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Low VoltageTechnology
Pulse Generator TechnologyLead Technology
Pulse Generator
1958, 8 October...
Identity ADx XL DR
Feed Through
Telemetry Coil
Sensor
X-ray marker
Capacitors
Defib. protection
Crystal
All bonding is doubled for safety reasons
Golden Thread Welded Bonds
Magnettest rate
100
85
Magnet Rate <99/min:(and normal energy consumption)
6 months F-U interval
Magnet Rate ~93/min:(and normal energy consumption)
Replacement within 3 months
Magnet Rate <85/min:Immediate replacement
Elective Replacement Indicator
98.6
BOL
86.3ERI
EOL
EOJ
Stimulationrate
63.2
65.9
67.4
69.0
70.6
64.5
EOLBOL10 20 30 40
Battery impedance kOhms
Elective Replacement Indicator
5
10
15
20
25
Cur
rent
dra
in µ
A
0,5ms 1,0ms
1,0 Volt
0,5ms 1,0ms
2,5 Volt
0,5ms 1,0ms
7,5 Volt
Single-chamber unit, rate 60min-1 and 500Ω lead imp.
Intrinsic current consumption
Stimulation current consumption
Exemple of current drain
Lead Connectors
IS-1 Connector in the Header
Tightening the Set Screw
Silicone rubber sealing membrane
How to ”find” the set screw
VS 1
IS -1
IS -1
Cordis 3.2 mm
VS 1B
IS -1
Different 3.2 mm ”Short Bore” Connectors
IS -1
Cordis 3.2 mm
VS 1B
IS -1
VS 1A / IS -1
VS 1B / IS -1
Different 3.2 mm ”Long Bore” Connectors
VS 1B / IS -1 IS -1 IS -1
Sensolog*Dialog*
Sensorithm*Regency*Paragon*
Synchrony*Trilogy*Affinity*
Entity
Integrity†
Identity†
ADx Family†*
Integrity µ-size Identity µ-size
ADx Family µ-size
Microny
† Not µ-size cans* Not M/S version
Connectors in our Products
Connectors
M, 5 mm
S, 6 mm
K, 3.2 mm (IS-1)
T, 3.2 mm (IS-1)
Bifurcated 3.2 mm (VDD)
C, 3.2 mm inline (VDD)(for old version AddVent, obsolete now)
Leads
Endocardial
Myocardial
Epicardial
Lead position
Bi-polar Uni-polar
Polarity configuration
Advantages - Bi-polar
• Less risk of myopotential oversensing
• Less risk of musclestim.• Less risk of Crosstalk and
Far Field Sensing
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
( )
Uni-polar or bi-polar leads?
Far-field sensingSensing intrinsic
activity in the other chamber
CrosstalkSensing pacemaker- activity in the other chamber
Bi-polar
Uni-polar
IS-1 connector
Coaxial Coil Design
Passive Active
Fixation methods
Passive and Active Fixation
Myocardial lead
J-shaped lead(1421T)
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
Lead position
Inflammatory reaction
Scar tissue
Polarisation losses
Insulation defects/Conductor failure
Factors affecting threshold
Insulation defect
Conductor failure
Lead defects
Reaction to sensing
III
0=NoneT=TriggeredI=InhibitedD=Dual (T+I)
Rate Modulation
IV
0=None R=Rate Modulation
What is stimulated?
I
0=NoneA=AtriumV=VentricleD=Dual (A+V)
S=Single(A or V)
MultisitePacing
V
0=NoneA=AtriumV=VentricleD=Dual (A+V)
What is sensed?
II
0=NoneA=AtriumV=VentricleD=Dual (A+V)
S=Single(A or V)
The Revised NASPE/BPEG Generic Code forAntibradycardia, Adaptive-Rate, and MultisitePacing, PACE , Volume 25, No. 2, February 2002
NASPE/BPEG Generic Pacemaker Code