dual-chamber timing göran mathson, 2005 reaction to sensing iii 0=none t=triggered i=inhibited...

Dual-Chamber Timing

Göran Mathson, 2005

A-A

A-A

AV Delay

AV and PV interval... Late atrial activation

150 ms250 ms

The AV Delay can be programmed max. 100 ms longer than the PV Delay

A-A

AV Delay

A-A terminated by intrinsic P-wave

A-A

AV Delay

A-A terminated by a PVC A-A – AV delay timer starts on detection of a PVC

A-A

AV Delay

Noise Mode, Atrial Channel

PVARP

Programmable PVARP

Absolute RelativeA-A Interval

A-A

PVARP

VRP Ventricular Refractory Period

AV Delay

A-A

PVARP

VRP

VentricularBlanking Period

AV Delay

125300

325350

375400150

175200

225250

425450

47527512…51ms

Example of programmability...

A-A

PVARP

VRP

MTRI

Maximum Tracking Rate Interval

AV Delay

Maximum Tracking Rate Interval

A-A

PVARP

VRP

MTRI

AV Delay

MTR Interval MTR Interval MTR Interval MTR Interval

Pseudo Wenckebach Upper Rate Behaviour

A-A

PVARP

VRP

MTRI

MSRI

AV Delay

A = Atrial paced event

P = Atrial sensed event

V = Ventricular paced event

R = Ventricular sensed event

Markers…

AV-Pacing

AR-Pacing

PV-Pacing

PR-Pacing

DDD(R) Pacing States

AV-Pacing

DDD(R) Pacing States

PV-Pacing

DDD(R) Pacing States

PR-Pacing

DDD(R) Pacing States

AR-Pacing

DDD(R) Pacing States

AA V PR RV P

Pacing States

Markers

AV

PR

142546

694

170617

759

P

R

Atrial Refractory period

Ventricular Refractory period

DDI Timing

PVARP

VRP

MSRI

AEI

AVI

VEI

AVI

AEI

PVARP

VRP

VEI

MSRI

AVI

AEI

PVARP

VRP

VEI

MSRI

P P P P P PV

AVI

AEI

PVARP

VRP

VEI

MSRI

Intervention-rate

Hysteresisrate

Basic rate

Advanced Hysteresis Response

Cycle Count

Intervention Duration

Sensor

Recovery

Rate

SearchInterval

Cycle Count

A V A V A V A V A VP VAR

AR

P V

Crosstalk…

Crosstalk

Decrease atrial output?

Decrease ventricular sensitivity?

Prolong ventricular blanking?

Enable Ventricular Safety Standby!

Ventricular Safety Standby

Bla

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P

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Cro

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Det

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W

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Ventricular Safety Standby

Crosstalk V. Safety Pacing after 120 ms

Is Ventricular Safety Pacing Present In This Panel?

Vetricular Safety Pacing

Ventricular Safety Standby

Sensing in Crosstalk Detection WindowV. Safety Pacing after 120 ms

Ventricular Safety Standby

Blanking Period UndersensingV. Pacing after programmed AV Interval