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CRM Product Performance Report Q1  2009

Product Advisory

23-Mar-09 — Respiratory Sensor Oversensing

COGNIS

Models N118/N119

TELIGEN VR

Models E102/E103/F102/F103

TELIGEN DR

Models E110/E111/F110/F111

ORIGINAL COMMUNICATION 23-Mar-09 — Respiratory Sensor Oversensing

Voluntary Physician Advisory

FDA Classification: Pending

COGNIS CRT-Ds and TELIGEN ICDs include a Respiratory Sensor that can be activated to monitor the patients respiratory rate. For any implantable defibrillator, delivery of appropriate therapy is dependent upon lead system integrity. Conversely, if any component of the defibrillator system is compromised, appropriate therapy cannot be assured. For example, certain RV lead complications can cause inappropriate shocks or anti-tachycardia pacing, and/or inhibition of pacing. Boston Scientific has determined that if such RV lead complications were to occur with the Respiratory Sensor programmed On, additional oversensing may occur, thereby increasing the probability of inappropriate therapy. Five to eight successive inappropriate shocks could leave the device unable to treat an actual arrhythmia until the current episode ends.

No patient deaths have been reported. Additional events can be prevented if recommendations are followed.

Reported Events and Rate of Occurrence

Boston Scientific estimates that the Respiratory Sensor has been programmed On in approximately 8,000 COGNIS and TELIGEN devices worldwide. Inappropriate therapy as described above has been reported 15 times (0.2%).

Current Status 23-Mar-09

Reported events (worldwide)

Fifteen (15) reports of inappropriate therapy have been reported from an estimated 8,000 COGNIS and TELIGEN devices in which the Respiratory Sensor has been programmed On.

There have been no reported patient deaths associated with this advisory.

Rate of Occurrence

Fifteen reported events represents 0.2% of the estimated 8,000 devices with Respiratory Sensor programmed On worldwide.

Current Recommendation 23-Mar-09

Device programming records should be reviewed for each patient with a COGNIS CRT-D or TELIGEN ICD to determine if the Respiratory Sensor is programmed to On or Off.

  • When the Respiratory Sensor is Off, this advisory does not apply and routine follow-up is indicated.
  • If the Respiratory Sensor is On, Boston Scientific recommends that the Respiratory Sensor be programmed Off as follows:
    1. Select the SETTINGS tab
    2. Select the SETTINGS SUMMARY tab
    3. In the BRADY section, select the NORMAL SETTINGS details icon
    4. In the SENSORS AND TRENDING section, select the ACCELEROMETER details icon
    5. For RESPIRATORY SENSOR, select Off, and press PROGRAM

Physicians should review concurrent risks such as pacemaker dependency, historic lead fracture performance, patient age and activity level, etc. when considering the most appropriate management options for each patient.

Standard Warranty program available, please contact your local representative for terms and conditions.

With respect to the number of reported events listed in the summaries above, Boston Scientific recognizes that the actual number of clinical malfunctions may be greater than the number actually reported. Additionally, rate projections are provided with the acknowledgement that predictive modeling is inherently uncertain due to its dependence on the device age distribution of reported events and resultant statistical approximation and assumptions.

Advisory notifications may vary by geography, based upon local regulatory requirements. Please contact the local Guidant office for more information. Not all products may be approved for use in all geographies, as product approval is geography specific.

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