Arc Welding and Implanted Medical Devices

Arc Welding and Implanted Medical Devices
A Closer Look
SUMMARY
Electromagnetic Interference (EMI) is the
disruption of normal operation of an
electronic device when it is in the vicinity of
an electromagnetic field created by another
electronic device.
Electric arc welding refers to a process that
uses a power supply to create an electric
arc between two metals.
This article describes the potential interaction
between the arc welder and Boston Scientific
implantable pacemakers and defibrillators. It
also provides suggestions to minimize
potential interactions.
Products Referenced
All CRM ICDs, S-ICDs, CRT-Ds,
CRT-Ps, and Pacing Systems
Products referenced are unregistered or
registered trademarks of Boston Scientific
Corporation or its affiliates. All other trademarks
are the property of their respective owners.
For comprehensive information on device
operation, reference the full instructions for use or
found at: www.bostonscientific-elabeling.com.
CAUTION: The law restricts this device to sale by
or on the order of a physician.
Products referenced herein may not be approved in
all geographies. Information is for the use in
countries with applicable Health Authority product
registrations. All graphics produced by Boston
Scientific Corporation, unless otherwise noted.
CRT-D:
CRT-P:
ICD:
S-ICD:
Cardiac Resynchronization Therapy Defibrillator
Cardiac Resynchronization Therapy Pacemaker
Implantable Cardioverter Defibrillator
Subcutaneous Implantable Defibrillator
Contact Information
www.bostonscientific.com
Americas
Technical Services
LATITUDETM Customer Support
1.800.CARDIAC (227.3422)
+1.651.582.4000
Patient Services
1.866.484.3268
Europe, Middle East, Africa
Technical Services
+32 2 416 7222
intltechservice@bsci.com
LATITUDE Customer Support
latitude.europe@bsci.com
Japan
Technical Services
japantechservice@bsci.com
LATITUDE Customer Support
japan.latitude@bsci.com
Arc Welding and Implanted Medical Devices
Description
The electrical signals generated by arc welders may interfere with the proper
function of ICDs, S-ICDs, CRT-Ds, CRT-Ps or pacing systems. This interference
may have the potential to be interpreted by the device as electrical noise or as
electrical activity of the heart. Such interference may result in temporary
asynchronous pacing (loss of coordination between the heart and the device),
inhibition of pacing and/or shock therapy (therapy not delivered when required),
or inappropriate tachyarrhythmia therapy (therapy delivered when not required).
This article refers to Gas Metal Arc Welding—including Metal Inert Gas (MIG)
and Metal Active Gas (MAG)—Manual Metal Arc (MMA),Tungsten Inert Gas
(TIG) welding, and plasma cutting. For questions regarding inductive or spot
welding, or welding using current greater than 160 amps, please contact
Technical Services.
Potential EMI interactions
Electromagnetic interference (EMI) may occur when electromagnetic waves from
one electronic device interfere with the operation of another electronic device.
Electromagnetic waves of sufficient amplitude, pulse width, and/or frequency,
generated within the proximity of an implanted pacemaker or defibrillator may
result in unnecessary shock therapy or inhibition of pacing therapy when needed.
Arc Welding considerations
Should arc welding be performed, Boston Scientific recommends that
patients maintain a distance of 24 inches (60 centimeters) between their
implanted device and the arc welding equipment (i.e., the power supply,
cabling, and the arc). If symptoms of faintness, dizziness, nausea, shocks etc.
are felt, stop immediately and step away from the area or turn off the equipment.
The risk of interference is minimized by using the lowest current setting possible.
Other arc welding considerations include, but are not limited to:
• Strictly follow the safety precautions mentioned in the welder manual.
• Work in a dry area. Wear dry, electrically insulated gloves and dry shoes.
• Keep all cables straight, close together, and extending away from the body.
Do not coil cables.
• Arrange the work area so that the handle and rod will not contact the metal
being welded.
• Use short, intermittent, and irregular bursts at the lowest feasible energy
levels; wait several seconds between welds. Do not weld with rapidly
repeating short bursts, as they are more likely to be interpreted as electrical
activity of the heart.
• Ensure all equipment is properly grounded and is in proper working condition.
• Limit welding currents to less than 160 Amps.
Asia Pacific
Technical Services
+61 2 8063 8299
aptechservice@bsci.com
LATITUDE Customer Support
latitudeasiapacific@bsci.com
© 2016 by Boston Scientific Corporation
or its affiliates. All Rights Reserved.
