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