2. Low VoltageTechnology Pulse Generator Technology Lead Technology

3. Pulse Generator

4. 1958, 8 October...

5. Identity ADx XL DR

6. Feed Through Defib. protection Capacitors Sensor Crystal Telemetry Coil X-ray marker

7. Golden Thread Welded Bonds All bonding is doubled for safety reasons

8. Magnet Rate <99/min: (and normal energy consumption) 6 months F-U interval 98.6 BOL Magnet Rate ~93/min: (and normal energy consumption) Replacement within 3 months ERI 86.3 Magnet Rate <85/min: Immediate replacement Elective Replacement Indicator Magnet test rate 100 85 EOL EOJ

9. Stimulationrate 63.2 64.5 65.9 67.4 69.0 70.6 Battery impedance kOhms 10 20 30 40 BOL EOL Elective Replacement Indicator

10. 25 20 15 Stimulation current consumption 10 5 Exemple of current drain Single-chamber unit, rate 60min-1 and 500Ω lead imp. Current drain µA Intrinsic current consumption 0,5ms 1,0ms 0,5ms 1,0ms 0,5ms 1,0ms 1,0 Volt 2,5 Volt 7,5 Volt

11. Lead Connectors

12. IS-1 Connector in the Header

13. Tightening the Set Screw

14. How to ”find” the set screw Silicone rubber sealing membrane

15. VS 1 IS-1 IS-1 VS 1B Cordis 3.2 mm IS-1 Different 3.2 mm ”Short Bore” Connectors

16. VS 1A / IS-1 VS 1B / IS-1 IS-1 IS-1 VS 1B Cordis 3.2 mm Different 3.2 mm ”Long Bore” Connectors

17. VS 1B / IS -1 IS-1 IS-1 † Not µ-size cans * Not M/S version Connectors in our Products Sensolog* Dialog* Sensorithm* Regency* Paragon* Synchrony* Trilogy* Affinity* Entity Integrity† Identity† ADx Family†* Microny Integrity µ-size Identity µ-size ADx Family µ-size

18. M, 5 mm S, 6 mm K, 3.2 mm (IS-1) T, 3.2 mm (IS-1) C, 3.2 mm inline (VDD) (for old version AddVent, obsolete now) Bifurcated 3.2 mm (VDD) Connectors

19. Leads

20. Lead position Endocardial Myocardial Epicardial

21. Polarity configuration Bi-polar Uni-polar

22. Advantages - Bi-polar Less risk of myopotential oversensing Less risk of musclestim. Less risk of Crosstalk and Far Field Sensing Uni-polar or bi-polar leads? • 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

23. Far-field sensing Sensing intrinsic activity in the other chamber Crosstalk Sensing pacemaker- activity in the other chamber

25. IS-1 connector Bi-polar Uni-polar

26. Coaxial Coil Design

28. Fixation methods Passive Active

29. Passive and Active Fixation

30. Myocardial lead

31. J-shaped lead (1421T)

32. 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

33. Factors affecting threshold Insulation defects/Conductor failure Lead position Inflammatory reaction Scar tissue Polarisation losses

34. Insulation defect Conductor failure Lead defects

35. I II III V IV What is stimulated? What is sensed? Reaction to sensing MultisitePacing Rate Modulation 0=NoneR=Rate Modulation 0=None A=AtriumV=VentricleD=Dual (A+V) 0=None A=AtriumV=VentricleD=Dual (A+V) 0=NoneT=TriggeredI=InhibitedD=Dual (T+I) 0=None A=AtriumV=VentricleD=Dual (A+V) S=Single (A or V) S=Single (A or V) NASPE/BPEG Generic Pacemaker Code The Revised NASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite Pacing, PACE , Volume 25, No. 2, February 2002