Medtronic SVDD303 Programming Guide

SIGMA

™

300/200/100Software 1.1

Vision™Software Model 9963

Pacemaker Programming Guide

Medtronic.Sigma 300/200/100 Series
Pacemaker Programming Guide

A guide to using the
9790 Series
programmer for
Medtronic.Sigma
300/200/100 Series
pacemakers



Refer to the Medtronic.Sigma
300/200/100 Series Pacemaker
Reference Guide for information
on the pacemakers.

The following terms are trademarks of Medtronic, Inc.

Marker Channel, Medtronic, Medtronic.Sigma, Medtronic.Vision, Auto-PVARP, Quick Look, Quick Secure, Sigma, Significant Events,
and Vision.

Created by Cardiovascular Technical Communications



Medtronic, Inc. 1999

All Rights Reserved

How to Use This Guide

Information is Contained in Two Guides

Product information about Medtronic.Sigma Series software and
pacemakers is presented in two separate guides.

The Pacemaker Programming Guide (PPG) accompanies
Medtronic.Sigma 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.Sigma Series
pacemakers.

Note:

Refer to the technical manual supplied with the pacemaker

for information about which features are supported by a
Medtronic.Sigma pacemaker.

About this Guide

How to Use 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 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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

iii

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.

iv

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Table of Contents

1. Programmer Basics

Table of Contents

How to Use This Guide iii

Information is Contained in Two Guides iii
About this Guide iii
About the Pacemaker Reference Guide iv

Setting Up the 9790 Programmer 1-2

Programmer Setup Check List 1-2

Connecting an External Monitor/Recorder 1-4
Connecting the Programmer to Skin Electrodes 1-6
Positioning and Using the Programming Head 1-7

When to Position the Programming Head 1-7

Effect of the Programming Head on Pacemaker

Operation 1-9

Observing Magnet Mode Operation 1-10

Alternative PROGRAM and

INTERROGATE Buttons 1-10

Automatic Interrogation at the

Start of a Session 1-11
About the Display Screen 1-12

Features and Conventions of the Display Screen 1-12

Using the On-Screen Keyboard 1-18

Audible Tones 1-20
Programming Emergency Parameters 1-21
Recording an ECG Strip 1-22

About the ECG Recording 1-23
Using the On-line Help Feature 1-25

Entering the Help System 1-26

Using the Links in Help 1-27

Exiting the Help System 1-28

Searching for Information in Help 1-28

2. Conducting a Patient Session

Important Reminders About
Medtronic.Sigma Pacemakers 2-2

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

v

Table of Contents

New Programmer Features 2-2
Automated Monitoring and Collection of Patient

Diagnostic Data 2-3

Starting a Patient Session 2-4

The Starting Point of a Patient Session 2-4
The Tool Palette Between Sessions 2-5
About Automatic Interrogation 2-6
Procedure for Starting a Patient Session 2-7

Proceeding with Task Selection 2-10

The First Task Screen 2-10

Selecting Another Task or Function 2-10
Interrogating the Pacemaker 2-12
Taking a Quick Look at Pacemaker Operation 2-13

The Quick Look Screen 2-13

Viewing Data on the Quick Look Screen 2-14
Viewing Battery and Lead Measurements 2-17

Battery and Lead Measurements Screen 2-17

Pacemaker Battery Measurements 2-18

Lead System Measurements 2-19

Updating the Displayed Data 2-20
Checking the Present Parameter Settings 2-21

The Therapy Parameters Screen 2-21
Viewing Patient Information Stored in the Pacemaker 2-22
Recording an ECG Strip of Magnet Operation 2-23

The Magnet Test Setup Screen 2-23

Procedure for Conducting a Magnet Test 2-24

Collecting an ECG Strip 2-25

About the Collected ECG Strips 2-25
Checking the Patient’s Underlying Rhythm 2-26

The Underlying Rhythm Test Screen 2-26

Procedure for Checking the Patient’s Underlying

Rhythm 2-27

Collected ECG Strips 2-29
Printing Data Reports 2-30

Using the Print Button 2-30

Printing Additional Reports 2-32

Using the Continuous Print “Trace” Mode 2-33

vi

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Table of Contents

Printing Reports Held in the Print Queue 2-33

Ending a Patient Session 2-35

Saving a Session on Diskette 2-37
Options for Clearing Pacemaker Data 2-39

3. Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms 3-2

Expanding the Live Rhythm Monitor Window 3-3
About the Waveform Traces 3-4

Adjusting and Configuring the Display 3-7

Adjusting Waveform Size 3-9
Selecting a Trace Source 3-9
Color Coding the Waveform Traces 3-11
Selecting a Different Sweep Speed 3-12
Programming a Different Telemetry Mode 3-13
Selecting the ECG Filter 3-14
Enabling Artifact Enhancement 3-15
Arranging the Waveforms 3-15

