User's Manual

24 – US-ENGLISH
7. PATIENT SELECTION AND TREATMENT
7.1. INDIVIDUALIZATION OF TREATMENT
Exercise stress testing. If the patient’s condition permits, use
exercise stress testing to:
─ Determine the maximum rate of the patient’s normal rhythm,
─ Identify any supraventricular tachyarrhythmias,
─ Identify exercise-induced tachyarrhythmias.
The maximum exercise rate or the presence of supraventricular
tachyarrhythmias may influence selection of programmable
parameters. Holter monitoring or other extended ECG monitoring
also may be helpful.
CAUTION: When a parameter is reprogrammed during an exercise
stress test, PARAD/PARAD+ algorithm forces acceleration to
"ventricular". During conducted sinus tachycardia within the
programmed Tachy zone, the device detects a 1:1 fast rhythm.
Assuming that acceleration was set to ventricular by reprogramming,
the device concludes for a VT, and immediately applies the
corresponding therapy. This event could have been avoided with
appropriate device handling during tests.
Electrophysiologic (EP) testing: EP testing may be useful for ICD
candidates. EP testing may identify the classifications and rates of all
the ventricular and atrial arrhythmias, whether spontaneous or during
EP testing.
Drug resistant supraventricular tachyarrhythmias (SVTs): Drug
resistant supraventricular tachyarrhythmias (SVTs) may initiate
frequent unwanted device therapy. A careful choice of programming
options is necessary for such patients.