Implementation of automatic mode switching in Pacesetter's Trilogy DR+ and Affinity DR pulse generators

Levine, Paul A.; Bornzin, Gene A.; Hauck, Greg; Florio, Joe

doi:10.1007/s003990050112

Cited by 3 publications

(2 citation statements)

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“…In an unbiased MAR calculation, an atrial cycle above the MAR reduces the MAR interval to the same extent as a cycle below the MAR prolongs it. In a biased MAR calculation (e.g., St. Jude-Pacesetter Trilogy and Affinity, St. Paul, MN, USA, 15,16 Medtronic Thera, Minneapolis, MN, USA 8,17 ), a short cycle reduces the current MAR to a higher extent than a long cycle prolongs it. For example, an atrial cycle above the MAR reduces the MAR interval by 39 ms (St. Jude-Pacesetter Affinity) or 23 ms (Medtronic Thera I), a cycle below the MAR prolongs the MAR interval only by 16 ms (St. Jude-Pacesetter Affinity) or 8 ms (Medtronic Thera I).…”

Section: Figure 2 Blanked Atrial Flutter ("2:1 Lock-in") Simultaneomentioning

confidence: 99%

Analysis of Mode Switching Algorithms in Dual Chamber Pacemakers

Israel

2002

Pacing Clinical Electrophis

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Dual chamber systems are currently implanted in an increasing number of patients with a pacing indication and paroxysmal atrial tachyarrhythmias (ATAs). To avoid tracking of high atrial rates during ATA while providing AV synchronous pacing during sinus rhythm and AV block, automatic mode switching (MS) to a nontracking mode has been developed. Several concepts of MS algorithms have been introduced differing in sensitivity and specificity of ATA detection, delay between ATA onset and MS, pacing mode during MS, rapidity of MS termination upon detection of sinus rhythm, and special algorithms pertinent to MS. This review classifies and analyzes algorithms that are integrated into MS concepts and outlines considerations on optimal MS performance. Based on simulations and clinical studies, fast MS concepts avoiding high paced ventricular rates seem preferable but require special functions to avoid loss of AV synchrony by inappropriate MS. Similarly, fast return to tracking mode after ATA cessation seems preferable but requires algorithms to prevent mode oscillations. Sudden ventricular rate changes have to be avoided by rate smoothing functions, and an appropriate ventricular rate during nontracking mode has to be provided by rate responsive pacing. Programming of the device includes individual optimization of atrial sensitivity, atrial blanking times, and tachycardia detection rates. In addition, a high signal-to-noise ratio by careful atrial lead implantation, narrowly spaced bipolar atrial leads and a good sensing amplifier, together with special algorithms for atrial sensing adjustment improve the performance of MS algorithms.

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Section: Figure 2 Blanked Atrial Flutter ("2:1 Lock-in") Simultaneomentioning

confidence: 99%

Analysis of Mode Switching Algorithms in Dual Chamber Pacemakers

Israel

2002

Pacing Clinical Electrophis

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“…Mode-Switch-Algorithmen, die eine mittlere atriale Frequenz berechnen (MAF; zum Beispiel Medtronic Thera i und Kappa 400 [42], St. Jude-Pacesetter Trilogy und Affinity [36,37]), vergleichen das aktuelle mit ei- Algorithmen zur Detektion atrialer Tachyarrhythmien (AFR = Atrial Flutter Response™; ATR = Atrial Tachycardia Response™; MAF = mittlere atriale Frequenz; np = nicht programmierbar; p = programmierbar; TARP = total atrial refractory period; TDR = tachycardia detection rate; 1 = über einen "Evidenz-Zähler"). Table 1.…”

Section: Prinzipien Verschiedener Mode-switch-algorithmenunclassified

Mode-Switch-Algorithmen: Programmierbarkeit und Nutzen

Israel

2001

Herz

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Improved performance may be achieved by a combination of different mode-switching algorithms (e.g. one algorithm for detection of atrial fibrillation, another one for detection of atrial flutter). In addition, programmability of several algorithms (e.g. mean atrial rate, beat-to-beat, x out of y) within the same device and atrial cycle-dependent sensitivity adjustment similar to automatic gain control in implantable defibrillators may further increase the clinical use of automatic mode switching.

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