Programming Technology/Features

Question 1

What is implant detection algorithm?

Answer 1

Initial programming parameters present in device prior to implant

Question 2

When is implant detection algorithm triggered?

Answer 2

when lead is introduced into the header and device starts recognizing unipolar and bipolar pacing changes

Question 3

How does lead monitor algorithm operate?

Answer 3

measures lead impedance and can switch from bipolar to unipolar when low or high impedance is detected.

Question 4

What are the three programmable lead monitor algorithms?

Answer 4

Configure
Adaptive
Monitor Only

Question 5

What are the four basic steps of AutoCapture pacing system?

Answer 5

Capture confirmation
Loss of capture recovery
Threshold search
Automatic output regulation

Question 6

What factors can increase pacing thresholds?

Answer 6

medication
hydration
temperature
sleep
electrolytes

Question 7

What is the goal of automatic PVARP algorithms?

Answer 7

Provide higher 2:1 block rate by shortening the PVARP and SAV at higher tracking rates

Protect against PMT at lower rates by providing longer PVARP

Question 8

How do sinus preference algorithms work?

Answer 8

Avoid unnecessary atrial pacing by searching for intrinsic atrial rates that are close to the sensor indicated rates

Question 9

How do rate adaptive AV algorithms work?

Answer 9

Shortens the SAV and PAV times as the heart rate increases to mimic the heart’s normal conduction system

Question 10

What is the purpose of Search AV+ and similar algorithms?

Answer 10

Prevent unnecessary RV pacing by extending AV delays to promote intrinsic conduction

Question 11

What is the purpose of a ventricular rate stabilization (VRS) algorithm?

Answer 11

reduce the incidence of variability of R-R intervals as a way of decreasing symptoms associated with the occurrence of AF/AFL RVR

Question 12

How does VRS work?

Answer 12

Monitors the last two R-R intervals
Maintains V pacing within a few beats per minute
Modifies the V pace rate to avoid sudden changes in the R-R interval

Question 13

What is the goal of atrial preference pacing (APP)?

Answer 13

Provides continuous pacing slightly faster than sinus rate to reduce triggers of atrial arrhythmias such as PACs

Question 14

How does APP work?

Answer 14

Dynamically adjusts the pacing escape interval in response to AS events

After programmable period of 100% AP, gradually reduces rate to more closely match sinus rate

Next sinus beat reinitiates APP

Question 15

What is the purpose of conducted AF Response (CAFR)?

Answer 15

Regularize V-V intervals in patients with an irregular ventricular response during AF

Question 16

How does the CAFR algoirthm regularize ventricular rates during AF?

Answer 16

Modify the ventricular pacing rate to be faster when ventricular sensed events occur and slower when ventricular pacing pulses occur during periods of AT/AF

Question 17

What is post mode switch overdrive pacing (PMOP)?

Answer 17

Provides overdrive AAI pacing following the termination of an atrial arrhythmia to prevent early recurrences of AF

Question 18

How does non-competitve atrial pacing (NCAP) work?

Answer 18

Prohibits pacing into the atrial vulnerable period when a premature atrial contration occurs during PVARP

When programmed on, AS falling in refractory period starts a 300ms NCAP period during which no atrial pacing may occur

Question 19

What is the goal of rate hysteresis?

Answer 19

Promote intrinsic conduction and limit unnecessary RV pacing

Question 20

How does hysteresis work?

Answer 20

At intermittent intervals for programmed amount of time, device will search for intrinsic activity below the base rate but above the hysteresis rate.
If there is intrinsic conduction, the device will continue to allow for lower rates.
If there is pacing at this point, hysteresis will end until next timed interval.

Question 21

How does managed ventricular pacing (MVP) algorithms work?

Answer 21

Allows the device to stay in atrial based pacing mode until pre-assigned number of non-conducted P waves occur at which time the device with switch to DDD pacing.

Question 22

How does ventricular intrinsic preference (VIP) help to reduce RV pacing?

Answer 22

Extends the paced/sensed AV delays when intrinsic conduction is detected

Question 23

What is the strength of indication for PPM insertion in vasovagal syncope?

Answer 23

Class IIB

Question 24

What is Auto Rest Rate (ARR) and how does it work?

Answer 24

Rate that is lower than base rate and is utilized during patient sleep
Only available in devices with rate response
Device monitors patterns on inactivity to determine when patient is sleeping

Question 25

How does ventricular safety pacing algorithms work?

Answer 25

110ms safety interval is started in the V channel in response to atrial PACED event.
If any ventricular sensed event occurs within the 110ms interval, v pacing will occur at the end of that interval.
Only AP events can trigger safety pacing, no AS events.

Question 26

What is the purpose of PVC response algorithms?

Answer 26

Prevent tracking of retrograde P waves generated by PVCs leading to PMT (in DDD/DDDR/VDD modes).
Prevents inhibition of atrial pacing that can result from retrograde P waves (in DDIR/DDI modes)