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Pacemaker Diagnostics

Pacemaker Diagnostics. Dwight Reynolds MD University of Oklahoma Health Sciences Center. Pacemaker Diagnostics . The Goals of “Diagnostics” More and better information Faster follow-up Less face-to-face follow-up. Pacemaker Diagnostics . Device Information

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Pacemaker Diagnostics

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  1. Pacemaker Diagnostics Dwight Reynolds MD University of Oklahoma Health Sciences Center

  2. Pacemaker Diagnostics The Goals of “Diagnostics” • More and better information • Faster follow-up • Less face-to-face follow-up

  3. Pacemaker Diagnostics • Device Information • Device-Patient Interface Information • Patient Information (A discussion based on currently available technology)

  4. Pacemaker Diagnostics • Device Information • Device Identification / Implant Date • Program Settings • Device Longevity Estimate • Lead Monitoring

  5. Pacemaker DiagnosticsDevice Identification and Implant Date • This data can be very important, especially in patients who are not geographically stable and who are not maintained in consistent follow-up

  6. Pacemaker DiagnosticsProgram Settings • This data can be viewed in this format or in more detail on another screen

  7. Pacemaker DiagnosticsDevice Longevity Estimate • Device longevity estimate appears on this initial interrogation and on another screen • Based on remaining battery voltage / battery impedance and percent pacing

  8. Pacemaker DiagnosticsDevice Longevity Estimate • The “Elective Replacement Indicator” warning automatically appears in the “Significant Events” window on this screen The remaining longevity estimate is also on this screen

  9. Pacemaker DiagnosticsLead Monitoring • Automatically included on this initial interrogation report Measured Data includes: Lead Impedances Lead Status

  10. Pacemaker DiagnosticsLead Monitoring • Chronic lead impedance trends can be accessed via links on the “Quick Look” screen Automatic Lifetime Lead Impedance Trends

  11. Pacemaker Diagnostics • Device-Patient Interface Information • Atrial/Ventricular Sensing/Pacing time • Sensing Thresholds • Pacing Thresholds • Mode Switching #’s and time

  12. Pacemaker DiagnosticsAtrial/Ventricular Sensing/Pacing Time • This important information is part of the initial interrogation information and appears on the “Quick Look” screen

  13. Pacemaker DiagnosticsSensing Thresholds • While sensing can be evaluated at the time of follow-up, some current devices can do this automatically and adapt automatically • Measure intrinsic P and R wave • Adapt sensitivity based on target safety margins • Designed to automatically provide safe sensing margins • Designed to increase the sensitivity of Mode Switch detection

  14. Pacemaker DiagnosticsSensing Thresholds • Diagnostic Information • P and R-Wave amplitudes • Atrial and Ventricular sensitivity • Data recorded every 7 days (can be set to as often as every 2 hours)

  15. Pacemaker DiagnosticsRole of Pacing Thresholds in Maximizing Longevity 1.5V, 1.5V 2.0V, 1.0V 2.5V, 1.5V 2.5V, 2.5V 3.5V, 3.5V 5.0V, 5.0V Longevity (Years) 100% pacing, 0.4 ms, 600 ohms Example of one device’s longevity estimates at different output settings

  16. Pacemaker DiagnosticsPacing Thresholds • While we can measure thresholds manually at the time of follow-up and adjust outputs, some devices can do this automatically and provide diagnostic information • Automatically measure ventricular thresholds • Automatically reprogram ventricular outputs using an appropriate safety margin • Optimize device longevity • Use with a wide variety of leads • Provide diagnostics to verify performance

  17. Pacemaker DiagnosticsPacing Thresholds - Automatic • Automated threshold measurements rely on sensing the evoked response to the pacing pulse • The characteristics of this sensed response is how the pacemaker determines if the pulse has captured the myocardium • Evoked response sensing can be affected by: • Lead tissue interface (acute vs. chronic lead) • Lead Polarization • Tip-to-Ring spacing • Lead tip design • Other factors

  18. Pacemaker DiagnosticsPacing Thresholds - Automatic Pacing Threshold Search • Amplitude threshold determined at 0.4 ms pulse width • Threshold voltage reported at 0.4 ms pulse width • Minimum programmable pulse width 0.4 ms • Acute period • Thresholds tested, outputs may remain unchanged or increased • Chronic period • Outputs may increase, remain unchanged or decrease

  19. Pacemaker DiagnosticsPacing Thresholds - Automatic 1.50 V Pulse Width Threshold 1.25 V 1.0 V 0.75 V Amplitude Threshold 0.5 V 0.12 ms 0.21 ms 0.4ms 1.0 ms Recommended amplitude with a 2.0V minimum output selected 2X Amplitude Safety Margin Curve

  20. Pacemaker DiagnosticsPacing Thresholds - Automatic • Simple to program-choose only the amplitude safety margin and minimum amplitude • Minimum adapted pulse width 0.4ms • Choose when to do the test

  21. Pacemaker DiagnosticsPacing Thresholds - Automatic • Capture Management Trend • Lifetime trend data • Data reported every 30 days (can be as often as every search - maximum 668) • EGM of last search

  22. Pacemaker DiagnosticsMode Switching - Automatic 4/7 Mode Switching Mode Switching Goals: • Accurate detection of SVT’s • Fast switching to a non-P wave tracking mode designed to avoid symptoms

  23. Pacemaker Diagnostics • Patient Information • Demographics • Sensor Information • AV Conduction Information • Arrhythmia Information

  24. Pacemaker DiagnosticsArrhythmia Monitoring • Continuous monitoring and diagnostics • Automatically accessed with initial interrogation

  25. Pacemaker DiagnosticsArrhythmia Monitoring • What types of arrhythmias are present? Arrhythmia Log Up to 48 seconds of EGM collection triggered by either atrial or ventricular high rates

  26. Pacemaker DiagnosticsArrhythmia Monitoring • What is the atrial arrhythmia burden? Arrhythmia Trend-Cardiac Compass A 6-month rolling trend providing hours/day patient is in atrial arrhythmia

  27. Pacemaker DiagnosticsArrhythmia Monitoring • What is the ventricular rate during atrial arrhythmias? Episode Log Provides the Maximum atrial and ventricular, average ventricular, and sensor rates during arrhythmias

  28. Pacemaker DiagnosticsArrhythmia Monitoring • What is the ventricular rate during atrial arrhythmias? Ventricular Rate during Atrial Arrhythmia Histogram Information on ventricular response to SVT’s, Divided into Paced and Sensed Events

  29. Pacemaker DiagnosticsArrhythmia Monitoring • What is the frequency/duration of the arrhythmia? Episode Log Displays time in atrial high rates, average hours/day and episode durations

  30. Pacemaker DiagnosticsArrhythmia Monitoring • What is the frequency/duration of the arrhythmia? Atrial Arrhythmia Durations Atrial Arrhythmia Trend Cardiac Compass

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