March 25, 2016
002-1376, Rev. C, US
Page 1 of 1
CRT-D System from Boston Scientific - COGNIS TM
Indications and Usage
These Boston Scientific Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) are indicated for patients with heart failure who receive stable optimal pharmacologic therapy (OPT) for heart failure
and who meet any one of the following classifications:
• Moderate to severe heart failure (NYHA Class III-IV) with EF ≤ 35% and QRS duration ≥ 120 ms
• Left bundle branch block (LBBB) with QRS ≥ 130 ms, EF ≤ 30%, and mild (NYHA Class II) ischemic or nonischemic heart failure or asymptomatic (NYHA Class I) ischemic heart failure
Contraindications
There are no contraindications for this device.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. For single patient use only. Do not reuse, reprocess, or resterilize. Program the pulse generator
Tachy Mode to Off during implant, explant or postmortem procedures. Always have sterile external and internal defibrillator protection available during implant and electrophysiologic testing. Ensure that
an external defibrillator and medical personnel skilled in CPR are present during post-implant device testing. Advise patients to seek medical guidance before entering environments that could adversely
affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI
scanning. Do not subject a patient with an implanted pulse generator to diathermy, Do not use atrialtracking modes in patients with chronic refractory atrial tachyarrhythmias. Do not use atrial-only modes
in patients with heart failure. LV lead dislodgment to a position near the atria can result in atrial oversensing and LV pacing inhibition. Physicians should use medical discretion when implanting this device
in patients who present with slow VT. Do not kink, twist or braid the lead with other leads. Do not use defibrillation patch leads with the CRT-D system. Do not use this pulse generator with another pulse
generator. For Patient Triggered Monitor (PTM) feature, make sure the feature is enabled prior to sending the patient home with a magnet. Once the PTM feature has been triggered and the magnet
response programming is set to inhibit therapy, the patient should not reapply the magnet.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization, storage and handling; implant and device programming; follow-up testing;
explant and disposal; environmental and medical therapy hazards; hospital and medical environments; home and occupational environments. Advise patients to avoid sources of electromagnetic
interference (EMI) because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
Potential Adverse Events
Potential adverse events from implantation of the CRT-D system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias,
lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, and component failure.
Patients may develop psychological intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases severe complications or
device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only. (Rev. S)
CRT-D Systems from Boston Scientific – PUNCTUATM , ENERGENTM , and INCEPTATM
Indications and Usage
The PUNCTUATM, ENERGENTM, and INCEPTATM Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) are indicated for patients with heart failure who receive stable optimal pharmacologic therapy
(OPT) for heart failure and who meet any one of the following classifications:
• Moderate to severe heart failure (NYHA Class III-IV) with EF ≤ 35% and QRS duration ≥ 120 ms
• Left bundle branch block (LBBB) with QRS ≥ 130 ms, EF ≤ 30%, and mild (NYHA Class II) ischemic or nonischemic heart failure or asymptomatic (NYHA Class I) ischemic heart failure
Contraindications
There are no contraindications for this device.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. For single patient use only. Do not reuse, reprocess, or resterilize. Program the pulse generator
Tachy Mode to Off during implant, explant or postmortem procedures. Always have external defibrillator protection available during implant and electrophysiologic testing. Ensure that an external
defibrillator and medical personnel skilled in CPR are present during post-implant device testing. Advise patients to seek medical guidance before entering environments that could adversely affect the
operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI scanning. Do
not subject a patient with an implanted pulse generator to diathermy, Do not use atrial-tracking modes in patients with chronic refractory atrial tachyarrhythmias. Do not use atrial-only modes in patients
with heart failure. LV lead dislodgment to a position near the atria can result in atrial oversensing and LV pacing inhibition. Physicians should use medical discretion when implanting this device in patients
who present with slow VT. Do not kink, twist or braid the lead with other leads. Do not use defibrillation patch leads with the CRT-D system. Do not use this pulse generator with another pulse generator.
For Patient Triggered Monitor (PTM) feature, make sure the feature is enabled prior to sending the patient home with a magnet. Once the PTM feature has been triggered and the magnet response
programming is set to inhibit therapy, the patient should not reapply the magnet. For DF4-LLHH or DF4-LLHO leads, use caution handling the lead terminal when the Connector Tool is not present
on the lead and do not directly contact the lead terminal with any surgical instruments or electrical connections such as PSA (alligator) clips, ECG connections, forceps, hemostats, and clamps. Do not
contact any other portion of the DF4-LLHH or DF4-LLHO lead terminal, other than the terminal pin even when the lead cap is in place.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization and storage; implantation; device programming; follow-up testing; explant
and disposal; environmental and medical therapy hazards; hospital and medical environments; home and occupational environments; and supplemental precautionary information. Advise patients to avoid
sources of electromagnetic interference (EMI) because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
Potential Adverse Events
Potential adverse events from implantation of the CRT-D system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias,
lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, and component failure.