Freezing and Analyzing a Waveform Strip 3-18

Using the On-Screen Calipers 3-19
Adjusting the Frozen Traces 3-21
Displaying a Marker Channel Diagram 3-22
Saving a Frozen Waveform Strip 3-27
Printing the Frozen Strip 3-27

Recalling and Viewing Waveform Strips 3-28

4. Collecting Diagnostic Data

About Data Collected by the Pacemaker 4-2

Types of Collected Data 4-2
Important Points about Using the Data Function 4-4

Displaying Collected Data 4-7

About the Collected Data - Graphs and Tables Screen 4-7
Automatically Collected Data 4-8

Choosing Clinician-Selected Detailed Data Collection 4-17

Off 4-17
Custom Rate Trend (Rate versus Time) 4-17
High Rate Detail (Atrial or Ventricular) 4-21

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

vii

Table of Contents

Programming Data Collection 4-23

Setup Options 4-23
Clearing Data From the Pacemaker 4-26

5. Evaluating Parameter Settings

Measuring Stimulation Thresholds 5-2

The Threshold Test Setup Screen 5-2

Setting Up a Threshold Measurement Test 5-3

Executing a Strength-Duration Threshold Test 5-6

Executing an Auto Decrement (Amplitude or Pulse Width)

Threshold Test 5-13

Conducting a Manual Threshold Test 5-15
Determining a Sensitivity Setting 5-18

The Sensing Test Setup Screen 5-18

Checking the Patient’s Intrinsic Rate 5-19

Executing an Automatic Sensing Test 5-20

Automatic Sensing Test Results 5-23

Executing a Manual Sensing Test 5-24
Using Temporary Programming to Evaluate

Parameter Settings 5-27

The Temporary Test Setup Screen 5-27

Procedure for Conducting a

Temporary Test 5-28

Programming a High Temporary Pacing Rate 5-30

viii

6. Programming Pacemaker Parameters

Programming Parameters 6-2

Selecting the Therapy Parameters Screen 6-2

Programming, Printing, and Clearing Parameter

Values 6-3

Parameter Restrictions 6-4

How to Program Parameters 6-6

How to Program Subordinate Parameters 6-8
Saving/Retrieving a Set of Parameter Values 6-13

Saving a Set of Parameter Values 6-14

Retrieving a Saved or Nominal Set of Parameter

Values 6-15

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Table of Contents

7. Rate Response Setup

Using Exercise Test to Verify Rate Response 7-2

Overview of the Exercise Test 7-2
Selecting the Exercise Test 7-3
Starting the Exercise Test 7-3
Evaluating the Results of the Exercise Test 7-5
Adjusting Rate Response 7-6

8. Miscellaneous Setup Options - Programmer and Pacemaker

Selecting System Operating Preferences 8-2
Adjusting Programmer Time and Date 8-4
Improving the Detection of Pacing Artifacts 8-5
Checking the Software Version 8-6
Starting the Demonstrations Option 8-7
Programming Patient Data into Pacemaker Memory 8-9
Connecting an External Printer 8-11

Printer Compatibility 8-11
Materials You Will Need 8-13
Connecting the Printer 8-14

A. Appendix: Parameter Values and Restrictions

Programmable Modes and Parameters A-2
Automatic Diagnostics A-13
Clinician-Selectable Diagnostics A-15
Programming Restrictions A-18

I. Index

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

ix

Table of Contents

x

Medtronic.Sigma 300/200/100 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.

1

Setting Up the 9790
Programmer

1-2

1

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

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Connecting the Programmer to
Skin Electrodes

Positioning and Using the
Programming Head

About the Display Screen

Programming Emergency
Parameters

Recording an ECG Strip

Using the On-line Help
Feature

1-25

1-6

1-7

1-12

1-21

1-22

1-1

Programmer Basics

Setting Up the 9790 Programmer

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

disconnect the stylus.

1-2

Note:

Programming Head

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

(Stylus)

Do not

ECG Cable

Figure 1-1.

The Programmer

Programmer Basics

Setting Up the 9790 Programmer

Figure 1-2.

Figure 1-3.

Power Cord

Programming Head

Figure 1-4.

ECG Cable

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-3

Programmer Basics

Setting Up the 9790 Programmer

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.

Calibrate Button

w

Warning:

Peripheral equipment connected to the 9790
programmer must be certified according to the applicable IEC
standards (IEC 950 for data processing equipment and IEC 601-1
for medical equipment). The system formed by connecting
peripheral equipment to the 9790 programmer must comply with
IEC 601-1-1 for medical electrical systems. It is the responsibility
of the person who connects the peripheral equipment to comply
with IEC standards. It is the responsibility of the user to keep
peripheral equipment that is certified to IEC 950 at least two
meters away from the patient. Contact the peripheral equipment
manufacturer for information about IEC certification.

