Medical Education Implant Procedure Concepts

1 1 4 Device 7. Disclaimer Troubleshooting Differentiators 2 5 LV Lead 8. Objectives Precautions Placement 3 RA & RV Lead 6 9. Magnets Questions Placement Medical Education Implant Procedure Concepts Pacemaker, ICD and CRT Overview Disclaimer Medical Education Pacemaker, ICD, and CRT This presentation is provided with the understanding that Overview the slide content must not be altered in any manner as the Disclaimer content is subject to FDA regulations. Objectives This presentation is to be used in conjunction with other RA & RV Lead resource material including the applicable Boston Scientific Placement device physician's manual and any Implant accessories Device instructions for use. Differentiators This presentation is not intended to replace Implant training. LV Lead Placement Magnets Proper surgical procedures and techniques are the responsibilities of the Medical professional. Troubleshooting If this presentation is not used in its entirety, the following Precautions information must be included: Summary /.

2 Questions Appropriate Indications Contraindications Warnings Precautions and Adverse Events 2 2007 Boston Scientific Corporation Objectives Medical Education Pacemaker, ICD, and CRT When we complete this program you will be able to: Overview Disclaimer List the primary difference between a pacemaker and an implantable cardioverter defibrillator (ICD). Objectives RA & RV Lead Identify the purpose of a biventricular Placement pacing/defibrillation system Device Differentiators Explain the differences between magnet response in a LV Lead Placement pacemaker vs. an ICD. Magnets List one Medical Procedure that is not recommended for Troubleshooting patients with implanted devices Precautions Summary /. Questions 3 2007 Boston Scientific Corporation Lead Placement Medical Education Pacemaker, ICD, and CRT. Overview Disclaimer Objectives RA & RV Lead Placement Device Differentiators LV Lead Placement Magnets Troubleshooting Precautions Summary /.

3 Questions 4 2007 Boston Scientific Corporation Device Differentiators Medical Education Pacemaker, ICD, and CRT Pacemaker Overview Disclaimer Purpose Objectives Maintain rhythm (bradyarrhythmias). RA & RV Lead Selections Placement Single or dual chamber Device Differentiators Rate-responsive or sensor-driven abilities LV Lead Placement Longevity Magnets Size Troubleshooting Precautions Summary /. Questions 5 2007 Boston Scientific Corporation Device Differentiators Medical Education Pacemaker, ICD, and CRT Implantable Cardioverter Defibrillator (ICD). Overview Disclaimer Purpose Objectives Break fast arrhythmias (tachyarrhythmias) all ICDs have pacemakers RA & RV Lead Placement Selections Device Differentiators Single (ventricular) or dual chamber models LV Lead Placement Rate-responsive or sensor-driven abilities Magnets Size Troubleshooting Longevity Precautions Summary /. Questions 6 2007 Boston Scientific Corporation Device Differentiators Medical Education Pacemaker, ICD, and CRT Biventricular or Cardiac Resynchronization Therapy (CRT).

4 Overview Disclaimer Purpose Objectives CRT/CRT-D improves the symptoms of heart failure RA & RV Lead Involves placement of three leads (right atrium, right Placement ventricle and left ventricle). Device Differentiators Goal is to pace the ventricles 100%. LV Lead Placement Selections Magnets Both pacemaker and ICD/pacemaker options available Troubleshooting Precautions Summary /. Questions 7 2007 Boston Scientific Corporation Biventricular Lead Placement Medical Education Pacemaker, ICD, and CRT. Overview Disclaimer Objectives RA & RV Lead Placement Device Differentiators LV Lead Placement Magnets Troubleshooting Precautions Summary /. Questions 8 2007 Boston Scientific Corporation Magnets Medical Education Pacemaker, ICD, and CRT How do magnets affect implantable devices? Overview Disclaimer Application of a magnet affects all pacemakers and ICDs Objectives Pacemakers and ICDs respond differently RA & RV Lead Placement Doughnut, horseshoe or rectangular magnet shapes will Device work on most devices (however, a doughnut magnet will Differentiators work with all devices).

5 LV Lead Placement Magnets Troubleshooting Precautions Summary /. Questions 9 2007 Boston Scientific Corporation Magnets Medical Education Pacemaker, ICD, and CRT What happens when a magnet is applied to a pacemaker? Overview Disclaimer Cause the device to pace in a DOO, VOO, or AOO mode depending on programming Objectives RA & RV Lead Pacing rate is dependent on the company and model (but Placement usually 80-100). Device Differentiators Output is usually the programmed output LV Lead Placement Magnets Troubleshooting Precautions Summary /. Questions 10 2007 Boston Scientific Corporation Magnets Medical Education Pacemaker, ICD, and CRT What happens when a magnet is applied to an ICD? Overview Disclaimer Will inhibit tachy therapy when magnet is present Objectives Does not affect the pacing settings or the ability of the RA & RV Lead device to pace and sense Placement Device Differentiators LV Lead Placement Magnets Troubleshooting Precautions Summary /.