Patients may develop psychological intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases severe complications or
device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only. (Rev. C)
CRT-D Systems from Boston Scientific – DYNAGEN, INOGEN, and ORIGEN
Indications and Usage
These Boston Scientific Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) are indicated for patients with heart failure who receive stable optimal pharmacologic therapy (OPT) for heart failure
and who meet any one of the following classifications: Moderate to severe heart failure (NYHA Class III-IV) with EF ≤ 35% and QRS duration ≥ 120 ms; or left bundle branch block (LBBB) with QRS
duration ≥ 130 ms, EF ≤ 30%, and mild (NYHA Class II) ischemic or nonischemic heart failure or asymptomatic (NYHA Class I) ischemic heart failure.
Contraindications
There are no contraindications for this device.
Warnings
Read this manual thoroughly before implantation to avoid damage to the pulse generator and/or lead. For single patient use only. Do not reuse, reprocess, or resterilize. Always have external defibrillation
equipment available during implant and electrophysiologic testing. Ensure that an external defibrillator and medical personnel skilled in CPR are present during post-implant device testing should the
patient require external rescue. Advise patients to seek medical guidance before entering environments that could adversely affect the operation of the active implantable medical device, including areas
protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI scanning. Do not subject a patient with an implanted pulse generator and/or lead
to diathermy. Do not use atrial tracking modes in patients with chronic refractory atrial tachyarrhythmias. Do not use atrial-only modes in patients with heart failure. Left ventricular lead dislodgement to a
position near the atria can result in atrial oversensing and left ventricular pacing inhibition. Physicians should use medical discretion when implanting this device in patients who present with slow VT. Do
not kink, twist, or braid the lead with other leads. Do not use defibrillation patch leads with the pulse generator system. Do not use this pulse generator with another pulse generator. Ensure that Patient
Triggered Monitor (PTM) is enabled prior to sending the patient home by confirming the magnet response is programmed to Store EGM. Once the PTM feature has been triggered and the magnet
response set to Inhibit therapy the patient should not reapply the magnet. For DF4–LLHH or DF4–LLHO leads, use caution handling the lead terminal when the Connector Tool is not present on the lead
and do not directly contact the lead terminal with any surgical instruments or electrical connections such as PSA (alligator) clips, ECG connections, forceps, hemostats, and clamps. Do not contact any
other portion of the DF4–LLHH or DF4–LLHO lead terminal, other than the terminal pin, even when the lead cap is in place. Do not contact any other portion of the IS4–LLLL lead
terminal, other than the terminal pin, even when the lead cap is in place.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations, sterilization and storage, implantation, device programming, hospital and medical
environments, home and occupational environments, environmental and medical therapy hazards, follow-up testing, explant and disposal, supplemental precautionary information. Advise patients to avoid
sources of EMI because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
ADDENDUM TO: 002-1376, Rev. C, US
Current Brief Summaries found @ http://www.bostonscientific.com/
March 25, 2016
Potential Adverse Events
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage
(fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks /pacing/sensing), infection, procedure related, and component failure. Patients may develop
psychological intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only.(Rev A)
CRT-P System from Boston Scientific – CONTAK RENEWAL™ TR
Indications
The CONTAK RENEWAL™ TR Pulse Generator is indicated for patients who have moderate to severe heart failure (NYHA Class III/IV) including left ventricular dysfunction (EF ≤ 35%) and QRS duration
≥ 120 ms and remain symptomatic despite stable, optimal heart failure drug therapy (as defined in the clinical trials section in the System Guide). These devices provide atrial-ventricular tracking modes to
help preserve AV synchrony and adaptive-rate pacing for patients who would benefit from adjusted pacing rates concurrent with physical activity.
Contraindications
These devices are contraindicated in patients who have a separate implanted cardioverter-defibrillator (ICD). Single-chamber atrial pacing is contraindicated in patients with impaired AV nodal conduction.
Atrial tracking modes are contraindicated for patients with chronic refractory atrial tachyarrhythmias (atrial fibrillation or flutter), which might trigger ventricular pacing. Asynchronous pacing is
contraindicated in the presence (or likelihood) of competition between paced and intrinsic rhythms.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. For single patient use only. Do not reuse, reprocess, or resterilize. Such damage can result in
patient injury or death. Do not expose a patient to MRI device scanning. Do not expose a patient with an activated implanted pulse generator to diathermy. Do not use atrial-only modes in patients with
heart failure. The clinical outcomes for patients with chronic refractory atrial tachyarrhythmias are not fully known. Safety and effectiveness studies have not been conducted. If a chronic refractory atrial
tachyarrhythmia develops in a patient with these devices, do not use dual-chamber or single-chamber atrial pacing. Left ventricular (LV) lead dislodgment to a position near the atria can result in atrial
oversensing and LV pacing inhibition.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization, storage and handling; implantation and device programming; pulse
generator explant and disposal; environmental and medical therapy hazards. Advise patients to avoid sources of electromagnetic interference (EMI) because EMI may cause the pulse generator to deliver
inappropriate therapy or inhibit appropriate therapy.
