5.1.2. Therapies

Disease management section spans two pages covering brady and tachy data reported since the last transmission:

  • Brady Therapies
  • Tachy Therapies and Episodes
  • Ventricular Arrhythmia History and Atrial Arrhythmia History
  • Summary graph
  • SonR graph

5.1.2.1. Brady Therapies

Brady therapies section provides the value of the following brady parameters and statistics:

  • Pacing mode
  • Basic rate
  • Max Rate
  • AVD at rest and in exercise
  • AVD offset
  • Ventricular sensitivity
  • Number of detected PMT episodes
  • Number of Mode Switches
  • Total Time in Mode Switch
  • V chamber
  • VV delay
  • Multipoint LV pacing (MP)

5.1.2.1.1. Brady Graphs

The 24 Hour Heart Rate Curve
The trend of the ventricular heart rate detected in the 24 hours preceding the transmission shows the paced rhythm in blue and the spontaneous rhythm in green
Cardiac Cycles
In DDD, DDD-R, DDD/DDIR, SafeR and SafeR-R modes, the distribution graph provides information about:
  • atrial ventricular association during paced and sensed rhythm
  • information about cycles during atrial arrhythmia and PVCs
  • The percentage of rate responsive paced cycle is displayed in red
  • First 4 bars show the percentage of Ap-Vp, Ap-Vs, As-Vp and As-Vs cycles with respect to the total number of cardiac cycles
  • Last 4 bars show the percentage of PAC-Vs, Vp, Vs events during Atrial Arrhythmia and the percentage of PVC, computed with respect to the total number of cardiac cycles
In VVI and VVIR, the distribution graph displays Vp, Vs, Vs acc.
In DDI and DDIR, the distribution graph displays Ap-Vp, Ap-Vs, As-Vs, Vp, Vs, Vs acc.

5.1.2.2. Tachy Therapy and Episodes

This section is composed of a table and a summary. The table is divided in two parts: the top part gives information about episodes detected and therapies applied, while the bottom part consists of the programmed tachy therapies.

The upper part of the table shows the BTO feature, highlighting the overlap in rate between the pacing zone and the SlowVT zone (or VT zone when slow VT zone not programmed).

Recorded Data
The upper part of the table is structured as the table provided in the Disease Management Summary. It presents the arrhythmic episodes detected and the therapies delivered by the device.
  • Columns: automatically detected rhythms:
    • Slow VT
    • VT
    • FVT/VF
    • SVT->VT
    • Total: cumulative number for each row
    • SVT/ST: no treatments are possible
  • Rows: total number of episodes detected, applied therapies
    • Episodes: total number of episodes detected (in bracket for episodes treated)
    • ATP: events treated by ATP (in brackets for episodes treated successfully)
    • Shocks: events treated by shock (in brackets for episodes treated successfully)
    • Shocks 42J: events treated by max energy shock (in brackets for episodes treated successfully)
  • Cell: number of events recorded for the corresponding detected rhythm (column) and the corresponding therapy (row)

If one or more shocks (or Max energy shocks) applied for a specific detected rhythm was not effective, the associated cell will be highlighted.

5.1.2.2.1. Programmed Therapies

The bottom part of the table reports the therapies programmed for the different detection zones: Slow VT (Slow VT ON), VT (VT ON), FVT/VF (VF ON).

This table resembles the display in the programmer.

  • Detection: shows the detection algorithm working for the different zones
  • ATP1 and ATP2: show the ATP programmed for the different zones (OFF is a possible value)

    If the programmable parameter "Enable ATP" is programmed OFF all the cells related to ATP will show the value OFF

  • Shock1 and Shock2: show the energy programmed for the first two shocks in the different zones if some are programmed (OFF is a possible value)

    If OFF in a VF zone, the corresponding cell will be highlighted

  • 42J Shock: shows the max number of shocks at max energy that will be applied in case of multiple inefficient shocks

    4 is the maximum programmable and OFF is a possible value except for VF zone in which 1 is the minimum allowed

    If the number of max energy shocks in VF zone is different from 4, the cell will be highlighted

If the programmable parameter Enable Shocks is programmed OFF all the cells related to Shocks will show the value OFF. Data regarding shocks in VF zone will be highlighted.