Connector Type:
Output Signal:

(switchable)

ABCD

±

1V

BNC

±1 Volt or ±5mV

Signal Output Adaptor

±

5mV

Connecting Optional Adaptor to the Analog

Output Port on the Programmer.

Figure 1-5.

1-4

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Adaptor Output Signals

(after model selection):

- Patient’s ECG (upper most ECG

A

on display)

- Telemetered EGM (upper most EGM

B

on display)

- Telemetered EGM (other EGM

C

if programmed)

- Marker Channel Telemetry

D

Connecting the Optional External Adaptor

Programmer Basics

Setting Up the 9790 Programmer

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.

5 mV

1 mV

Figure 1-7.

Marker Channel Signals

EGM Calibration Signals

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-5

Programmer Basics

Connecting the Programmer to Skin Electrodes

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.

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

Connecting the Programmer to Skin Electrodes

LA (L)

C (C)

LL (F)

( ) = IEC Coding

1-6

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Programmer Basics

Positioning and Using the Programming Head

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.Sigma 300/200/100 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.

1-8

Figure 1-9.

2.

Position the programming head so that the amber light in

Positioning the Programming Head

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.

Light Array

Figure 1-10.

Green

Amber/Green

Light Array Indicator

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

The present pacing mode
shows in the status bar at

the top of the screen.

Programmer Basics

Positioning and Using the Programming Head

Effect of the Programming Head on
Pacemaker Operation

If model selection and application (software) loading are
complete, positioning the programming head over a
Medtronic.Sigma 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.Sigma 300/200/100 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,
positioning the programming head over a Medtronic.Sigma
pacemaker will result in magnet mode operation.

Alternative

INTERROGATE

To initiate the Program and Interrogate commands, you have the
option to use the on-screen
the Program
head.

[Interrogate]

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.

PROGRAM

Buttons

[P] and Interrogate [I] buttons on the programming

Button

Figure 1-11.

Alternative Program and Interrogate

Programming Head Buttons

and

[Program] and [Interrogate] buttons or

Light Array

[Program]

Button

1-10

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Programmer Basics

Positioning and Using the Programming Head

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 all 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 all the data stored in the pacemaker,
including diagnostic data, the process may take a number of
seconds.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-11

Programmer Basics

About the Display Screen

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

1-12

Task area

Active Field Button Tool PaletteCommand Bar

Figure 1-12.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Main Elements of a Display Screen Example

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 8-2.

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

Live Rhythm Monitor

Window

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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 upper-right 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.

1-13

Programmer Basics

About the Display Screen

The waveform trace or traces that show in this window depend on
the selected task screen and how traces have been arranged in the
full-screen view. Refer to “Viewing the ECG and Other Rhythm
Waveforms” on page 3-2 for information about the live rhythm
monitor.

1-14

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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 1-21, “Interrogating the
Pacemaker” on page 2-12, and “Ending a Patient Session” on
page 2-35.

Active fields show as

unshaded areas on

the screen.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Active Fields

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

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.

1-15

Programmer Basics

S

About the Display Screen

electing an active field

opens a menu or window of

alternative options, or in

some cases, an

on-screen keyboard.

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 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 having a less

distinct shaded label are

not presently active.

1-16

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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.

Buttons

Icons

Programmer Basics

About the Display Screen

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.

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 2-2 on page 2-11 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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-17

Programmer Basics

About the Display Screen

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

Cursor

Position Keys

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

1-18

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Programmer Basics

About the Display Screen

Table 1-1.

Button or Feature Function

Text Entry Window

(See Figure 1-13)

Space Bar

(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.

Locks all characters into upper case until the

key is selected again. While the

[Caps]

key is down, the
operate as 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.

Keyboard Buttons

and

[Shift]

key.

[Alt]

[Shift Lock]

[Caps]

keys

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-19

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.

1-20

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Programming Emergency Parameters

Emergency

+

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.

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

Red Button

Emergency Button

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.

Emergency values are programmed settings that provide higher­than-normal energy output. It is not intended that the pacemaker be
left at these settings. Refer to Sigma Pacemaker Reference Guide for a
list of Emergency parameters settings for Medtronic.Sigma
pacemakers.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-21

Programmer Basics

Recording an ECG Strip

Recording an ECG Strip

At any time during a patient session, you can initiate a
continuous, real-time ECG recording as described below.

To Start an ECG Recording

♦

➤

Press the desired paper speed button (

12.5 mm/sec

25 mm/sec

12.5 mm/sec

Paper Advance

25 mm/sec or

).

1-22

Figure 1-14.

To Stop the Recording

♦

➤

Press the same paper speed button again.

Before you tear off the ECG strip, press the
button to advance the strip to a perforation.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

ECG Chart Recorder Control Buttons

[Paper Advance]

Annotations

ECG Trace

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.