Potential Adverse Events
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage
(fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (pacing/sensing), infection, lead tip deformation and/or breakage, procedure related, and component failure. In
rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/ precautions and adverse events. Rx only. (Rev. O)
CRT-P Systems from Boston Scientific – VALITUDETM , VALITUDE X4TM , INTUATM , and INVIVETM
Indications and Usage
Boston Scientific cardiac resynchronization therapy pacemakers (CRT-Ps) are indicated for patients with moderate to severe heart failure (NYHA Class III/IV) including left ventricular dysfunction
(EF <=35%) and QRS duration >= 120 ms and remain symptomatic despite stable optimal pharmacological therapy (OPT) for heart failure. Atrial tracking modes are also indicated for patients who may
benefit from maintenance of AV synchrony. Adaptive-rate pacing is indicated for patients exhibiting chronotropic incompetence and who would benefit from increased pacing rates concurrent with
increases in physical activity.
Contraindications
These Boston Scientific pulse generators have the following contraindications:
• In patients who have a separate implanted cardioverter defibrillator (ICD) with transvenous leads;
• Unipolar pacing or use of the Respiratory Sensor with a Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) is contraindicated because it may cause inappropriate therapy or inhibition of
appropriate S-ICD therapy;
• Single-chamber atrial pacing is contraindicated in patients with impaired AV nodal conduction;
• Atrial tracking modes are contraindicated in patients with chronic refractory atrial tachyarrhythmias (atrial fibrillation or flutter), which might trigger ventricular pacing;
• And asynchronous pacing is contraindicated in the presence (or likelihood) of competition between paced and intrinsic rhythms.
Warnings
Read this manual thoroughly before implantation to avoid damage to the pulse generator and/or lead. For single patient use only. Do not reuse, reprocess, or resterilize. Such damage may result in patient
injury, illness, or death. Always have external defibrillation equipment available during implant and electrophysiologic testing. Using multiple pulse generators could cause pulse generator interaction,
resulting in patient injury or a lack of therapy delivery. In response to applicable nonrecoverable or repeat fault conditions, the pulse generator will switch irreversibly to Safety Core operation. Do not kink,
twist, or braid the lead with other leads. For leads that require the use of a Connector Tool, use caution handling the lead terminal when the Connector Tool is not present on the lead. Do not contact any
other portion of the IS4–LLLL lead terminal, other than the terminal pin, even when the lead cap is in place. Do not use atrial tracking modes in patients with chronic refractory atrial tachyarrhythmias. Do
not use atrial-only modes in patients with heart failure. Lead Safety Switch should be programmed Off for patients with an ICD. Unipolar pacing due to Lead Safety Switch is contraindicated for patients
with an ICD. Unipolar pacing due to RAAT is contraindicated and should be programmed off for patients with an ICD. Left ventricular lead dislodgement to a position near the atria can result in atrial
oversensing and left ventricular pacing inhibition. If programmed to a fixed atrial Sensitivity value of 0.15 mV, or a fixed sensitivity value of 2.0 mV or less in a unipolar lead configuration in any chamber,
the pulse generator may be more susceptible to electromagnetic interference. Advise patients to seek medical guidance before entering environments that could adversely affect the operation of the active
implantable medical device. Do not expose a patient to MRI scanning. Do not subject a patient with an implanted pulse generator and/or lead to diathermy.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization and storage; implantation; device programming; environmental and
medical therapy hazards; hospital and medical environments; follow-up testing; explant and disposal; supplemental precautionary Information These pulse generators are compatible for use with a
Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) when implanted with bipolar leads and programmed to a bipolar pacing configuration.
Potential Adverse Events
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage
(fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (pacing/sensing), infection, procedure related, and component failure. Patients may develop psychological
intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined s hocking. In rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only.(Rev B)
ICD Systems from Boston Scientific – PUNCTUATM , ENERGENTM , and INCEPTATM
ICD Indications and Usage
PUNCTUATM, ENERGENTM, and INCEPTATM ICDs are intended to provide ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular
arrhythmias.
Contraindications
Use of these ICD systems are contraindicated in: Patients whose ventricular tachyarrhythmias may have reversible cause, such as 1) digitalis intoxication, 2) electrolyte imbalance, 3) hypoxia, or 4)
sepsis, or whose ventricular tachyarrhythmias have a transient cause, such as 1) acute myocardial infarction, 2) electrocution, or 3) drowning. Patients who have a unipolar pacemaker.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the ICD system. For single patient use only. Do not reuse, reprocess, or resterilize. Program the pulse
generator ventricular Tachy Mode to Off during implant, explant or post-mortem procedures. Always have external defibrillator protection available during implant and electrophysiologic testing. Ensure
that an external defibrillator and medical personnel skilled in cardiopulmonary resuscitation (CPR) are present during post-implant device testing. Patients should seek medical guidance before entering
environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator.
