1. Warren Klibbe
Marketing Manager, Berlin

2. Philos II
Functionality

3. The Philos II Pacemaker Family3
Philos II S has received a CE Mark too, but it will not be produced

4. Philos II Functionality
Active Capture Control (ACC)
Wide Band IEGM Recordings
Auto-Initialisation
VES Lock-In Protection
Rate Fading
Mode Switching with 2:1 Lock-in-Protection
Negative AV Hysteresis
Follow-up
Home Monitoring 4

5. Active Capture Control
ACC Function Overview
Automatic, periodic measurement of ventricular pacing threshold
Automatic reprogramming of pulse amplitude
Provides beat-to-beat capture confirmation
Back-up pulse upon detection of non-capture
Signal check & threshold measurement - automatic and repeated
Fusion discrimination algorithm 5

6. Active Capture Control
3 Components of ACC Algorithm
ACC
at each periodically periodically pace
Active Threshold Monitoring ATM
Signal-analysis
Threshold search
Adjust-ment of the pacing amplitude
Capture Control
Successful
Successful 6

7. Active Capture Control
Evoked Response & Polarization Artefact
Evoked Response - The response of the myocardium to a pacing pulse of sufficient amplitude to cause cardiac depolarization. The evoked response is not related to the pacing threshold, R-wave amplitude, or slew rate.
Polarization Artifact - Noise that occurs between the pacing electrode and cardiac tissue after delivery of a pacing pulse. The polarization artifact is affected by the amplitude of the pacing pulse as well as the design of the surface of the lead. 7

8. Active Capture Control
Signal Check
Determinates whether evoked response and polarization artifact are acceptable
Pacing with capture
Pacing without capture
Polarisation- artefact
Polarisation- artefact
Evoked response 8

9. Active Capture Control
Pacing- Cause and Effect
Decreased polarization artifact
Improved lead surface
(low polarization lead)
No evoked response
No polarization artifact
No pacing
Decreased pacing amplitude
Increased polarization artifact
Increased pacing amplitude
Evoked response
Some polarization artifact
Pacing with capture
Pacing without capture
Result
Event 9

10. Active Capture Control
Non-Capture, Loss of Capture
Non-Capture
A single ventricular pacing pulse that is classified as non-capture by ACC event classifier
Loss of Capture
A series of ventricular pacing pulses at varying AV delays that are classified as non-capture by ACC (with a maximum of 3 consecutive non-captures) 10

11. Active Capture Control
Signal analysis
Over the first 5 paces: analysis of the evoked response together with polarisation artefact.
In the second step, 2 coupled paces (with a 100 ms interval) are applied for five cycles. Based on the in-effective second pace, the maximum polarisation artefact can be determined 11

12. Active Capture Control
Automatic Threshold Measurement
The ventricular threshold is measured periodically and the stimulation amplitude is adapted
The measurement starts with the programmed „Maximum Amplitude“
The output pace will step down at the beginning in larger and finally in smaller steps during the threshold measurement . Each decreased amplitude contains 2 paces
A back-up pcace with higher energy is applied in case of no capture
If, with a pacing amplitude of 0.1 Volt, the measurement indicates still capture, than the threshold-test is declared as „ not succesful“. 12

13. Active Capture Control
Automatic Threshold Measurement
Back-up Pulse ms
Example
Maximum ACC Amplitude = 2.4 V
Safety Margin = 0.5 V
Threshold = 0.9 V
2.4 V
2.1 V
1.8 V
1.6 V
1.4 V
1.2 V
1.0 V
0.9 V
0.8 V
1.4 V 13

14. Active Capture Control
Amplitude Steps during Threshold Measurement
... 17
0.9 16
1.0 15
1.1 14
1.3 13
1.5 12
1.7
1.2 11
1.9
1.4 10
2.2
1.6 9
2.5
1.8 8
2.9
2.1 7
3.3
2.4 6
3.8
2.8 5
4.3
3.2 4
4.9
3.7
2.7 3
5.6
4.2
3.1 2
6.4
4.8
3.6 1
Amplitude Steps
(if capture is not lost during test)
Maximum
ACC
Amplitude
Note: below 1.0 V the step is always 0.1V 14