Summary Panel
The summary panel provides the following data regarding shocks and ATP:
  • Last Shock: date of last shock applied with:
    • Impedance of shock (ohms)
    • Charge time (s)
    • Energy (J) programmed and delivered
  • Total shocks since implant
  • Total charges since implant
  • Deleterious ATP since last remote follow-up.
    • highlighted if different from 0
Ventricular Arrhythmia History
Provides a list of arrhythmic episodes that have been automatically detected as sustained ventricular arrhythmia and recorded by the device since the last transmission.

The list displays:

  • Only recorded episodes, not all detected
    • The total number of episodes recorded by the device cannot be higher than 16, including ventricular and atrial ones
    • If more than 16, the device automatically prioritises ventricular when selecting the ones to be kept
    • Listed in chronological order descending from the most recent episode
  • Each row corresponds to a different episode recorded
    • Multiple episodes detected in the same day are grouped by a grey background color. Episode date is not repeated if more episodes happen in the same day.

The total number of ventricular events detected is provided in the Tachy Therapies and Episodes section.

For each episode the following information are provided:

  • Type of rhythm detected
    • Different types of rhythm are displayed in 4 corresponding columns to quickly select the episodes of a specific type and they can be VF, VT, Slow VT, SVT ->VT
  • Duration in seconds
  • Date
  • Time
  • Treated or Not Treated
  • Most critical therapy applied
  • ATP and Shocks are reported in two different columns to quickly select the episodes treated with a specific therapy
  • A separate EGM Report provides the sustained episodes recorded by the implantable device since the last transmission to analyze the corresponding EGM and tachogram

Last row provides the total number of episodes recorded categorized for Rhythm type.

5.1.2.2.2. Atrial Arrhythmia History

The list displays:

  • Only recorded sustained episodes, not all detected
    • The total number of episodes recorded by the device cannot be higher than 16, including ventricular and atrial ones
    • If more than 16, the device automatically prioritizes ventricular when selecting the ones to be kept
    • Listed in chronological order descending from the most recent episode
  • Each row corresponds to a different episode recorded
    • Multiple episodes detected in the same day are grouped by a grey background color. (Episode date is not repeated if several episodes happened in the same day.)

For each episode the following information are provided:

  • Type of event detected
    • Mode Switch
    • SVT/ST
  • Duration
  • Date
  • Time
  • An EGM Report is provided for all episodes (including ventricular ones), to analyze the corresponding EGM and tachogram (episodes are marked in the EGM Report column)

5.1.2.2.3. Non-Sustained Arrhythmia History

When Non-Sustained Episodes are activated in the CLINIC profile, the non-sustained arrhythmia history provides a list of non sustained episodes that have been detected and recorded by the device since the last transmission. By definition, those episodes are not persistent and are not treated.

The origin of those episodes may be physiological:

  • atrial runs, or
  • ventricular runs

or not physiological:

  • due to oversensing such as myopotentials, or
  • interferences with external signals / noise

For each episode, the following information is provided:

  • Type of event: Non-sustained
  • Date 
  • Time

5.1.2.2.4. Summary

The summary graph is composed of several 6 month records synthesized to present a snapshot of the patient's cardiac rhythm. Trends are synchronized.

Heart Rate
The heart rate trends the two daily means of atrial rhythm line and ventricular rhythm.
V Pacing
Trend of ventricular pacing percentage, computed with respect to the total number of ventricular cycles.
VT/VF Episodes
Histograms show the daily number of ventricular arrhythmic episodes. (All detection zones are included: Slow VT, VT, FVT, VF)
  • blue: treated episodes
  • red: not treated
Time in AF
Trend of the daily time spent in AF by the patient.
SonR
Available when CRT optimization is activated, the SonR graph displays the following three trends:
  1. VV delay at rest, both programmed value (in red) and optimal value as based on automatic SonR evaluation (in black)
  2. Sensed AV delay at rest, both programmed value (in red) and optimal value as based on automatic SonR evaluation (in black)
  3. Weekly mean of SonR signal amplitude. Values are measured in g (gravital acceleration).