Do not expose a patient to MRI scanning. Do not subject a patient with an implanted pulse generator to diathermy. Do not use atrial tracking modes in patients with chronic refractory atrial
tachyarrhythmias. Do not use this pulse generator with another pulse generator. Do not kink, twist or braid lead with other leads. For Patient Triggered Monitor (PTM) feature, make sure the feature is
enabled prior to sending the patient home with a magnet. Once the PTM feature has been triggered and the magnet response programming is set to inhibit therapy, the patient should not reapply the
magnet. For DF4-LLHH or DF4-LLHO leads, use caution handling the lead terminal when the Connector Tool is not present on the lead and do not directly contact the lead terminal with any surgical
instruments or electrical connections such as PSA (alligator) clips, ECG connections, forceps, hemostats, and clamps. Do not contact any other portion of the DF4-LLHH or DF4-LLHO lead terminal, other
than the terminal pin even when the lead cap is in place.
ADDENDUM TO: 002-1376, Rev. C, US
Current Brief Summaries found @ http://www.bostonscientific.com/
March 25, 2016
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization and storage; implantation; device programming; environmental and
medical therapy hazards; hospital and medical environments; home and occupational environments follow-up testing; explant and disposal; supplemental precautionary information. Advise patients to
avoid sources of electromagnetic interference (EMI).
Potential Adverse Events
Potential adverse events from implantation of the ICD system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias,
lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, psychologic intolerance to
an ICD system – patients susceptible to frequent shocks despite antiarrhythmic medical management/imagined shocking, and component failure. In rare cases severe complications or device failures can
occur.
Refer to the product labeling for specific indications, contraindications, warnings/ precautions and adverse events. Rx only. (Rev. C)
ICD Systems from Boston Scientific –TELIGENTM
ICD Indications and Usage
ICDs are intended to provide ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. ICDs (i.e. Vitality AVT) with atrial therapies
are also intended to provide atrial antitachycardia pacing and atrial defibrillation treatment in patients who have or are at risk of developing atrial tachyarrhythmias.
Contraindications
Use of ICD systems are contraindicated in: Patients whose ventricular tachyarrhythmias may have reversible cause, such as 1) digitalis intoxication, 2) electrolyte imbalance, 3) hypoxia, or 4) sepsis, or
whose ventricular tachyarrhythmias have a transient cause, such as 1) acute myocardial infarction, 2) electrocution, or 3) drowning. Patients who have a unipolar pacemaker.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the ICD system. For single patient use only, Do not reuse, reprocess, or resterilize. Program the pulse
generator ventricular Tachy Mode to Off during implant, explant or post-mortem procedures. Always have external defibrillator protection available during implant and electrophysiologic testing. Ensure
that an external defibrillator and medical personnel skilled in cardiopulmonary resuscitation (CPR) are present during post-implant device testing. Patients should seek medical guidance before entering
environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator.
Do not expose a patient to MRI scanning. Do not subject a patient with an implanted pulse generator to diathermy. Do not use atrial tracking modes (or an AVT device) in patients with chronic refractory
atrial tachyarrhythmias. Do not use this pulse generator with another pulse generator. Do not kink, twist or braid lead with other leads. For Patient Triggered Monitor (PTM) feature, make sure the feature
is enabled prior to sending the patient home with a magnet. Once the PTM feature has been triggered and the magnet response programming is set to inhibit therapy, the patient should not reapply the
magnet.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization and storage; implantation; device programming; environmental and
medical therapy hazards; hospital and medical environments; home and occupational environments follow-up testing; explant and disposal; supplemental precautionary information. Advise patients to
avoid sources of electromagnetic interference (EMI).
Potential Adverse Events
Potential adverse events from implantation of the ICD system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias,
lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, psychologic intolerance to
an ICD system – patients susceptible to frequent shocks despite antiarrhythmic medical management/imagined shocking, and component failure. In rare cases severe complications or device failures can
occur.
Refer to the product labeling for specific indications, contraindications, warnings/ precautions and adverse events. Rx only. (Rev. S)
ICD Systems from Boston Scientific – DYNAGEN™ EL ICD, DYNAGEN™ MINI ICD, INOGEN™ EL ICD, INOGEN™ MINI ICD, ORIGEN™ EL ICD, ORIGEN™ MINI ICD
Indications and Usage
Boston Scientific implantable cardioverter defibrillators (ICDs) are intended to provide ventricular antitachycardia pacing (ATP) and ventricular defibrillation for automated treatment of life-threatening
ventricular arrhythmias.