15. Active Capture Control
Continuous Capture Confirmation
Continuous beat-by-beat testing to ensure effective pacing
In case of no capture:  Back-up pace with increased energy
In case of loss of capture (a sequence of no-capture) :  Start of a new threshold measurement 15

16. Active Capture Control
The Back-up Pulse
Detection of
evoked response
60 ms
Ventricular Blanking
20 ms
Calculation, Programming
50 ms
131 ms
Ventricular pace
actual amplitude with 0.4 ms non-capture
Back-up pace
actual amplitude with 1.0 ms capture 16

17. Active Capture Control
Is the Backup Pulse effective?
The 2002 multicenter PACC study investigating the effectiveness of ACC showed that each backup pulse was successful.1)
Analyzed Holters 41
Detected ventricular events
Ventricular stimuli (82.5%)
Ineffective stimuli (0.1%)
Backup pulses (0.1%)
Effective backup pulse (100%)
1) Philos DR Active Capture Control (PACC) IDE #G Clinical Report, Tab. 18, Dec 17

18. Active Capture Control
Fusion - Possible Effects
Fusion can affect the morphology of the signal, which in some cases can cause ventricular pacing with fusion to be inappropriately classified as non-capture
AV delay is modulated (lengthened / shortened) using a specific sequence to promote ventricular sensing or to promote ventricular pacing without fusion
Fusion discrimination is only relevant during Capture Confirmation - AV delay during Signal Check/ Threshold Measurement is automatically set to a very short interval to ensure ventricular pacing and prevent fusion
Fusion is not a safety issue but simply results in unnecessary back-up pacing 18

19. Active Capture Control
Fusion Discrimination - Possible Effects
Non-capture during Capture Confirmation could be the result of
True non-capture
Ventricular pacing with fusion
Without fusion discrimination, Signal Check/ Threshold measurement would be initiated any time no capture was detected
Fusion discrimination algorithm is invoked any time non-capture is detected at the normal AV delay 19

20. Active Capture Control
Fusion Discrimination Algorithm
Step 1 - Lengthen the AV delay by 65 ms if non-capture is detected
Promotes intrinsic ventricular activity
Avoids unnecessary ventricular pacing
AV delay remains lengthened as long as ventricular sensing occurs
Return to normal AV delay if ventricular pacing with capture occurs
Go to next step if non-capture is detected at long AV delay
Step 2 - Return to the normal AV delay
Promotes ventricular pacing
Eliminates fusion that could have occurred at long AV delay
AV delay remains at the normal AV delay as long as ventricular sensing occurs
Go to next step if non-capture is detected at the normal AV delay
Step 3 - Shorten AV delay to 15/50 ms following As/Ap events
Return to Step 0 if capture is detected for 2 beats
Initiate Signal Check/Threshold Measurement if non-capture is still detected 20

21. Active Capture Control
When does ACC algorithm start a new measurement?
At change of relevant parameter: - mode - ventricular pulse amplitude and pulse width - ACC parameters - ventricular sense/pace polarity
At the scheduled time/ interval
At Loss-of-Capture detection (NOT at non-capture detection) 21

22. Active Capture Control
Parameter Description
Maximum ACC Amplitude (MaxACCAmp)
The maximum amplitude setting that ACC can use and still distinguish capture from non-capture. In other words, this is the maximum amplitude where ACC will not misinterpret polarization artifact as capture (evoked response).
Minimum Amplitude
The smallest amplitude that the algorithm allows the output to be set to between automatic threshold searches. 22

23. Active Capture Control
Parameter Description
Safety Margin
The difference between the measured pacing threshold and the programmed pacing amplitude. In other words, the safety margin is added to the measured pacing threshold.
Search Time
These parameter determines when the signal quality is checked and the pacing threshold is measured.
Two times of day or an interval of certain hours is alternatively programmable. 23