6 Questions 11 2007 Boston Scientific Corporation Magnets Medical Education Pacemaker, ICD, and CRT So do we really need to use magnets? Overview Disclaimer Objectives RA & RV Lead Placement Device Differentiators LV Lead Placement Magnets Troubleshooting Precautions Summary /. Questions Note: Use caution for your pacer-dependent patient if cautery is used 12 2007 Boston Scientific Corporation Troubleshooting Medical Education Pacemaker, ICD, and CRT. Overview There are several features in Disclaimer I don't see any devices that may affect Objectives pacer spikes, the pacing function RA & RV Lead device isn't Placement working right. Telemetry can interfere with Device pacing spike display Differentiators LV Lead Placement Main concern should be Magnets whether or not the rhythm is regular and safe for the Troubleshooting patient Precautions Summary /. Questions 13 2007 Boston Scientific Corporation Troubleshooting Medical Education Pacemaker, ICD, and CRT.

7 Overview Determine if the patient has an Disclaimer I think that ICD, Pacemaker, or both Objectives something is RA & RV Lead wrong, what Determine the company of Placement should I do now? patient's device Device Differentiators Contact appropriate rep or LV Lead Placement technical services for quicker service Magnets Troubleshooting Record rhythm strips to Precautions illustrate the problem you are seeing Summary /. Questions Gather as much information as possible with regard to device settings 14 2007 Boston Scientific Corporation Troubleshooting Medical Education Pacemaker, ICD, and CRT. Overview Disclaimer Knowing just a few of the device settings can give you Objectives Is this thing a lot of information about RA & RV Lead working right? how the device should be Placement operating Device Differentiators Pacing mode LV Lead Placement Lower rate limit (LRL) . Magnets slowest the rhythm should Troubleshooting be allowed to go Precautions Upper rate limit (URL, MTR, MSR) maximum Summary /.

8 Questions rate the pacemaker is allowed to pace AV delay the PR interval of the device 15 2007 Boston Scientific Corporation Troubleshooting Medical Education Pacemaker, ICD, and CRT Common Questions Overview Disclaimer Pacing into the QRS complex Objectives Indicates a potential oversensing or undersensing issue RA & RV Lead Placement Can also be fusion between the pace complex and the Device intrinsic complex Differentiators LV Lead Placement Magnets Troubleshooting Precautions Summary /. Questions 16 2007 Boston Scientific Corporation Troubleshooting Medical Education Pacemaker, ICD, and CRT Common Questions Overview Disclaimer Patient is in VT but device is not doing anything, what should I do? Objectives Use your Medical judgment, if patient is unstable don't RA & RV Lead Placement wait for the device to act, proceed with external Device cardioversion Differentiators Contact the company to have device interrogated LV Lead Placement Magnets Troubleshooting Precautions Summary /.

9 Questions 17 2007 Boston Scientific Corporation Precautions Medical Education Pacemaker, ICD, and CRT Items that are considered safe Overview Disclaimer Microwave ovens Safe Items Objectives Televisions, VCRs RA & RV Lead AM/FM Radios, CD players Placement Table top appliances Device Differentiators (toasters, blenders, can openers, etc.). LV Lead Placement Hand-held appliances Magnets (shavers, hair dryers, etc.). Troubleshooting Electric blankets, heating Common Questions pads Precautions Personal computers Summary / Fax/copy machines Questions 18 2007 Boston Scientific Corporation Precautions Medical Education Pacemaker, ICD, and CRT Items that are considered safe at a distance Overview Disclaimer Stereo speakers 12+ inches away Objectives Slot machines RA & RV Lead Placement Chain saws Device Differentiators Hedge clippers LV Lead Placement Magnets Arc welders Troubleshooting Battery-powered tools Common Questions Running motors/alternators Precautions Summary /.

10 Questions 19 2007 Boston Scientific Corporation Precautions Medical Education Pacemaker, ICD, and CRT Cell Phones Overview Disclaimer Hold the cell phone on 6+ inches away the opposite side Objectives RA & RV Lead Placement Do not carry the active phone near the device Device Differentiators LV Lead Placement Magnets Troubleshooting Common Questions Precautions Summary /. Questions 20 2007 Boston Scientific Corporation Precautions Medical Education Pacemaker, ICD, and CRT Metal Detectors / Security Systems Overview Disclaimer Walk through the systems at a normal pace Objectives RA & RV Lead Do not lean against the Placement system Device Differentiators If scanning with a hand- LV Lead Placement held metal detector is Magnets required Photo courtesy Federal Aviation Administration (FAA). Troubleshooting Inform the security Common personnel of the Questions implanted electronic Precautions Medical device Summary / Show Implant card Questions 21 2007 Boston Scientific Corporation Precautions Medical Education Pacemaker, ICD, and CRT EMI from Medical Devices Overview Disclaimer Electrocautery Objectives Cardioversion RA & RV Lead Placement TENS (Transcutaneous Device Differentiators electrical nerve LV Lead Placement stimulation).