How Works

2. How • Works

3. Mitral valve closure can be estimated by measuring the interatrial conduction time (P-wave duration)¹ Onset of isovolemic contraction can be measured using the peak of the R-wave² QuickOpt Timing Cycle OptimizationHypothesis 1Worley, et al. “Optimization of cardiac resynchronization: left atrial electrograms measured at implant eliminates the need for echo and identifies patients where AV optimization is not possible” 2 Koglek, et al. 3 Meine, et al. “IEGM Based Method For Estimating Optimal VV Delay in Cardiac Resynchronization Therapy” Europace Supplements, Vol. 6, June 2004 (#149/2)

4. AS D SAVopt Electronic Optimization of Sensed AV Delays The IEGM estimates inter-atrial conduction delay by measuring the width of the P wave. The QuickOpt™ algorithm utilizes this measurement to calculate the optimal sensed and paced AV delays, with the goal maximizing preload and allowing for proper timing of mitral valve closure. The optimal sensed AV delay is the sum of AS (sensed P wave) and D (an added interval that allows for ventricular filling). The interval added is 30 or 60 ms, depending on the measured P Wave. A short P wave would have a longer interval added, while a longer P wave would have a shorter interval added. SAVopt = AS + D D = 30 or 60 ms SAV is Sensed AV Delay AS is sensed P wave D is added interval

5. Electronic Optimization of Sensed AV Delays Short P Wave Example QRS AS + D = SAVopt 50 + 60 = 110 time AS D SAVopt Long P Wave Example QRS AS + D = SAVopt 120 + 30 = 150 time AS D SAVopt SAVopt = AS + D D = 30 or 60

6. Electronic Optimization of Paced AV Delays • If sensed AV Delay is 110 ms then the paced AV Delay would be: • 110 ms + 50 ms = 160 ms • If the sensed AV Delay is 150 ms then the paced AV Delay would be: • 150 ms + 50 ms = 200 ms

7. QuickOpt Timing Cycle OptimizationProgrammability QuickOpt electrically characterizes the conduction properties of the heart and calculates the optimal sensed and paced AV delays

8. QuickOpt Timing Cycle OptimizationProgrammability • Tests can be run automatically or manually • Parameters required for testing are adjusted • automatically

9. QuickOpt Timing Cycle OptimizationTest in Progress • Automatic testing performs all relevant tests

10. QuickOpt Timing Cycle OptimizationResults • Results are displayed in about a minute

11. QuickOpt Timing Cycle OptimizationResults • Press “Manual Testing and Results”

12. QuickOpt Timing Cycle OptimizationResults • Display of Optimized values and EGM button 90 + 60 = 150 ms 150 + 50 = 200 ms

13. QuickOpt Timing Cycle OptimizationResults • Display of EGM

14. QuickOpt Timing Cycle OptimizationResults • If the test was unable to be performed at the • current settings a message prompts you to • make changes

15. QuickOpt Timing Cycle OptimizationSummary • QuickOpt can be used as a practical approach to optimizing all patients, can be the optimal AV delay to use as a start before VIP™ extension • Allows frequent optimization (at every follow-up) in response to changing timing cycles • Quick and easy • Clinically proven • QuickOpt provides optimized therapy…not just another diagnostic • Why wouldn’t you want the option to optimize all patients?