Contraindications
Use of these Boston Scientific pulse generators are contraindicated for the following: patients whose ventricular tachyarrhythmias may have reversible cause, such as: digitalis intoxication, electrolyte
imbalance, hypoxia, sepsis; or patients whose ventricular tachyarrhythmias have a transient cause, such as: acute myocardial infarction (MI), electrocution, drowning; or patients who have a unipolar
pacemaker.
Warnings
Read this manual thoroughly before implantation to avoid damage to the pulse generator and/or lead. For single patient use only. Do not reuse, reprocess, or resterilize. Program the pulse generator
Tachy Mode(s) to Off during implant, explant, or postmortem procedures to avoid inadvertent high voltage shocks. Always have external defibrillation equipment available during implant and
electrophysiologic testing. Ensure that an external defibrillator and medical personnel skilled in CPR are present during post-implant device testing should the patient require external rescue. Patients
should seek medical guidance before entering environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents
entry by patients who have a pulse generator. Do not expose a patient to MRI scanning. Do not subject a patient with an implanted pulse generator and/or lead to diathermy. If desired, ensure that Patient
Triggered Monitor is enabled prior to sending the patient home. Once the Patient Triggered Monitor feature has been triggered by the magnet and an EGM has been stored, or after 60 days have elapsed
from the day that Store EGM was enabled, the patient should not apply the magnet. For leads that require the use of a Connector Tool, use caution handling the lead terminal when the Connector Tool is
not present on the lead. Do not directly contact the lead terminal with any surgical instruments or electrical connections such as PSA (alligator) clips, ECG connections, forceps, hemostats, and clamps.
Do not contact any other portion of the DF4–LLHH or DF4–LLHO lead terminal, other than the terminal pin, even when the lead cap is in place. Do not use this pulse generator with another pulse
generator. This combination could cause pulse generator interaction, resulting in patient injury or a lack of therapy delivery. Do not kink, twist, or braid the lead with other leads as doing so could cause
lead insulation abrasion damage or conductor damage. Do not use atrial tracking modes in patients with chronic refractory atrial tachyarrhythmias. Tracking of atrial arrhythmias could result in ventricular
tachyarrhythmias.)
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations, sterilization and storage, implantation, device programming, environmental and
medical therapy hazards, hospital and medical environments, home and occupational environments, follow-up testing, explant and disposal, supplemental precautionary information
Potential Adverse Events
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage
(fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, and component failure. Patients may develop
psychological intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only.(Rev A)
Pacing Systems from Boston Scientific – ALTRUATM and INSIGNIATM
Indications
Pacemaker indications include: symptomatic paroxysmal or permanent second- or third-degree AV block; symptomatic bilateral bundle branch block; symptomatic paroxysmal or transient sinus node
dysfunction with or without associated AV conduction disorders; bradycardia-tachycardia syndrome, to prevent symptomatic bradycardia or some forms of symptomatic tachyarrhythmias; neurovascular
(vaso-vagal) syndromes or hypersensitive carotid sinus syndromes. Adaptive-rate pacing is indicated for patients who may benefit from increased pacing rates concurrent with increases in minute
ventilation and/or level of physical activity. Pacemakers’ dual-chamber and atrial tracking modes are also indicated for patients who may benefit from maintenance of AV synchrony. Dual-chamber modes
are specifically indicated for: conduction disorders that require restoration of AV synchrony, including varying degrees of AV block; VVI intolerance (eg, pacemaker syndrome) in the presence of persistent
sinus rhythm.
Contraindications
Pacemakers are contraindicated for the following patients under the circumstances listed: patients with unipolar pacing leads or in MV mode with an implanted ICD because it may cause unwanted
delivery or inhibition of ICD therapy; use of the MV sensor in patients with only unipolar leads, because a bipolar lead is required in either the atrium or the ventricle for MV detection (INSIGNIA® Plus,
ALTRUA® 20/40); MV mode in patients with both unipolar atrial and ventricular leads (INSIGNIA® Ultra, ALTRUA® 60); single-chamber atrial pacing in patients with impaired AV nodal conduction; atrial
tracking modes for patients with chronic refractory atrial tachyarrhythmias, which might trigger ventricular pacing; dual-chamber and single-chamber atrial pacing in patients with chronic refractory atrial
tachyarrhythmias; asynchronous pacing in the presence (or likelihood) of competition between paced and intrinsic rhythms.