Marker Telemetry

EGM Telemetry

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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.

1-23

Programmer Basics

Recording an ECG Strip

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 3-7). 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. When the telemetry mode is Dual EGM,
atrial and ventricular EGMs appear.

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.

1-24

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Using the On-line Help Feature

The On-line Help system provides summaries on-screen about
many of the features and operations of the programmer. (Refer to
the manuals that apply to the pacemaker for more complete
information.) 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
Table 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.

Programmer Basics

Using the On-line Help Feature

Table 1-2.

Button or Icon What It Does

[Previous]

[Topics]

button Displays the Help window last viewed or closes

button Closes the Help window.

[Close]

button Displays a list of terms discussed in Help. From

[Index]

button Displays a list of all available Help topics. From

Getting Around in the Help System

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.

the Help window first opened.

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

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

1-25

Programmer Basics

Using the On-line Help Feature

Table 1-2.

Button or Icon What It Does

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

Scroll bar Use this if a Help topic extends beyond the

Getting Around in the Help System

a pop-up window that defines the phrase. Select

[Previous]

window size.

to close the pop-up window.

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.

1-26

[Help…]

Title bar for window having

button for

general Help

icon for

[?]

specific Help

specific Help

Figure 1-16.

Entering On-line Help

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Programmer Basics

Using the On-line Help Feature

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

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
go backward through the series of topics one at a time.

Pop-up definition window Link to definition window Scroll Bar

[Previous]) to close it.

[Previous] button to

Topic window

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Help push buttons Link to another

Figure 1-17.

Typical Help Windows (Topic and Definition)

Help topic

1-27

Programmer Basics

Using the On-line Help Feature

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 right­hand column. You can view:

1-28

– 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 right-hand 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.Sigma 300/200/100 Series Pacemaker Programming Guide

Programmer Basics

Using the On-line Help Feature

Unexpanded

Help categories

To open a

Help topic,

select its

link icon

To expand a new Help category,

select its name

Figure 1-18.

Topics List for Help

Expansion of a Help category

To open a Help topic,

select the link icon for its

Index listing.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Figure 1-19.

Help Index

1-29

Programmer Basics

Using the On-line Help Feature

1-30

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a
Patient Session

This chapter describes how to begin a patient session
and how to execute some of the typical tasks you
might use to evaluate operation of the patient’s pacing
system. Information about printing, saving, and
transferring session data is also included.

Important Reminders About
Medtronic.Sigma
Pacemakers

Starting a Patient Session

Proceeding with Task
Selection

Interrogating the
Pacemaker

Taking a Quick Look at
Pacemaker Operation

Viewing Battery and Lead
Measurements

2-2

2-4

2-10

2-12

2-13

2-17

2

Checking the Present Parameter
Settings

Viewing Patient Information
Stored in the Pacemaker

Recording an ECG Strip of
Magnet Operation

Checking the Patient’s
Underlying Rhythm

Printing Data Reports

Ending a Patient Session

2-21

2

2-22

2-23

2-26

2-30

2-35

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-1

Conducting a Patient Session

Important Reminders About Medtronic.Sigma Pacemakers

Important Reminders About
Medtronic.Sigma Pacemakers

This section lists some of the important features of the
Medtronic.Sigma pacing system.

■

New features of the programmer software

■

Automated monitoring and collection of diagnostic data by
the pacemaker

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.

2-2

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Important Reminders About Medtronic.Sigma Pacemakers

Automated Monitoring and Collection of
Patient Diagnostic Data

Diagnostic monitors collect data automatically in the background:

■

Rate and AV Conduction Histograms

■

Atrial High Rate Episodes (including Mode Switch Episodes)
and Ventricular High Rate Episodes

■

Chronic Lead Impedance Trend

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-3

Conducting a Patient Session

Starting a Patient Session

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 2-35.

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 2-7. 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.

2-4

Figure 2-1.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Select Model Screen

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 Medtronic.Sigma
pacemakers. This button allows you to set up Site Nominals if
you select a pacemaker with this feature.

The Tool Palette Between Sessions

Table 2-1.

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

Freezes a segment of the live rhythm display.

Note:

saved) between patient sessions. Markers and EGM traces
are not present between patient sessions.

Accesses the rhythm strips saved during a patient session.

Note:

sessions.

Opens a window of options for adjusting the live rhythm
display.

Note:

patient session.

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

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

Tool Palette Between Patient Sessions

page 3-18

A frozen strip can be viewed and printed (but not

page 3-28

No saved strips are available between patient

page 3-7

Additional adjustment options are present during a

page 2-4

page 2-33

page 8-2
page 8-4
page 8-5
page 8-6
page 8-7

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-5

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
Session” on page 2-7), the programmer automatically attempts to
interrogate the patient’s pacemaker to retrieve all the data that
might be needed during the session.

