Indications, Safety, and Warnings
The Compia MRI™ CRT-D SureScan™ Model DTMC1D1 and Compia MRI™ Quad CRT-D SureScan™ Model DTMC1QQ, hereafter referred to collectively as the Compia MRI™ CRT-D device, is MR Conditional and, as such is designed to allow patients to be safely scanned by an MRI machine when used according to the specified MRI conditions for use. When programmed to “on,” the MRI SureScan™ feature allows the patient to be safely scanned while the device continues to provide appropriate pacing.
Indications for use
The Compia MRI™ CRT-D system is indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias and for providing cardiac resynchronization therapy in heart failure patients on stable, optimal heart failure medical therapy if indicated, and meet any of the following classifications:
New York Heart Association (NYHA) Functional Class III or IV and who have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration.
Left bundle branch block (LBBB) with a QRS duration ≥ 130 ms, left ventricular ejection fraction ≤ 30%, and NYHA Functional Class II.
NYHA Functional Class I, II, or III and who have left ventricular ejection fraction ≤ 50% and atrioventricular block (AV block) that are expected to require a high percentage of ventricular pacing that cannot be managed with algorithms to minimize right ventricular pacing.
Optimization of heart failure medical therapy that is limited due to AV block or the urgent need for pacing should be done post-implant.
A complete SureScan™ CRT-D system is required for use in the MR environment. A complete SureScan™ CRT-D system includes the following components:
The Compia MRI™ CRT-D device
A SureScan™ right atrial pacing lead or a Model 6725 pin plug for the right atrial port
A SureScan™ left ventricular pacing lead
A SureScan™ defibrillation lead
When a single coil SureScan™ defibrillation lead is used, a Medtronic DF-1 pin plug must be secured in the SVC port to make a complete SureScan™ DF-1 defibrillation system. To verify that components are part of a SureScan™ system, visit mrisurescan.com . Any other combination may result in a hazard to the patient during an MRI scan.
Lead integrity alert
The RV Lead integrity alert feature is intended primarily for patients who have a Medtronic ICD or CRT-D device and a Sprint Fidelis™ lead (Models 6949, 6948, 6931, and 6930), based on performance data. The RV LIA feature may not perform as well with a St. Jude Medical Riata™*/Durata™* lead or a Boston Scientific ENDOTAK RELIANCE™ lead as it does when used with a Medtronic Sprint Fidelis™ lead. This is because different lead designs may have different failure signatures and conditions that may or may not be detected early by the RV LIA feature.
Contraindications
The Compia MRI™ CRT-D system is contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The device is contraindicated for patients who have a unipolar pacemaker implanted. The device is contraindicated for patients with incessant incessant ventricular tachycardia (VT) or ventricular fibrillation (VF). The device is contraindicated for patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF.
Warnings and precautions
Changes in patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Certain programming and device operations may not provide cardiac resynchronization.
Patients and their implanted systems must be screened to meet the following requirements for MRI: no implanted lead extenders, lead adaptors, or abandoned leads; no broken leads or leads with intermittent electrical contact as confirmed by lead impedance history; a SureScan™ CRT-D system implanted in the left or right pectoral region; no diaphragmatic stimulation at a pacing output of 5.0 V and at a pulse width of 1.0 ms in patients whose device will be programmed to an asynchronous pacing mode when MRI SureScan™ is programmed to “on.”
Additionally for pacemaker-dependent patients, it is not recommended to perform an MRI scan if the right ventricular (RV) lead pacing capture threshold is greater than 2.0 V at 0.4 ms. A higher pacing capture threshold may indicate an issue with the implanted lead.
Patients may be scanned using a horizontal field, cylindrical bore, clinical 1.5T or 3T MRI system for hydrogen proton imaging, maximum spatial gradient ≤ 20 T/m, and maximum gradient slew rate performance per axis ≤ 200 T/m/s. 1.5T scanners must be operated in “normal operating mode” (whole body averaged specific absorption rate (SAR) ≤ 2.0 W/kg, head SAR ≤ 3.2 W/kg). 3T scanners must be operated in "first level controlled operating mode" or “normal operating mode.” B1+RMS must be ≤ 2.8 μT when the isocenter (center of the bore) is inferior to the C7 vertebra. Scans can be performed without B1+RMS restriction when the isocenter is at or superior to the C7 vertebra.
Continuous patient monitoring is required while MRI SureScan™ is programmed to “on.” While MRI SureScan is programmed to “on,” arrhythmia detection and therapies are suspended, leaving the patient at risk of death from untreated spontaneous tachyarrhythmia. In addition, if the device is programmed to an asynchronous pacing mode, arrhythmia risk may be increased.
Potential complications
Potential complications include, but are not limited to, rejection phenomena, erosion through the skin, muscle or nerve stimulation, oversensing, failure to detect and/or terminate tachyarrhythmia episodes, acceleration of ventricular tachycardia, and surgical complications such as hematoma, infection, inflammation, and thrombosis. Other potential complications related to the lead may include lead dislodgement, lead conductor fracture, insulation failure, threshold elevation, or exit block.
Potential MRI complications for the SureScan™ system include, but are not limited to, lead electrode heating and tissue damage resulting in loss of sensing or capture or both, or induced currents on leads resulting in continuous capture, VT/VF, and/or hemodynamic collapse; spontaneous tachyarrhythmia occurring during the scan that is not detected and treated because tachyarrhythmia detection is suspended while MRI SureScan™ is programmed to “on”; potential for VT/VF induction when the patient is programmed to an asynchronous pacing mode during MRI SureScan™; device heating resulting in tissue damage in the implant pocket or patient discomfort or both; or damage to the functionality or mechanical integrity of the device resulting in the inability of the device to communicate with the programmer.
See the MRI SureScan™ technical manual before performing an MRI Scan and device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1-800-328-2518 or visit mrisurescan.com .
Caution: Federal law (United States) restricts this device to sale by or on the order of a physician.
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