24. Active Capture Control
Programmable Parameters
0.7 V
0.1 …(0.1)…actual Amplitude
Minimum Amplitude
0.5 V
0.3 … (0.1) … 1.2 V
Safety Margin
02:00 & 14:00
00: (15 minutes)... 23:45
Time of Day
12 hours
Interval
3.6 V
ATM
Standard value
0.1, 0.3, 1, 3, 6, 12, 24 hour
Off, ATM,On
ACC activation
Interval, Time of Day
Search Schedule
2.4, 3.6, 4.8, 6.4 V
Maximum Amplitude
Range
Parameter 24

25. Active Capture Control
Programming 25

26. Active Capture Control
Status Information 26

27. Active Capture Control
ACC Algorithm Overview
Signal Check
Threshold Measurement
Capture Confirmation Ÿ
Sets AV delay to 50ms
Five paces at MaxACCAmp
Five "double paces" to
evaluate polarization
Pass
Fail
AV delay remains 50ms
Starting from MaxACCAmp,
stepwise reduction of the
output every 2 cycles until
threshold is found with a
0.1V resolution
Back-up pulse is emitted if
No Capture occurs (pulse
width set to 1ms)
Set Amp = MaxACCAmp or
higher
Repeat Signal Check/Threshold
measurement at next scheduled time
Three consecutive double
failures of Signal Check/Threshold
measurement will disable ACC
Set Amp = Threshold +
Safety Margin
Beat-to-beat monitoring for
non-capture
If Loss of Capture is con-
firmed, set Amp = MaxACC
Amp and perform Signal Check/Threshold measurem.
Fusion avoidance scheme
(AVD lengthening and
shortening) 27

28. Active Capture Control
Examples of Amplitude Settings
4.4 V (no Capture Confirmation)
2.0 V
1.0 V
1.5 V
0.7 V
Reprogrammed Amplitude
0.2 V
Safety Margin = 0.5 V
Maximum ACC Amplitude = 3.6 V
Minimum ACC Amplitude = 0.7 V
3.2 V
Safety Margin = 1.0 V
Minimum ACC Amplitude = 1.0 V
Measured Threshold
Parameter Settings 28

29. Active Capture Control
Behavior in special Situations (1)
Capture Confirmation will be disabled temporarly (back-up pulse as well) during following events:
Mode Switching
permanent noise
rates above 110 ppm
After the end of the event the pacemaker returns to Capture Confirmation.
During the event the amplitude will be set to last measured threshold V (maximun safety margin) 29

30. Active Capture Control
Behaviour in Special Situations (2)
Signal Check was not successful (possible reason: too high polarisation artefact or non-capture at MaxAccAmp)
immediately after re-programming:
ACC will be disabled
pacing amplitude = MaxACCAmp
later:
polarisation artefact too high -> MaxACCAmp
non-capture at MaxACCAmp -> MaxACCAmp + 1.2V „maximaler Amplitude“) gesetzt
later, 3 consecutive measurements
pacing amplitude = MaxACCAmp V 30

31. Active Capture Control
Behaviour in Special Situations (3)
Threshold measurement was not successful (possible reason: pacing with capture at 0.1 V)
first measurement after reprogramming:
ACC will be disabled
pacing amplitude = MaxACCAmp
later:
ACC will be disabled temporarily 31

32. Active Capture Control
Behaviour in Special Situations (4)
ERI has been reached:
ACC will be disabled
The pacing amplitude will be set automatically to last measured threshold + 1.2V (1.2V =maximum safety margin) 32

33. Active Capture Control
Available Statistics for ACC
Last measured threshold Status (if “disabled“: the reason - signal quality not sufficient - too much loss-of-capture - initial test not successful - ERI )
Threshold trend 33

34. ACC Diagnostik Available Statistics for ACC
Histogram of ventrticular pacing amplitude
Ventricular pacing amplitude trend 34

35. Active Capture Control
Competitors
All similar competitor algorithms perform a threshold measurement and adjustment of the pacing amplitude
Comparison aspects:
Back-up pace at no capture?  Main feature for patient safety
Unipolar and bipolar pacing possible?  compatible with defibrillators  additional programming option at Phrenicus pacing / diaphragm pacing
Fusion discrimination algorithm?  Avoidance of unnecessary back-up pacing
Many of the terms sound similar but should not be confused. 35