Note:

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:

button, you cannot proceed with session activities until the
interrogation is 100% complete.

[Start] button (see “Procedure for Starting a Patient

To take advantage of this automatic interrogation, you

Except for use of the

[Emergency] button or the [Stop]

2-6

You can choose to stop interrogation and continue with other
activities (not using the automatic interrogation feature). To do
this, select the
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 2-12).

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Stop] button or lift the programming head before

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

You must acknowledge the message before proceeding with other
activities. You can attempt to clear an ERI or POR message 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 6-11.

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 “Medtronic.Sigma Series” selection displayed
on the screen and then selecting the

Note:

To review software screens without interrogating a

[Start] button.

pacemaker, use the demonstrations option (See “Starting the
Demonstrations Option” on page 8-7). Starting a session without
interrogating a pacemaker provides only a limited number of
screens for review.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-7

Conducting a Patient Session

Starting a Patient Session

To Start a Session Using Auto-Identify

♦

1.

2.

3.

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

– 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 2-35.

Position the programming head over the patient’s pacemaker
and continue to hold it steady.

Select the

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.

[Medtronic] button if it appears on the screen.)

[Auto-Identify] button at the bottom of the screen.

2-8

Refer to “Proceeding with Task Selection” on page 2-10 for
information on selecting the functions or tasks you have planned
for the session.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Categories

Models

[Start]

♦

button

Conducting a Patient Session

Starting a Patient Session

To Start a Session by Selecting the Pacemaker Model

1.

Display the Select Model screen. (Refer to the previous
procedure.)

2.

Select the appropriate category to view pacemaker models.

3.

Select “Medtronic.Sigma Series” from the list of models. (The
specific model number will appear on the status bar at the
top of the display screen during the patient session.)

4.

If you want the programmer to automatically interrogate the
patient’s pacemaker, position the programming head.

5.

Select the

6.

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 the next topic for information on selecting the functions
or tasks you have planned for the session.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Start] button.

2-9

Conducting a Patient Session

Proceeding with Task Selection

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 2-13 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 2-11). 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.

2-10

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Proceeding with Task Selection

Table 2-2.

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

Freezes a segment of the live rhythm display. page 3-18

Accesses the rhythm strips saved since the start of the
session.

Opens a window of options for adjusting the live rhythm
display.

Accesses the available Help topics Chapter 1

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 6-2

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: page 2-22

Tool Palette During a Patient Session

page 3-28

page 3-7

page 2-13
page 4-7
page 2-17
page 4-23

page 2-23
page 2-26
page 5-2
page 7-2
page 5-18
page 5-27

page 2-32
page 2-33

Displays case studies in Demo mode

Note:

Demo diskette is needed for Demo mode. Otherwise, icon is not visible.

page 8-7

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-11

Conducting a Patient Session

Interrogating the Pacemaker

Interrogating the Pacemaker

At the start of the patient session (as described in “Procedure for
Starting a Patient Session” on page 2-7) the programmer performs
an automatic interrogation to retrieve all 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.

Collected data can

be interrogated

only once during a

patient session.

Select the
screen or press the Interrogate
head.

2.

From the window of options, select the type of information
you want to retrieve. You can select more than one option.

[Interrogate] button at the bottom center of the

[I] button on the programming

2-12

The word “(AGAIN)” indicates that a previous interrogation
has already retrieved this data.

3.

Position the programming head and select the
or press the programming head Interrogate

Hold the programming head steady until the interrogation is
100% complete as shown by the status gauge at the bottom of
the screen. The

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Stop] button lets you cancel the interrogation.

[Start] button

[I] button.

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Pacemaker Information on the Quick Look Screen

2-13

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

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.

2-14

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

Ventricular Lead – Data under this heading includes
programmed values for ventricular amplitude, pulse width, and
sensitivity. The measured impedance of the ventricular pacing
lead appears also.

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

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

(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 4-9.

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 4-7 for
information about viewing the data recorded by the various
monitoring functions.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-15

Conducting a Patient Session

Taking a Quick Look at Pacemaker Operation

Table 2-3.

Event Sequence Categories

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

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

Table 2-4.

Significant Event Monitoring Functions

Functions and Criteria Used for Significant Event Reporting

Ventricular High Rate Episodes One or more episodes detected.

Atrial Polarity Switch

a

Lead impedance outside Notify if > and
Notify if < settings.

Ventricular Polarity Switch

a

Lead impedance outside Notify if > and
Notify if < settings.

2-16

Electrical Reset Monitor Occurrence of reset conditions.

ERI Monitor Occurrence of ERI conditions.

Mode Switch Episodes One or more episodes detected

Atrial High Rate Episodes One or more episodes detected.

a

Lead impedance reported if lead polarity is switched

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Viewing Battery and Lead Measurements

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.

