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Phrenic nerve stimulation that cannot be terminated
With LV pacing, chronic phrenic nerve stimulation can in rare cases not be terminated
by reprogramming the available left ventricular pacing configurations or by other
measures.
• Possibly set a right ventricular mode both in the permanent program and for
Mode Switching.
Avoiding risks in the case of exclusive LV pacing
Lead dislodgement in the case of exclusive left ventricular pacing could pose the
following risks: loss of ventricular pacing as well as induction of atrial arrhythmia.
• Consider sensing and pacing parameters with reference to loss of therapy.
• Exclusive LV pacing is not recommended for patients who depend on the device.
• Take possible interruption of automatic Active Capture Control into consideration.
• In the case of follow-ups and threshold tests, take loss of synchronized ventricular
pacing into consideration.
• Mode Switching does not allow exclusive LV pacing; consider the consequences
when setting Mode Switching parameters.
If an ICD is implanted at the same time, do not permit unipolar pacing
If an ICD is implanted in addition to a pacemaker and a lead failure occurs, it is possible
to switch to unipolar pacing after resetting the pacemaker or using the automatic lead
check. As a result, the ICD could falsely inhibit or trigger tachyarrhythmia therapy
activity.
• Unipolar leads are not permitted in this configuration.
Recognizing lead failure
Automatic impedance measurement is always switched on.
• Impedance values that indicate technical failure of a lead are documented in the
event list.
Consider power consumption and service time
The pacemaker permits programming of high pulse amplitudes with long pulse widths
at high rates to be able to adequately treat even rare diagnoses. In combination with
low lead impedance, this results in a very high level of power consumption.
• When programming large parameter values, take into account that the battery
depletion indicator ERI will be reached very early because the service time of the
battery may be reduced to less than 1 year.
• Home Monitoring ON reduces the service time by 3 months approximately.
RF telemetry requires somewhat more power: More frequent use of RF telemetry than
assumed during service time calculation (20 min per year) reduces the service time by
about 7 days for the SR(-T), 6 days for the DR(-T), and 5 days for the HF-T device.
• Do not establish unnecessary RF telemetry.
• After 5 minutes without input, SafeSync switches to the economy mode.
• Check the battery capacity of the device at regular intervals.
Magnet Response
Programming head application
When the programming head is applied, time remains for device interrogation before
the device switches back to the previously set permanent therapy mode. The same
applies to programming head application to establish RF telemetry contact.
Magnet response in standard program
Applying a magnet or the programming head can result in an unphysiological rhythm
change and asynchronous pacing. The magnet response is set as follows in the
standard program of BIOTRONIK pacemakers:
• Asynchronous:
For the duration of the magnet application – mode D00 (possibly V00 / A00) without
rate adaptation;
Magnet rate: 90 bpm
• Automatic:
For 10 cycles – mode D00, subsequently mode DDD without rate adaptation;
Magnet rate: 10 cycles with 90 bpm, subsequently set basic rate
• Synchronous:
Mode DDD (where applicable: VVI) without rate adaptation;
Magnet rate: set basic rate
Note:
See also the replacement indication information.
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