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Low Voltage Technology

Low Voltage Technology. Pulse Generator Technology Lead Technology. Pulse Generator. 1958, 8 October. Identity ADx XL DR. Feed Through. Defib. protection. Capacitors. Sensor. Crystal. Telemetry Coil. X-ray marker. Golden Thread Welded Bonds. All bonding is doubled for safety reasons.

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Low Voltage Technology

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  1. Low VoltageTechnology Pulse Generator Technology Lead Technology

  2. Pulse Generator

  3. 1958, 8 October...

  4. Identity ADx XL DR

  5. Feed Through Defib. protection Capacitors Sensor Crystal Telemetry Coil X-ray marker

  6. Golden Thread Welded Bonds All bonding is doubled for safety reasons

  7. Magnet Rate <99/min: (and normal energy consumption) 6 months F-U interval 98.6 BOL Magnet Rate ~93/min: (and normal energy consumption) Replacement within 3 months ERI 86.3 Magnet Rate <85/min: Immediate replacement Elective Replacement Indicator Magnet test rate 100 85 EOL EOJ

  8. Stimulationrate 63.2 64.5 65.9 67.4 69.0 70.6 Battery impedance kOhms 10 20 30 40 BOL EOL Elective Replacement Indicator

  9. 25 20 15 Stimulation current consumption 10 5 Exemple of current drain Single-chamber unit, rate 60min-1 and 500Ω lead imp. Current drain µA Intrinsic current consumption 0,5ms 1,0ms 0,5ms 1,0ms 0,5ms 1,0ms 1,0 Volt 2,5 Volt 7,5 Volt

  10. Lead Connectors

  11. IS-1 Connector in the Header

  12. Tightening the Set Screw

  13. How to ”find” the set screw Silicone rubber sealing membrane

  14. VS 1 IS-1 IS-1 VS 1B Cordis 3.2 mm IS-1 Different 3.2 mm ”Short Bore” Connectors

  15. VS 1A / IS-1 VS 1B / IS-1 IS-1 IS-1 VS 1B Cordis 3.2 mm Different 3.2 mm ”Long Bore” Connectors

  16. VS 1B / IS -1 IS-1 IS-1 † Not µ-size cans * Not M/S version Connectors in our Products Sensolog* Dialog* Sensorithm* Regency* Paragon* Synchrony* Trilogy* Affinity* Entity Integrity† Identity† ADx Family†* Microny Integrity µ-size Identity µ-size ADx Family µ-size

  17. M, 5 mm S, 6 mm K, 3.2 mm (IS-1) T, 3.2 mm (IS-1) C, 3.2 mm inline (VDD) (for old version AddVent, obsolete now) Bifurcated 3.2 mm (VDD) Connectors

  18. Leads

  19. Lead position Endocardial Myocardial Epicardial

  20. Polarity configuration Bi-polar Uni-polar

  21. Advantages - Bi-polar Less risk of myopotential oversensing Less risk of musclestim. Less risk of Crosstalk and Far Field Sensing Uni-polar or bi-polar leads? • Advantages - Uni-polar • Smaller diameter • Larger “spikes” on ECG ( ) With a bipolar lead, you can program the device to e.g. stimulate unipolar but sense bipolar

  22. Far-field sensing Sensing intrinsic activity in the other chamber Crosstalk Sensing pacemaker- activity in the other chamber

  23. IS-1 connector Bi-polar Uni-polar

  24. Coaxial Coil Design

  25. Fixation methods Passive Active

  26. Passive and Active Fixation

  27. Myocardial lead

  28. J-shaped lead (1421T)

  29. This fractal coating creates a microscopic area ~4-600 times larger than the macro-scopic area (~15 cm2 vs 3,2 mm2 (Isoflex)) Titanium nitride (TiN) coating

  30. Factors affecting threshold Insulation defects/Conductor failure Lead position Inflammatory reaction Scar tissue Polarisation losses

  31. Insulation defect Conductor failure Lead defects

  32. I II III V IV What is stimulated? What is sensed? Reaction to sensing MultisitePacing Rate Modulation 0=NoneR=Rate Modulation 0=None A=AtriumV=VentricleD=Dual (A+V) 0=None A=AtriumV=VentricleD=Dual (A+V) 0=NoneT=TriggeredI=InhibitedD=Dual (T+I) 0=None A=AtriumV=VentricleD=Dual (A+V) S=Single (A or V) S=Single (A or V) NASPE/BPEG Generic Pacemaker Code The Revised NASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite Pacing, PACE , Volume 25, No. 2, February 2002

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