Note:

The values measured for the pacemaker battery and the
lead system can change from one measurement to the next.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

The Battery and Lead Measurements Screen

2-17

Conducting a Patient Session

Viewing Battery and Lead Measurements

Pacemaker Battery Measurements

Battery Status – Displays an “OK” or “Replace Pacer” message
based on battery voltage and internal impedance measurements.

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.

2-18

Caution:

estimated remaining longevity. For this decision, use only the
elective replacement indicators or the “Replace Pacer” battery
status message.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Elective replacement should not be based on the

Conducting a Patient Session

Viewing Battery and Lead Measurements

Voltage – The battery voltage obtained during the previous
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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-19

Conducting a Patient Session

Viewing Battery and Lead Measurements

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

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

[Measure Again] button.

2-20

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Checking the Present Parameter Settings

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Figure 2-4.

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” on
page 6-2. Table 6-1 lists subordinate therapy parameters.

The Therapy Parameters Screen

2-21

Conducting a Patient Session

Viewing Patient Information Stored in the Pacemaker

Viewing Patient Information Stored in the
Pacemaker

The Medtronic.Sigma 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 8-9).

2-22

Figure 2-5.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Viewing the Patient Information Screen

Conducting a Patient Session

Recording an ECG Strip of Magnet Operation

Recording an ECG Strip of Magnet Operation

With the Medtronic.Sigma 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 Sigma 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

Temporary

Sensing

Figure 2-6.

Magnet Test Setup Screen

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-23

Conducting a Patient Session

Recording an ECG Strip of Magnet Operation

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.

Procedure for Conducting a Magnet Test

To Conduct a Magnet Test

♦

1.

Display the Magnet Test Setup screen (see Figure 2-6 on
page 2-23).

2.

To start magnet operation, position the programming head
and select the

[START Magnet] button.

2-24

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 you have chosen to collect an ECG strip (see “Collecting an
ECG Strip” on page 2-25), a pop-up window shows progress
during the collection process. Select the
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

A pop-up window gives you the option to collect an ECG
strip of non-magnet operation. Select
magnet strip or select

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[No] to close the window.

[STOP Magnet] button.

[Stop Collection]

[Yes] to collect a non-

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
Non-Magnet 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 3-28 for information about using
the strip viewing feature.

To Print a Magnet Test Report

♦

➤

Select the
printing options. Refer to “Printing the Frozen Strip” on
page 3-27 for information about printing waveform strips
and reports.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Print...] button and then choose the desired

2-25

Conducting a Patient Session

Checking the Patient’s Underlying Rhythm

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.

Magnet

Underlying Rhythm

Threshold

Exercise

Temporary

Sensing

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.

2-26

Figure 2-7.

Underlying Rhythm Test Screen

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Conducting a Patient Session

Checking the Patient’s Underlying Rhythm

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.

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 2-26).

2.

To stop the output of pacing stimuli:

a. Position the programming head.
b. Press and hold the

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

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[INHIBIT Press and Hold] button.

[INHIBIT Press and Hold] button.

2-27

Conducting a Patient Session

Checking the Patient’s Underlying Rhythm

To Check Underlying Rhythm Using Manual Rate

♦

Decrease

1.

Display the Underlying Rhythm Test screen (see Figure 2-7
on page 2-26).

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
rate.

[START Test] button to engage the test mode and

2-28

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

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[STOP and Restore] button.

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 3-28
for information about using the strip viewing feature.

To Print an Underlying Rhythm Test Report

♦

➤

Select the
printing options. Refer to “Printing the Frozen Strip” on
page 3-27 for information about printing waveform strips
and reports.

[Print…] button and then choose the desired

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-29

Conducting a Patient Session

Printing Data Reports

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
button is available when there is a report available to print.
Selecting this
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. Test results may also be available from this
window.

As described in this section, you have the option to print full­page-sized reports. For this, the programmer must be connected
to a compatible external printer. Refer to “Connecting an
External Printer” on page 8-11 for instructions on connecting an
external full-page printer.

[Print…] button allows you to print a formatted data

[Print…]

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
the task screen.

[Print…] button appears near the bottom of

[Print…]

or becomes active when

2-30

button appears

task-related data has

been generated.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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

Conducting a Patient Session

To Print a Report Using the Print Button

♦

1.

Select the

2.

From the Print Options window, make the following
selections:

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

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

[Print…] button.

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

compatible, external printer be connected to the
programmer (see “Connecting an External Printer” on
page 8-11). Programmer Strip will print the report on the
programmer’s strip chart printer.

Printing Data Reports

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 desired print command:

– To print the report immediately, select the

button.

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

select

[Print Later]. See “Printing Reports Held in the Print

Queue” on page 2-33.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Print Now]

2-31

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.