Warnings
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. For single use only-do not resterilize devices. Inappropriate sustained high-rate pacing occurred
in the PULSAR™ MAX clinical study in 5 out of 130 patients with MV ON, 4 to 14 days after implant. If sustained high-rate pacing could be of concern, consider programming a reduced Max Sensor Rate
ADDENDUM TO: 002-1376, Rev. C, US
Current Brief Summaries found @ http://www.bostonscientific.com/
March 25, 2016
or MV to Passive. These programming recommendations are intended to assure that MV calibration is evaluated and, if necessary, recalibrated (4 →ON) when the patient and pacing system have
stabilized post implant. Continued monitoring of the MV sensor performance should be performed at all follow-up visits until implant stabilization has occurred.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: MV sensor calibration at implant; clinical considerations; sterilization, storage and handling; lead evaluation
and connection; implantation; programming and pacemaker operation; MV initialization; environmental and medical therapy hazards; elevated pressure; explanted pacemakers. Advise patients to avoid
sources of electric or magnetic interference (EMI). If the pacemaker inhibits or reverts to asynchronous operation at the programmed pacing rate or at the magnet rate while in the presence of the EMI,
moving away from the source or turning it off will usually allow the pulse generator to return to its normal mode of operation.
Potential Adverse Events
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, lead or accessory breakage (fracture/insulation/lead tip),
hematoma/seroma, inappropriate or inability to provide therapy (pacing/sensing), infection, procedure related, and component failure. In rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only. (Rev. S)
Pacing Systems from Boston Scientific – ACCOLADETM , ESSENTIOTM , VITALIOTM , INGENIOTM , ADVANTIOTM
Indications and Usage
Boston Scientific pacemakers are indicated for treatment of the following conditions:
• Symptomatic paroxysmal or permanent second- or third-degree AV block
• Symptomatic bilateral bundle branch block
• Symptomatic paroxysmal or transient sinus node dysfunction with or without associated AV conduction disorders (i.e., sinus bradycardia, sinus arrest, sinoatrial [SA] block)
• Bradycardia-tachycardia syndrome, to prevent symptomatic bradycardia or some forms of symptomatic tachyarrhythmias
• Neurovascular (vaso-vagal) syndromes or hypersensitive carotid sinus syndromes Adaptive-rate pacing is indicated for patients exhibiting chronotropic incompetence and who may benefit from
increased pacing rates concurrent with increases in minute ventilation and/or level of physical activity. Dual-chamber and atrial tracking modes are also indicated for patients who may benefit from
maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of the following:
• Conduction disorders that require restoration of AV synchrony, including varying degrees of AV block
• VVI intolerance (i.e., pacemaker syndrome) in the presence of persistent sinus rhythm
• Low cardiac output or congestive heart failure secondary to bradycardia
Contraindications
These Boston Scientific pacemakers are contraindicated in patients who have a separate implanted cardioverter defibrillator (ICD) with transvenous leads. Use of certain pacing modes and/or features
available in these Boston Scientific pacemakers is contraindicated for the following patients under the circumstances listed:
• Unipolar pacing or use of the MV Sensor with a Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) because it may cause inappropriate therapy or inhibition of appropriate S-ICD therapy.
• Minute Ventilation in patients with both unipolar atrial and ventricular leads
• Single-chamber atrial pacing in patients with impaired AV nodal conduction
• Atrial tracking modes for patients with chronic refractory atrial tachyarrhythmias (atrial fibrillation or flutter), which might trigger ventricular pacing
• Dual-chamber and single-chamber atrial pacing in patients with chronic refractory atrial tachyarrhythmias
• Asynchronous pacing in the presence (or likelihood) of competition between paced and intrinsic rhythms
WARNINGS
General
Read this manual thoroughly before implantation to avoid damage to the pulse generator and/or lead. Such damage can result in patient injury or death. For single patient use only. Do not reuse,
reprocess, or resterilize. Always have external defibrillation equipment available during implant and electrophysiologic testing. Using multiple pulse generators could cause pulse generator interaction,
resulting in patient injury or a lack of therapy delivery. In response to applicable nonrecoverable or repeat fault conditions, the pulse generator will switch irreversibly to Safety Core operation. Do not kink,
twist, or braid the lead with other leads. Do not use atrial tracking modes in patients with chronic refractory atrial tachyarrhythmias. Lead Safety Switch should be programmed Off for patients with an ICD.
Unipolar pacing due to Lead Safety Switch is contraindicated for patients with an ICD. Unipolar pacing due to RAAT is contraindicated and should be programmed off for patients with an ICD. If
programmed to a fixed atrial Sensitivity value of 0.15 mV, or a fixed sensitivity value of 2.0 mV or less in a unipolar lead configuration in any chamber, the pulse generator may be more susceptible to
electromagnetic interference. Advise patients to seek medical guidance before entering environments that could adversely affect the operation of the active implantable medical device. Do not expose a
patient to MRI scanning. Do not subject a patient with an implanted pulse generator and/or lead to diathermy.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization and storage; implantation; device programming; environmental and
medical therapy hazards; hospital and medical environments; home and occupational environments; follow-up testing; explant and disposal; supplemental precautionary information. Advise patients to
avoid sources of EMI. The pulse generator may inhibit pacing due to oversensing, or may switch to asynchronous pacing at the programmed pacing rate or at the magnet rate in the presence of EMI.
