrinsic rhythms.
■
Unipolar pacing for patients with an implanted cardioverterdefibrillator (ICD) because it may cause unwanted delivery or
inhibition of ICD therapy.
Pacing Modes
Contraindications
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
1-9
Pacing Modes
DDDR Mode
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)1and
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) is a pacemaker-defined PVC, and starts a new VA
interval.
1-10
Sensor-indicated
Interval
A
P
V
P
Parameters:
Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms PVARP = 280 ms
Sensor-indicated Rate = 90 ppm (667 ms) SAV Interval = 170 ms
A
P
V
S
Figure 1-3.
1
Example of DDDR Mode Operation
The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
Sensor-indicated
Interval
A
S
V
S
A
P
value.
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
A
S
V
P
V
P
200 ms
DDD Mode
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).
■
A ventricular paced event may track atrial sensed events up
to the programmed Upper Tracking Rate.
■
A ventricular nonrefractory sensed event in the VA interval
1
that is not preceded by an atrial sense (AS or AR) is a
pacemaker-defined PVC, and starts a new VA interval.
Lower Rate Interval
A
P
V
P
Para meters:
Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms
Figure 1-4.
A
P
V
S
SAV Interval = 170 ms
Example of DDD Mode Operation
1
The Total Atrial Refractory Period (TARP) may limit the tracking rate to a lesser
value.
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Lower Rate Interval
A
S
V
S
200 ms
A
P
1-11
Pacing Modes
DDIR Mode
DDIR Mode
The DDIR mode provides dual chamber, sensor-driven,
atrioventricular (AV) sequential pacing for heart rate variation
without atrial tracking.
■
Atrial pacing occurs at the sensor-indicated rate, with
ventricular pacing at the end of the PAV interval unless
inhibited.
■
An atrial event sensed outside the PVARP will inhibit a
scheduled atrial stimulus but will not start an AV interval.
That is, ventricular paced events after such sensed atrial
events occur at the sensor-indicated rate. The following
ventriculoatrial (VA) interval may be extended slightly to
avoid an increasing atrial paced rate.
■
A ventricular nonrefractory sensed event in the VA interval
starts a new VA interval.
Sensor-indicated
Interval
A
P
V
P
Para meters:
Lower Rate = 60 ppm (1000 ms) PAV Interval = 200 ms
Sensor-indicated Rate = 90 ppm (667 ms)
A
P
Figure 1-5.
1-12
Medtronic.Sigma 300/200/100 Series Pacemaker Reference Guide
Sensor-indicated
Interval
V
P
Example of DDIR Mode Operation
Sensor-indicated
VA Interval
A
S
V
P
Sensor-indicated
A
A
P
P
V
P
Interval
A
P
200 ms
Loading...