36. Active Capture Control
Competitors
unknown
yes
Yes
Medtronic
Kappa 900
(no Back-up-Puls)
Fusion discrimination algorithm no
Uni- and bipolar configuration possible
Back-up Pulse at non-capture
ELA
Talent 3
St. Jude Medical Identity
Guidant
Insignia Ultra
Biotronik
Philos II
Many of the terms sound similar but should not be confused. 36

37. Wide Band IEGM Recording
Storage of up to 15 IEGM Recordings
Recording of unfiltered atrial and ventricular IEGM’s and marker channel
Recording of 7,5 seconds before and 2,5 seconds after the trigger
Intelligent memory management 37

38. Broadband IEGM Recording
Trigger criteria
High atrial rate alternatively Mode Switching, Mode Conversion
Magnet (Patient Activated)
High ventricular rate
PMT Termination 38

39. Broadband IEGM Recording39

40. Broadband IEGM Recording40

41. Broadband IEGM Recording
Intelligent Memory Management
First 15 IEGM will be recorded.
If the number of IEGM recordings is > 15t the following recordings will NOT be overwritten
the latest 3 patient activated IEGM recordings
4x high atrial rate , Mode Switching, respectively (oldest, longest, highest ventr. Rate, latest)
3x high ventricular rate (longest, highest ventr.rate, latest) 41

42. Broadband IEGM Recording
Intelligent Memory Management
If the memory is filled with 15 IEGM recordings they will be overwritten by additional recordings with following priority:
oldest recording of high ventr. rate
oldest patient activated recording
oldes recording of high atrial rate, Mode Switching/Mode Conversion
oldest recording of PMT termination 42

43. Broadband IEGM Recording
Competitors
Ela: 3x 3 seconds IEGMrecording in Talent III
Vitatron: no real time IEGM untill „C60-Family“ no automatic recording of IEGMs.
Relevant competitors :Insignia Ultra (Guidant),
Identity (St.Jude Medical) Kappa 900 (Medtronic)
Many of the terms sound similar but should not be confused. 43

44. Broadband IEGM Recording
Competitors
48 (after trigger) 32 (before Trigger)
48 (a+v)
120 (one channel)
110
150
Total recording time [seconds]
a + v summarised*
a or v or summarised
a und v separately
Channels (a=atrial, v=ventricular)
8/0/6
4/4/4
2/16/0
a.a.
Medtronic
Kappa 900
12/2?/2?
4/6?/6?
1/24?/24?
31/2/2
7/7/7
2/28/14
15/7.5/2.5
Number of recordings /
Recording pre / post trigger [seconds]
St. Jude Medical
Identity
Guidant
Insignia plus
Biotronik
Philos II
Many of the terms sound similar but should not be confused.
* Sourse: Guidant Insignia plus Salesfolder 44

45. Auto-Initialisation Lead Detection
Continuous unipolar measurement of the lead impedance : Values between 200 and 3000 Ohm?
Unip. Lead impedance = Ohm -> switch to bipolar mode
Bip. Lead impedance = Ohm -> Philos II maintains bipolar mode
Bip. Lead impedance  Ohm -> Philos II switches back to unipolar mode
Implant confirmation time : 30 min 45

46. Auto-Initialisation Implant confirmation time
Confirmation time 30 minutes: Lead impedance within the range 200 – 3000 Ohm?
Yes DDD(R,T): both channels  Auto-Initialisation SLR,SR: vent. channel  Auto-Initialisation
No  New start of automatic lead detection
Inhibition of Philos II by sensing: triggert pacing each 3 minutes 46

47. Auto-Initialisation Function activation Start of the Statistics
Activating of Mode Switching
Activation of PMT-Protection
Start of ventricular Threshold Monitoring (ATM)
Storage of implantation date and lead polarity in the patient data 47

48. Implant Confirmation Time
Auto-Initialisation
Summary
Implant Confirmation Time
30 min
Lead Detection
Polarity Selection
Diagnostic
Memory
Mode Switching
PMT Management
Function activation
Threshold Monitoring 48