These pulse generators are compatible for use with a Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) when implanted with bipolar leads and programmed to a bipolar pacing configuration.
POTENTIAL ADVERSE EVENTS
Potential adverse events include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage
(fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (pacing/sensing), infection, procedure related, and component failure. Patients may develop psychological
intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only. (Rev.B)
S-ICD System from Boston Scientific - EMBLEM TM
Indications and Usage
The S-ICD System is intended to provide defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, incessant ventricular
tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing.
Contraindications
Unipolar pacing and impedance-based features are contraindicated for use with the S-ICD System.
Warnings
Read the manual thoroughly before using the S-ICD System to avoid damage to the pulse generator and/or subcutaneous electrode. Such damage can result in patient injury or death. For single patient
use only. Do not reuse, reprocess, or resterilize. All Boston Scientific S-ICD implantable components are designed for use with the Boston Scientific S-ICD System only. Connection of any S-ICD System
components to a non-compatible component will result in failure to deliver life-saving defibrillation therapy. Always have external defibrillation equipment and medical personnel skilled in CPR available
during implant and follow-up testing. Using multiple pulse generators could cause pulse generator interaction, resulting in patient injury or a lack of therapy delivery. Test each system individually and in
combination to help prevent undesirable interactions. Concomitant use of the S-ICD System and implanted electromechanical devices (for example a ventricular assist device, VAD; or implantable insulin
pump or drug pump) can result in interactions that could compromise the function of the S-ICD, the co-implanted device, or both. Electromagnetic (EMI) or therapy delivery from the co-implanted device
can interfere with S-ICD sensing and/or rate assessment, resulting in inappropriate therapy or failure to deliver therapy when needed. In addition, a shock from the S-ICD pulse generator could damage
the co-implanted device and compromise it’s functionality. To help prevent undesirable interactions, test the S-ICD system when used in combination with the co-implanted device, and consider the
potential effect of a shock on the co-implanted device. Handle the components of the SICD System with care at all times and maintain proper sterile technique. Do not modify, cut, kink, crush, stretch or
otherwise damage any component of the S-ICD System. Use caution handling the subcutaneous electrode connector. Do not directly contact the connector with any surgical instruments such as forceps,
hemostats, or clamps. Use appropriate anchoring techniques as described in the implant procedure to prevent S-ICD System dislodgement and/or migration. Use caution when placing a magnet over the
S-ICD pulse generator because it suspends arrhythmia detection and therapy response. In patients with a deep implant placement (greater distance between the magnet and the pulse generator) magnet
application may fail to elicit the magnet response. Do not expose a patient with an implanted S-ICD System to diathermy. Do not expose a patient to MRI scanning. Advise patients to seek medical
guidance before entering environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who
who have a pulse generator. The pulse generator may be more susceptible to low frequency electromagnetic interference at induced signals greater than 80 uV. The S-ICD System has not been
evaluated for pediatric use.
Precautions
For specific information on precautions, refer to the following sections of the product labeling: clinical considerations, sterilization and storage, implantation, device programming, environmental and
medical therapy hazards, hospital and medical environments, home and occupational environments, follow-up testing, explant and disposal and supplemental precautionary information. Advise patients to
avoid sources of EMI because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
ADDENDUM TO: 002-1376, Rev. C, US
Current Brief Summaries found @ http://www.bostonscientific.com/
March 25, 2016
Potential Adverse Events
Potential adverse events related to implantation of the S-ICD System may include, but are not limited to, the following: Acceleration/induction of atrial or ventricular arrhythmia, adverse reaction to
induction testing, allergic/adverse reaction to system or medication, bleeding, conductor fracture, cyst formation, death, delayed therapy delivery, discomfort or prolonged healing of incision, electrode
deformation and/or breakage, electrode insulation failure, erosion/extrusion, failure to deliver therapy, fever, hematoma/seroma, hemothorax, improper electrode connection to the device, inability to
communicate with the device, inability to defibrillate or pace, inappropriate post shock pacing, inappropriate shock delivery, infection, keloid formation, migration or
dislodgement, muscle/nerve stimulation, nerve damage, pneumothorax, post-shock/post-pace discomfort, premature battery depletion, random component failures, stroke, subcutaneous emphysema,
surgical revision or replacement of the system, syncope, tissue redness, irritation, numbness or necrosis. Patients who receive an S-ICD System may develop psychological disorders that include, but are
not limited to, the following: depression/anxiety, fear of device malfunction, fear of shocks, phantom shocks.
Refer to the product labeling for specific indications, contraindications, warnings/precautions and adverse events. Rx only. (Rev. B)
ADDENDUM TO: 002-1376, Rev. C, US
Current Brief Summaries found @ http://www.bostonscientific.com/
March 25, 2016
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