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The Attain Stability Quad™ MRI SureScan™ 4798 steroid eluting, quadripolar electrode, IS4 transvenous lead is indicated for chronic pacing in the left ventricle via the cardiac vein, when used with a compatible Medtronic Cardiac Resynchronization Therapy (CRT) system. Extended bipolar pacing is available using this lead in combination with a compatible cardioverter defibrillator CRT system and RV defibrillation lead.
The Attain Stability Quad lead is contraindicated for the following:
Coronary vasculature — These leads are contraindicated for patients with coronary venous vasculature that is inadequate for lead placement, as indicated by venogram.
Steroid use — This lead is contraindicated in patients for whom a single dose of 288 μg of dexamethasone acetate may be contraindicated.
Diathermy is a treatment that involves the therapeutic heating of body tissues. Diathermy treatments include high-frequency, short wave, microwave, and therapeutic ultrasound. Except for therapeutic ultrasound, do not use diathermy treatments on cardiac device patients. Diathermy treatments may result in serious injury or damage to an implanted device and lead system. Therapeutic ultrasound (including physiotherapy, high intensity therapeutic ultrasound, and high intensity focused ultrasound), is the use of ultrasound at higher energies than diagnostic ultrasound to bring heat or agitation into the body. Therapeutic ultrasound is acceptable if treatment is performed with a minimum separation distance of 15 cm (6 in) between the applicator and the implanted device and lead system, as long as the ultrasonic beam is pointing away from the device and lead system.
A complete SureScan system is required for use in the MRI environment. Before performing an MRI scan, refer to the MRI Technical Manual for important information about procedures and MRI-specific warnings and precautions. 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; the SureScan system is implanted in the left or right pectoral region; the SureScan device is operating within the projected service life; 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. 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.
Potential adverse events related to the use of transvenous leads include, but are not limited to, the following patient-related conditions: air embolism; avulsion or other damage to the endocardium, valve, or vein (particularly in fragile hearts); cardiac dissection; cardiac perforation; cardiac tamponade; coronary sinus dissection; death; endocarditis; erosion through the skin; extracardiac muscle or nerve stimulation; fibrillation or other arrhythmias; heart block; heart wall or vein wall rupture; hematoma/seroma; infection; lead conductor fracture or insulation failure; lead dislodgement; myocardial irritability; myopotential sensing; pericardial effusion; pericardial rub; pericarditis; pneumothorax; rejection phenomena (local tissue reaction, fibrotic tissue formation); threshold elevation or exit block; thrombosis; thrombotic embolism.
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 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 and/or consult the Medtronic website at medtronic.com or mrisurescan.com.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.