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Appendix A
Evia HF / HF-T Technical Manual
Appendix A
Mode-Specific Indications and Contraindications
Rate-adaptive Pacing
Evia HF/HF-T: DDDR, DDDR-ADIR, DDIR, DVIR, VDDR, VVIR, DDD-CLS, VVI-CLS, AAIR, VVTR,
DOOR, VOOR, AOOR, AATR, VDIR
NOTE:
For indications specific to the VDDR mode, see Indications for Use on page 1 (Section 2).
Indications for rate-adaptive pacing may include but are not limited to the following:
• Patients with chronotropic incompetence who have an anticipated moderate or high level of
activity and in whom there is a stable atrial rhythm, and for whom DDD, DDI, DVI, VDD, or VVI
pacing is also indicated.
• Patients who have persistent VA conduction (dual chamber modes).
These indications include but are not limited to sick sinus syndrome and AV block.
The rate-adaptive modes of the Evia family of CRT-Ps are contraindicated for patients who are known
to develop angina or ischemia at accelerated pacing rates. In addition, the rate-adaptive modes
are contraindicated in circumstances where the applicable non-rate-adaptive mode is noted as
contraindicated in the following text.
Dual Chamber
DDD
The DDD mode is clearly indicated if
• AV synchrony is needed over a broad range of rates, such as
• active or young patients with an adequate increase in atrial rate, and/or
• significant hemodynamic indication, and/or
• previous occurrence of pacemaker syndrome or of a reduction in systolic blood pressure of more
than 20 mm Hg under ventricular pacing with pulse generator implantation (regardless of any
evidence of retrograde VA conduction).
The DDD mode is conditionally indicated in the case of
• a complete AV block or of sick sinus syndrome and stable atrial rate, and/or
• proof that simultaneously setting the atrial and ventricular rates can inhibit tachyarrhythmia or if the
pulse generator can be set to a pacing mode suited for interrupting arrhythmia.
The DDD mode is contraindicated in the case of
• frequent or persistent supraventricular tachyarrhythmia, including atrial fibrillation or flutter, and/or
• inadequate intra-atrial complexes that do not permit safe sensing, and/or
• angina pectoris which would be aggravated by increased heart rates.
11
DDI
The DDI mode is useful in all cases in which dual chamber pacing is necessary, but where intermittent
supraventricular arrhythmias frequently occur.
11
The ACC/AHA Guidelines cannot replace a study of the relevant specialized literature, especially since the indications and
contraindications for using particular pacing modes are subject to constant advances in medical knowledge.