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AF Suppression™
Algorithm Overview
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AF Suppression™ Algorithm Overview
•The goal is to keep atrial arrhythmias from occurring
• Prevention of atrial fibrillation• A fib begets A fib!
•Solution: An algorithm designed to keep the atrial pacing rate just above the patient’s changing intrinsic atrial rate, resulting in constant atrial pacing
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> 90% Atrial Pacing
AFx ensures a high percentage of atrial stimulation at a rate following the patients natural circadian variations, thereby maintaining control of the atrium, reducing ectopy, and suppressing atrial tachyarrhythmias
AF Suppression, AFx
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MSR
Basic Rate
AFx
Intrinsic Rate
AF Suppression, AFx
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AF Suppression, AFx
AFx
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Search for intrinsic activity
67 66 65
Activity found(two P-waves)
64 65
Increase stimulation rate
74 74 7474
AF Suppression, AFx
ASAP AP ASAP APAP APVPVP VPVPVP VPVP VPVP
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… and to programme:
ON / OFF !AF Suppression, AFx
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AF Suppression™ Algorithm Overview
• Programmable: • ON• OFF (nominal)
• Screen: Parameters-Brady, AT/AF Detection & Response
• Only available in the following modes• DDD/R• AAI/R
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AF Suppression™ Algorithm Overview
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AF Suppression™ Algorithm Overview
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AF Suppression™ Algorithm Overview
•When the algorithm is activated, the device looks for
• 2 P-waves within 16 cycles• Only P-waves in the alert period will be used
• If 2 P-waves within 16 cycles are seen, the device will increase the atrial pacing rate
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AS AP AP AP AP AP AP AP AP AP AP AP AP AP AP AP AP0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Start 16-cycle counter
AS = P-waveAP = Atrial pacing
Only 1 P-wave was seen. Therefore, NO Overdrive occurs
End 16-cycle counter
Note: Notice how the algorithm starts with a “0” not a “1”
AF Suppression™ Algorithm Overview
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AF Suppression™ Algorithm Overview
AS AP AP AP AP AP AP AP AP AP AP AP AP AP AP AS0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Start 16-cycle counter
2 P-waves were seen therefore, Overdrive occurs
Start Overdrive
AS = P-waveAP = Atrial pacing
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AS AS
Overdrive Rate
Pacing Rate
2 P-waves were seen therefore, Overdrive occurs
AF Suppression™ Algorithm Overview
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AF Suppression™ Algorithm Overview
• A look-up table within the device determines the Overdrive rate
• The current atrial pacing rate is used to determine the increase in atrial rate
• The Maximum AF Suppression rate is the maximum rate for atrial overdrive pacing when AF Suppression is programmed on
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AF Suppression™ Algorithm Overview
• Once the atrial Overdrive rate is determined, the device will pace at this rate for a programmable number of cycles
• 15 (nominal), 20, 25, 30, 35 or 40 cycles
• When AF suppression is programmed ON, the Overdrive Pacing Cycles is the only programmable parameter
• Cycle count of 15 was programmed most often during the Adopt-A clinical trial
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AF Suppression™ Algorithm Overview
• Once the number of Overdrive cycles has been completed the Rate Recovery phase will start
• If the Overdrive rate is 100 ppm - 12 ms will be added to each cycle, resulting in a lower rate
• If the Overdrive rate is >100 ppm - 8 ms will be added to each cycle, resulting in a lower rate
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AS AS
Overdrive Rate
Pacing Rate
2 P-waves were seen therefore, Overdrive occurs followed by Rate Recovery
Pacing Rate
AF Suppression™ Algorithm Overview
Rate Recovery
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AF Suppression™ Algorithm Overview
What if there are additional P-waves sensed during the Overdrive portion?
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AF Suppression™ Algorithm Overview
• If 1 P-wave is sensed during the Overdrive portion, the 16 cycle counter will start
• If 2 P-waves are sensed within 16 cycles, the device will increase the atrial rate and Overdrive will start
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AS AS
Overdrive Rate
Pacing Rate Pacing Rate
AS AS
Overdrive Rate
AF Suppression™ Algorithm Overview
Rate Recovery
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AF Suppression™ Algorithm Overview
What if 1 P-wave is sensed in the Rate Recovery portion?
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AF Suppression™ Algorithm Overview
• If 1 P-wave is sensed during the Rate Recovery portion, the 16 cycle counter will start
• If 2 P-waves are sensed within 16 cycles, the device will increase the atrial rate and Overdrive will start
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AS AS
Overdrive Rate
Pacing Rate Pacing Rate
ASAS
Overdrive Rate
Rate Recovery
Rate Recovery
AF Suppression™ Algorithm Overview
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