49. Auto-Initialisation Programming
Programmable: ON, OFF, Lead Detection (= polarity setting without function activation )
Only active in Factory Mode
Parameter disappears from Programmer screen after performing Auto-Initialisation
Code „FACTORY” resets Philos II to factory values  Auto-Initialisation can start again 49

50. Auto-Initialisation Competitors St. Jude Medical
Vitatron do not provide Auto-Initialisation
Ela
Many of the terms sound similar but should not be confused. 50

51. Auto-Initialisation Competitors Medtronic Kappa 900
similar procedure (30 min. implant confirmation time, reprogramming to bipolar mode were applicable, asynchronous pacing every 5 min,)
Function activation :
Auto-Sensing
Capture Management
Sensor
Search AV (AV-Hystereses)
Statistcs
Many of the terms sound similar but should not be confused. 51

52. Auto-Initialisation Competitors Guidant Insignia plus
Measurement of unipolar lead impedance, NO implant confirmation time
NO switch to bipolar mode
Function activation:
Mode Switching
PMT Termination
AV-Hystereis without Scan Hysteresis
Statistics
Many of the terms sound similar but should not be confused. 52

53. Auto-Initialisation Competitors (Summary)
Philos II vs. Medtronic Kappa 900 / Enpulse
Turning on rate adaptive mode automatically is not desired by everyone.
Philos II vs. Guidant Insignia ultra
No programming of lead polarity no confirmation time, no activation of automatic threshold measurement (?)
Philos II vs. Rest
No Auto-Initialisation 53
* ...
Quelle: ...

54. VES Lock-In Protection
Description of VES-Lock-in
Creates the picture of atrial undersensing despite the presence of (intracardiac) P waves larger then the programmed atrial sensitivity
May only occur during episodes of spontaneously conducted P waves with somewhat longer PR times
In literature also referred to as “Functional Atrial Undersensing” 54

55. VES Lock-In Protection
What is VES-Lock-in?
It may occur that spontaneous P waves are sensed in the refractory period
As a consequence of this …
-> the following QRS-complex is classified as a VES
-> P waves will not be tracked
-> AV synchrony is lost
Mainly patients with first/second degree AV-Block are affected
Who is affected? 55

56. VES Lock-In Protection
VES-Lock-in Timing As
Ars
Ars
Vs („VES“)
Vs („VES“)
Vs (VES) Vp
ARP
Basic Interval
ARP Extention 56

57. VES Lock-In Protection
The Algorithm
Monitoring of Ars-VES sequences
Detection if programmed number (n= 4, 6 or 12) of Ars-VES cycles occur
Termination of the Lock-In situation by an atrial pace, triggered by the atrial refractory sense (Ars)
-> VES Lock-in Protection restores AV synchrony 57

58. ... VES Lock-In Protection VES-Lock-in Termination ... „n“ cycles ARP
Ars
Ars Ap As
Vs („VES“) Vp Vp
...
... „n“ cycles
ARP
Basic Interval
ARP Extention 58

59. VES Lock-In Protection
Programming
Factory and Standard setting = Off
Ves-Lock-in Protection = ON Programmable number of termination cycles: 4, 6, 12 59

60. VES Lock-In ProtectionVs
(VES)
Ars
Ars Ap Vp As 60

61. VES Lock-In Protection
Statistics
VES-Lock-in terminations counter in the „Special Events“ Window 61

62. VES Lock-In Protection
Competitors
VES-Lock-in protection is a unique function.
Competitors do not provide a similar algorithm.
BUT VES-Lock-in behaviour has been reported at competitor pacemakers:
Pacesetter1,2
Vitatron1
Medtronic1
Biotronik1
1) Bode et al., PACE 1999
2) Barold, PACE 1999
Many of the terms sound similar but should not be confused. 62

63. Rate Fading (Rate smoothing)
Purpose of Rate Fading
Prevention of an in-appropriate rate decrease:
for example, in patients with exercise induced bradycardia
after Mode-Switching
Prevention of symptoms related to sudden rate drop 63