Available Reports

Print Queue

Select

Reports > Available Reports.

2-32

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

4.

From the Print Options window, choose the desired print
options (see “Using the Print Button” on page 2-30).

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Print…] button.

♦

Check Box

Conducting a Patient Session

Printing Data Reports

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. Between sessions the Print Queue window indicates that
only reports from a Kappa pacemaker session are available,
however, reports from the previous Kappa and Sigma sessions are
available.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-33

Conducting a Patient Session

Printing Data Reports

To Print or Delete Reports From the Print Queue

♦

1.

Available Reports

Print Queue

2.

Select

Reports > Print Queue.

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

Caution:

3.

Select the button for the desired action:

–Select

–Select

Once deleted, a report cannot be recovered.

[Print] to print the report.

[Delete] to delete the report from the print queue

Report list.

2-34

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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

♦

Conducting a Patient Session

Ending a Patient Session

1.

Select the
bottom of the screen.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[End Session] button in the command bar at the

2-35

Conducting a Patient Session

Ending a Patient Session

2.

3.

4.

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.

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.

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

[End Now] button.

2-36

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

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.

Table 2-5.

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

Sensing Tests Last results for each test type

Exercise Test Last results for each test type

Automatic Diagnostics

To Save Session Data on a Diskette

♦

1.

Insert a 3.5-inch computer diskette into the disk drive on the

Saved Session Data

Initial interrogated values
Final programmed values

conducted (for each chamber tested)

conducted (for each chamber tested)

conducted
Event Counters

Atrial High Rate Episodes (including
Mode Switch Episodes)
Ventricular High Rate Episodes

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 2-35),
select the

[Save Session] button.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-37

Conducting a Patient Session

Ending a Patient Session

3.

Note:

If the diskette is full, the programmer will notify you
that you need to insert a different diskette.

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.

2-38

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
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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[End Now]

Conducting a Patient Session

Ending a Patient Session

Options for Clearing Pacemaker Data

All diagnostic data collected in the pacemaker except Chronic
Lead Impedance Trend is cleared one hour after you end a patient
session. Collection of new data then starts. You can restart a
session within one hour of ending it and still retrieve the collected
data.

The End Session window provides access to options that let you
make the following changes to the default settings:

■

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.

■

You can choose to program either of the following options
under “Pacemaker Data” instead of the default setting “1 hr
after session end”:

– Selecting the “Now” option causes the pacemaker to clear

the collected data and start collection of new data
immediately when you end the session. New data
collection starts when you lift the programming head.

– Selecting the “Don’t Clear” option allows the pacemaker

to retain the collected diagnostic data and resume data
collection after you end the session.

To Change a Clear Data Setting

♦

1.

From the End Session window (see step 1 on page 2-35),
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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

2-39

Conducting a Patient Session

Ending a Patient Session

Atrial Lead

Trend Field

Ventricular Lead

Trend Field

3.

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.

To change when the pacemaker data is cleared and collection
restarts, complete a, b, and c (if “Now” is selected) below.
Otherwise, skip to step 4.

2-40

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

“Clear Data in Pacemaker and Restart Collection.”

Pacemaker

Data Field

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

“Don’t Clear” option.

c. If you chose the “Now” option, select

pop-up window to proceed.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Continue] from the

Conducting a Patient Session

Ending a Patient Session

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 by selecting the
“Now” option, 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 or if you
performed step 3 and chose the “Don’t Clear” option, proceed
as follows:

a. Select the

options. (Selecting the

[PROGRAM] button to program the selected

[Undo Pending] button cancels the

selected options.

)

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

b. Select the
c. Select the

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Close] button.

[End Now] button to end the patient session.

2-41

Conducting a Patient Session

Ending a Patient Session

2-42

Medtronic.Sigma 300/200/100 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 1-22.

3

Viewing the ECG and Other
Rhythm Waveforms

Adjusting and Configuring the
Display

Freezing and Analyzing a
Waveform Strip

Recalling and Viewing
Waveform Strips

3-7

3-18

3-28

3

3-2

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

3-1

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

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 single­trace 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.

3-2

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.

Medtronic.Sigma 300/200/100 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 3-1.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Live Rhythm Monitor Window - Expanded View

3-3

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.

3-4

Figure 3-2.

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 3-3.

The source of the sixth trace, also shown in Figure 3-3 as
Ventricular EGM, is programmable to any one of four different
telemetry options. (See “Programming a Different Telemetry
Mode” on page 3-13.)

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

1

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.

2

3

4

5

6

Figure 3-3.

Waveform Trace Breakdown

The traces in Figure 3-3 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 3-9 and page 3-15.

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.Sigma 300/200/100 Series Pacemaker Programming Guide

3-5

Viewing the Patient’s ECG and EGM Traces

Viewing the ECG and Other Rhythm Waveforms

Table 3-1.

