User's Manual

137
Cautionary Notes
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Caution! Diathermy, transcutaneous nerve stimulation,
magnetic resonance imaging, and electrocautery
have been reported to interfere with
electromyographic monitoring. Cardiac activity
during any of these procedures should therefore be
monitored by additionally taking the patient's
peripheral pulse or blood pressure.
Defibrillation
The circuitry of BIOTRONIK pacemakers is protected against the
energy normally induced by defibrillation. Nevertheless, complete
protection is not possible. Any implanted pacemaker can be damaged
by defibrillation. Circumstances permitting, the following precautions
should be taken:
— The paddles should be in an anterior-posterior position or
perpendicular to the axis formed by the pacemaker and the
heart.
— The energy setting should not be higher than necessary for
defibrillation.
— The distance between the defibrillator paddles and the
pacemaker and the implanted lead should be at least 10 cm (4
inches).
After defibrillation, the pacemaker function and pacing threshold must
be checked and monitored for a sufficient time period.
Interaction with an Implantable Cardioverter- Defibrillator(ICD)
When implanting both an ICD and a pacemaker with bipolar pacing,
the tip electrodes should be positioned as far apart as possible.
Appropriate testing must ensure that the functioning of the one device
cannot interfere with the other. Such testing will include, among other
things:
— Test the arrhythmia detection function of the ICD while the
pacemaker is pacing. To do so, set the most unfavorable
combination, depending on the parameters set, with relation to
the pacing mode, the rate, and pulse energy.
— Test the pacemaker's functions after delivery of a maximum
energy shock from the ICD.