64. Rate Fading Terminology Back-up Rate Effective pacing rate
Target Rate Calculated rate
(mean detected rate)
RF-Increase speed of adaptation of the Back-up Rate towards a higher Target Rate
RF-Decrease speed of adaptation of the Back-up Rate towards a lower Target Rate 64

65. Rate Fading Rate Fading at sudden rate drop of intrinsic heart rate
10 bpm 65

66. Rate Fading Intrinsic Rate Target Rate Back-up Rate Basic Rate
Increasing the Back-up Rate for 2 bpm / cycle (example)
Reduction of the Back-up Rate for 0,5 bpm/cycle (example)
10 ppm
Basic Rate
4 Cycles
Time 66

67. Rate Fading
Programming 67

68. Rate Fading Competition Medtronic : no similar algorithm
St Jude Medical : no similar algorithm
Vitatron : „Flywheel“ is similar to Rate Fading but is not programmable
Guidant : „Rate Smoothing“ similar to Rate Fading
Rate increase 3% - 24% programmable
Smoothing at increase can lead to AV dissotiation.
Ela: „Smoothing“similar to Rate Fading
Rate decrease: „slow“; „fast“ Algorithm responds to slight rate variations too
Many of the terms sound similar but should not be confused. 68

69. Mode Switching with 2:1 Lock-in Protection
The goal of Mode Switching:
Provides transition of atrial tachycardias to the ventricle
The goal of 2:1 Lock-In Protection:
Ensures adequate Mode Switching even in „difficult“ situations, e.g. long blanking and „slow“ tachycardias 69

70. Mode Switching with 2:1 Lock-in Protection
When does 2:1 Lock-In occur?
A long blanking interval (>125ms) was programmed in the pacemaker
The patient suffers of atrial flutter 70

71. Mode Switching with 2:1 Lock-in Protection
Ars Blanking As Vp
Ars Blanking As Vp
Example: Atrial flutter 240bpm, TARP 425 ms, PVAB 200 ms
The pacemaker ignores every second P wave, because it occures in the blanking. The sensed rate is 120bpm.
TARP
Blanking 71

72. Mode Switching with 2:1 Lock-in Protection
Programming
and 72

73. Event below the intervention rate
Mode Switching with 2:1 Lock-in Protection
Desynchronisation
Resynchronisation
...
DDD(R)
DDI(R)
DDI(R)
DDD(R)
...
...
1 out of 8
0 out of 8
...
0 out of 8
2 out of 8
0 out of 8
0 out of 8
1 out of 8
0 out of 8
...
out of 8
1 out of 8
...
3 out of 8
...
5 out of 8
4 out of 8
Example: X=5 (3-8)
Example: Z=5 (3-8)
Event above the intervention rate
Event below the intervention rate
During ERI Mode Switching will not be disabled. 73

74. Mode Switching with 2:1 Lock-in Protection
The Algorithm
Suspicion phase Evaluation of VA intervals (rate > 100 ppm) Evaluation of the stability criterion
Confirmation phase Modulation of the AV-Delay (max.300 ms) to “uncover” intrinsic events during atrial blanking (PVAB)
Termination phase Termination of the 2:1 Lock-in-Situation by Mode Switching (without X/Z-out of 8 criterion) Stepwise decrease of AV delay if no p wave was detected 74

75. Mode Switching with 2:1 Lock-in Protection
Termination of 2:1 Lock-in by Mode Switching
Beginning of atrial flutter with 250 ppm. Philos II is in the 2:1 Lock-in . Beginning of the suspicion phases.
AV delay extention uncovers 2:1 Lock-in. Termination by immediate Mode Switching
Sinus-rhythm
2. P wave
1. P wave 75