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.

a

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

- Atrial pace

AP

- Atrial sense

AS

- Atrial sense during refractory

AR

- Ventricular pace

VP

- Ventricular sense

VS

- Ventricular sense during refractory

VR

Other Markers

- Triggered pace (AAT or VVT pacing mode)

TP

- Mode Switch episode (marks the beginning and end)

MS

- Error marker (indicates a marker signal that could not be decoded)

ER

Marker Intervals

a

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.

Waveform Trace Information

Single Chamber Models

-Pace

P

-Sense

S

- Sense during refractory

SR

Programmable Trace

(

Telemetry Mode

a

)

The Telemetry Mode feature described on page 3-13 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 3-13 for
a description of each of these four EGM options.

- Atrial EGM

- Ventricular EGM

- Dual EGM

- Summed EGM

The Telemetry Mode feature is not available when the pacemaker is

Note:

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

a

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

3-6

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Adjusting and Configuring the Display

The Adjust window contains controls that let you tailor the live
rhythm display to your specific needs. Note that once certain
display attributes have been adjusted, the programmer will
maintain these settings from one patient session to another.

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

Figure 3-4.

Live Rhythm Display Adjust Window

[Adjust] button near the top

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

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

3-7

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Adjust Size

Adjust Source

Adjust Color

Sweep speed

Telemetry Mode

ECG Filter

Table 3-2.

The Adjust Window Options

Select this button to adjust the amplitude of the
waveforms (see “Adjusting Waveform Size” on
page 3-9).

Select this button if you want to change the
source of a particular trace (see “Selecting a
Trace Source” on page 3-9).

Select this button if you want to change the color
of one or more of the waveform traces (see
“Color Coding the Waveform Traces” on
page 3-11). Option is only available on
programmers with color display panels.

Select the Sweep speed field to display the
sweep 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 3-12).

Select the Telemetry Mode field to display the
options for programming the type of waveform
telemetry transmitted by the pacemaker (see
“Programming a Different Telemetry Mode” on
page 3-13).

Select this checkbox to turn the ECG filter on or
off. A checkmark
turned on. The filter may improve clarity of the
ECG in the presence of interference (see
“Selecting the ECG Filter” on page 3-14).

indicates that the filter is

(✓)

3-8

Show Artifacts

Cleanup

Normalize

OK

Select this checkbox to enable or disable the
pacing artifact enhancement function. A
checkmark
enabled (see “Enabling Artifact Enhancement” on
page 3-15).

Select this button to equalize the spacing
between the traces

Select this button to equalize the trace spacing
and to adjust the size of each trace to the default
setting.

Select this button to close the Adjust window.

indicates that the function is

(✓)

Medtronic.Sigma 300/200/100 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

2.

For the trace you want to adjust, alternately press and release
the increase button or decrease button to change the
waveform size.

[Size] button in the Adjust window.

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

[Normalize] button.

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 3-15.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

3-9

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.

[Source]

Source field

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.

3-10

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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

[Color]

Color field

button

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

2.

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

[Color] button in the Adjust window.

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.Sigma 300/200/100 Series Pacemaker Programming Guide

3-11

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.

Sweep Speed field

2.

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

Menu of choices

3-12

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

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.

To Program a Different Telemetry Mode

♦

1.

Assure 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.

The Telemetry Mode options are as follows:

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

Ventricular 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.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

3-13

Viewing the Patient’s ECG and EGM Traces

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

ECG Filter

checkbox

Show Artifacts

checkbox

3-14

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

Enabling Artifact Enhancement

➤

Select the Show Artifacts checkbox to enable or disable the
pacing artifact enhancement function. A checkmark (✓)
indicates that the function is enabled.

The two trace illustrations in Figure 3-5 show how an ECG
trace appears with and without this feature enabled.

Artifact Enhancement Enabled (Checkmark)

Artifact Enhancement Disabled (No Checkmark)

Figure 3-5.

Examples of Artifact Enhancement

Arranging the Waveforms

In addition to arranging the waveform traces by selecting the
source as described on page 3-9, you can use the stylus to “drag”
a trace to the desired position. The procedure in the example
below shows how to move the Marker Annotation trace from its
position over the ECG Lead II trace to a position over the
Ventricular EGM trace.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide

3-15

Viewing the Patient’s ECG and EGM Traces

Adjusting and Configuring the Display

To Move a Trace Using the Stylus

♦

1.

First decide which trace you want to reposition. If the trace
name is not displayed (Marker Annotation in this case), tap
the name of the superimposed trace to display the hidden
name.

2.

Press and hold the stylus against the name of the trace you
want to move.

3-16

3.

Without lifting the stylus, drag the box now appearing
around the trace name to the desired location.

Medtronic.Sigma 300/200/100 Series Pacemaker Programming Guide