BIOTRONIK ProMRI Estella SR Manual Tecnico página 11

Setting triggered mode
Triggered modes perform pacing regardless of intrinsic cardiac events. To prevent
undersensing due to electromagnetic interference in special cases, a triggered mode
can be displayed.
Avoiding asynchronous pacing
High pacing rates with long refractory periods (A/V) can lead to intermittent,
asynchronous pacing. Such programming can be contraindicated in some cases.
Setting sensing
Manually set parameters can be unsafe. For example, unsuitable far-field protection
may impede sensing of intrinsic pulses.
• Use automatic sensitivity control.
Setting the sensitivity
A value set to < 2.5 mV/unipolar for device sensitivity may result in noise caused by
electromagnetic fields.
• Therefore, it is recommended that a value of ≥ 2.5 mV/unipolar be set according to
paragraph 28.22.1 of the EN 45502-2-1 standard. Setting sensitivity values < 2.5
mV/unipolar requires explicit clinical need. Values like this can only be set and
retained with physician supervision.
Preventing device-induced complications
BIOTRONIK devices are equipped with several functions to prevent device-induced
complications to the greatest extent possible:
• Measure the retrograde conduction time.
• If the function is not yet automatically set: activate PMT protection.
• Set the VA criterion.
Information on magnet response
Applying a magnet or the programming head can result in an unphysiological rhythm
change and asynchronous pacing. The magnet response is set as follows in the
standard program of BIOTRONIK pacemakers:
• Asynchronous:
For the duration of the magnet application – mode D00 (possibly V00 / A00) without
rate adaptation;
Magnet rate: 90 bpm
• Automatic:
For 10 cycles – mode D00, subsequently mode DDD without rate adaptation;
Magnet rate: 10 cycles with 90 bpm, subsequently set basic rate
• Synchronous:
Mode DDD without rate adaptation;
Magnet rate: set basic rate
Note: See information pertaining to replacement indications for magnet behavior at
ERI.
Preventing conduction of atrial tachycardia
BIOTRONIK devices are equipped with several functions to prevent conduction of atrial
tachycardia to the ventricle(s):
• Set Mode Switching for indicated patients.
• Set the upper rate and the refractory periods to prevent abrupt ventricular rate
switching.
• Give preference to Wenckebach response and avoid 2:1 behavior.
• Set all parameters so as to prevent constant changing between atrial and
ventricular-controlled modes.
If an ICD is implanted at the same time, do not permit unipolar pacing
If an ICD is implanted in addition to a pacemaker and a lead failure occurs, it is possible
to switch to unipolar pacing after resetting the pacemaker or using the automatic lead
check. As a result, the ICD could falsely inhibit or trigger tachyarrhythmia therapy
activity.
• Unipolar leads are not permitted in this configuration.
Consider power consumption and service time
The pacemaker permits programming of high pulse amplitudes with long pulse widths
at high rates to be able to adequately treat even rare diagnoses. In combination with
low lead impedance, this results in a very high level of power consumption.
• When programming large parameter values, take into account that the battery
depletion indicator ERI will be reached very early because the service time of the
battery may be reduced to less than 1 year.
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