76. beat-to-beat + rate increase
Mode Switching with 2:1 Lock-in Protection
Competitors
Biotronik
Philos II
Guidant
Insignia Plus
St. Jude Medical
Identity
Medtronic
Kappa 900
Vitatron
C60DR
ELA
Talent 3
Mode Switching Principle
x/z-out of-8
+1/-1 Counter
average. atrial rate
4-out-of-7
beat-to-beat + rate increase
rate increase
Speed
fast
fast
slow
fast
very fast
slow
Specifity
high (progr.)
high (progr.)
very high
medium
low
very high
Many of the terms sound similar but should not be confused.
2:1 Algorithm
yes
---
---
yes
---
---
Far field blanking PVAB (in ms)
Up to 200
Up to 200
up to 200
Up to350
Up to 300 ?
2nd algorithm
Mode Conv.
„Mode Conv.“
---
---
---
--- 76

77. Negative AV Hystersis AV Hysteresis „negative“:
Suppression of intrinsic AV conduction
Promoting of ventricular pacing
Indicated f.e. at HOCM patients (hypertrophyc obstructive cardio-myopathy) without alternative therapy possibility
The AV delay will be shortened only if necessary to promote ventricular pacing with optimum haemodynamics 77

78. Negative AV Hysteresis
The Algorithm
AV Delay
AV delay shortened by negative AV Hysteresis
repetitive cycles with shortened AV delay AS VP VS 78

79. AV Hysteresis
Programming
* ...
Quelle: ... 79

80. AV Hysteresis Competitors   0...-110 ms 1 ... 6 cycles 1
ventricular pace preference ms 
Negative AV Hysteresis
cycles
Repetitive AV Hysteresis 1
every 32 cycles
64 ms
Vitatron
C60DR
AV Delay modula-tion depending on no. of As/Ap in 16 intervalls
Medtronic
Kappa 900 5 8
Number of search cycles
100 cycles
5 min
cycles
every180 cycles
AV Scan Hysteresis Search Interval
DDD-AMC Mode ms
0% %
15% 30% 50%
Prolongation of the AV delay by the AV hysteresis
ELA
Talent 3
St. Jude Medical
Identity
Guidant
Insignia Plus
Biotronik
Philos II
Many of the terms sound similar but should not be confused. 80

81. Follow-up
Event List 81

82. Follow-up
Storage of follow-up data in the pacemaker 82

83. Follow-up
Storage of follow-up data in the pacemaker 83

84. Follow-up
Pre-Settings After choosing a Philos II Pacemaker type in the Preferences screen an additional register ”Philos II“ is available:
Automatic storage of follow-up data
Sensing Test with programmer parameters (i.e. 40 ppm VDD / VVI)
Sensing Test with pacemaker settings (permanent program) i.e. 60 ppm DDD) 84

85. Follow-up
Automatic Threshold Test 85

86. Follow-up Automatic Threshold Test Signal Check
Example with Max ACC Amplitude = 3.6V 86

87. Follow-up Automatic Threshold Test Double paces at each amplitude
Amplitude decrease first in bigger steps 87

88. Follow-up Automatic Threshold Test
Below 1.0 V amplitude decrements in 0.1V 88

89. Follow-up Automatic Threshold Test Threshold at 0.8V
No capture at 0.7V
Backup pace with capture at 0.7 V/ 1.0 ms 89

90. Follow-up
AT-Classification 90

91. Follow-up AT-Classification
Criterion for sudden onset: the average of the 4 previous atrial events is 25% higher than the average of 4 events prior to current average
Criterion of rate stability:
three of the five most recent atrial intervals do not differ from one another by more than 20% AS AS AS AS AS AS AS AS AS VP VP VS VP VP VP VP VP VP 91

92. Follow-up
AT-Classification 92

93. Follow-up High Resolution Impedance Trend
Impedance measurement is performed every 90 min by a triggered pace at 4.8V 93

94. Home Monitoring Home Monitoring principle
1. Patient has an implant with Home Monitoring option
2. CardioMessenger
relays on daily basis an SMS (and additional messages if needed)
4. Physician with a secured internet
entry
3. Automatic Data analysis in the Service Center 94

95. Home Monitoring
The Antenna 95

96. Home Monitoring Transmitted Data (selection)
Auto Lead Check (atrial and ventricular)
Status Active Capture Control
Ventricular Threshold
Status ERI
% AV Synchrony
P-/ R-Wave Amplitude Trend 96

97. Thank you for your Attention!97