Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) are indicated for patients with moderate to severe heart failure (NYHA III/IV) who remain symptomatic despite stable, optimal heart failure drug therapy, and have left ventricular dysfunction (EF ≥ 35%) and QRS duration ≥ 120 ms. Left ventricular coronary venous, steroid-eluting, pace/sense leads are transvenous leads intended for chronic LV pacing and sensing via the coronary veins when used in conjunction with a compatible pulse generator. Extended bipolar pacing and sensing is available using dual-electrode LV leads with an RV pace/sense/defibrillation lead or a bipolar RV pace/sense lead.
There are no contraindications for the CRT-D device. Use of LV leads are contraindicated in patients with a hypersensitivity to a nominal dose of 0.45, 0.7, or 1.0 mg dexamethasone acetate drug. Some LV lead models are contraindicated in patients with mechanical tricuspid heart valves, or obstructed or inadequate vasculature for intravenous catheterization.
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. Such damage can result in patient injury or death. Program the pulse generator Tachy Mode to Off during implant, explant, or postmortem procedures to avoid inadvertent high voltage shocks. Always have sterile external and internal defibrillator protection available during implant. If not terminated in a timely fashion, an induced tachyarrhythmia can result in the patient’s death. 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 area protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI device scanning. Strong magnetic fields may damage/interfere with the device and lead system and cause injury to the patient. Do not subject a patient with an implanted pulse generator and lead system to diathermy since diathermy may cause fibrillation, burning of the myocardium, and irreversible damage to the pulse generator because of induced currents. Do not use atrial tracking modes in patients with chronic refractory atrial tachyarrhythmias. Tracking of atrial arrhythmias could result in VT or VF. Do not use atrial only modes in patients with heart failure because such modes do not provide CRT. 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. Programming therapy for slow monomorphic VT may preclude CRT delivery at faster rates if these rates are in the tachyarrhythmia zones. Do not kink leads. Kinking leads may cause additional stress on the leads, possibly resulting in lead fracture. Do not use defibrillation patch leads with the CRT-D system, or injury to the patient may occur. Do not use this pulse generator with another pulse generator. This combination could cause pulse generator interaction resulting in patient injury or lack of therapy delivery. For specific models, when using a subpectoral implantation, place the pulse generator with the serial number facing away from the ribs. Implanting the pulse generator subpectorally with the serial number facing the ribs may cause repetitive mechanical stress to a specific area of the titanium case, potentially leading to a component failure and device malfunction. When using a RV pace/sense lead in conjunction with an LV pacing lead, it is recommended that a polyurethane-insulated lead be used. Failure to observe this warning could result in insulation damage of the RV lead, which can cause a periodic or continual loss of pacing, sensing or both. Lead fracture, dislodgment, abrasion or an incomplete connection can cause a periodic or continual loss of pacing, sensing or both. The use of battery-powered equipment is recommended during lead implantation and testing to protect against fibrillation that might be caused by leakage currents. Line-powered equipment used in the vicinity of the patient must be properly grounded. The lead connector must be insulated from any leakage currents that could arise from line-powered equipment. The lead is not designed to tolerate excessive flexing, bending, tension or injection pressure. This could cause structural weakness, conductor discontinuity or lead dislodgment. When using a finishing wire accessory kit, use the corresponding finishing wire model for the lead length If the wrong length finishing wire is used, the finishing wire tip may extend out of the distal end of the lead or not stabilize the lead properly. When placing the lead with a stylet, use only a stylet designed for use with the ACUITY Steerable lead. These stylets are specifically designed to prevent the stylet from extending past the lead tip. Extending the stylet past the lead tip may cause tissue damage.
For information on precautions, refer to the following sections of the PG 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 environment; 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. Refer to the following sections of the lead product labeling: sterilization and handling, and lead evaluation and implantation for cautions specific to handling, implanting, and testing the lead. Failure to observe these cautions could result in incorrect lead implantation, lead damage/dislodgment, or harm to the patient. It has not been determined whether the warnings, precautions, or complications usually associated with injectable dexamethasone acetate apply to the use of the low concentration, highly localized, controlled-release device. For a listing of potentially adverse effects, refer to the Physician’s Desk Reference.
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, 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. K)
ICDs are intended to provide ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life threatening ventricular arrhythmias. ICDs 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.
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.
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the ICD system. Such damage can result in patient injury or death. Program the pulse generator ventricular Tachy Mode to Off during implant, explant or post-mortem procedures to avoid inadvertent high voltage shocks. Always have sterile external and internal defibrillator protection available during implant. If not terminated in a timely fashion, an induced tachyarrhythmia can result in the patient’s death. Ensure that an external defibrillator and medical personnel skilled in cardiopulmonary resuscitation (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 area protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI device scanning. Strong magnetic fields may damage the device and cause injury to the patient. Do not subject a patient with an implanted pulse generator to diathermy since diathermy may cause fibrillation, burning of the myocardium, and irreversible damage to the pulse generator because of induced currents. Do not use atrial tracking modes (or an AVT device) in patients with chronic refractory atrial tachyarrhythmias. Tracking of atrial arrhythmias could result in VT or VF. (Applies to dual-chamber devices only.) Do not use this pulse generator with another pulse generator. This combination could cause pulse generator interaction resulting in patient injury or lack of therapy delivery. Do not kink leads. Kinking leads may cause additional stress on the leads, possibly resulting in lead fracture. For specific models, when using a subpectoral implantation, place the pulse generator with the serial number facing away from the ribs. Implanting the pulse generator subpectorally with the serial number facing the ribs may cause repetitive mechanical stress to a specific area of the titanium case, potentially leading to a component failure and device malfunction.
For information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization, storage and handling; implantation and device programming; follow-up testing; explant and disposal; environmental and medical therapy hazards; 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 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. L)
The LATITUDE Patient Management system is intended for use to remotely communicate with a compatible pulse generator from Boston Scientific CRM and transfer data to a central database.
The LATITUDE system is contraindicated for use with any pulse generator other than a compatible pulse generator from Boston Scientific CRM. Not all Guidant or Boston Scientific pulse generators are compatible with the LATITUDE system. For contraindications for use related to the pulse generator, refer to the System Guide for the pulse generator being interrogated.
The LATITUDE system is designed to notify clinicians within 24 hours if new pulse generator alert conditions are detected by the Communicator. Alert notifications are based on clinician configured alert settings. Pulse generator data will typically be available for review on the LATITUDE system within 15 minutes of a successful interrogation. However, data availability and alert notification can take up to 24 hours or the next business day. Note that data will not be available and alert notification cannot occur if:
• The Communicator is unplugged or is not able to connect to the LATITUDE system through an active phone line.
• The pulse generator and the Communicator cannot establish and complete a telemetry session. This session must be initiated by the patient if he or she has a pulse generator that uses inductive telemetry.
• The Communicator becomes damaged or it malfunctions.
• The patient is not compliant with prescribed use or is not using the LATITUDE system as described in the patient manual.
Up to two weeks may elapse before LATITUDE first detects the conditions mentioned above and additional time may be required for notification and resolution of the condition. During this time, no new patient data, device data, or alert notifications since the last successful data transmission will be available.
None Known
Refer to the product labeling for specific instructions for use. Rx only.
(Rev. I)