Stored Electrograms

Copyright © 2003 St. Jude Medical Cardiac Rhythm Management Division

 Stored Electrograms

• Provides a visual representation of what

happened during an episode
Electrogram Controls

Storage Parameters
 Storage Parameters

• For the device to store an electrogram first the

device must know what information you wish
to visualize
• In order to accomplish this, Storage Parameters
must be programmed
Source
 Source

• Allows choice of source for the stored EGM

• A Sense/Pace
• V Sense/Pace
• Custom
• Default is A and V Sense/Pace
• These intracardiac electrograms are what the
device uses to make its decisions
 Source

• Custom
• Allows selection of anode and cathode independently
• V-tip
• V-ring
• RV can
• A-tip
• A-ring
• SVC
• Custom values allow far-field EGMs to be stored
 Source

• Bipole or Near Field

• Records from the tip of the pacing/sensing lead to
the distal shocking coil or ring
• Allows us to see exactly what the device sees
• Farfield
• Records from the distal shocking coil to the device
• Looks similar to the surface ECG
 Source
Bipole EGMs are from the tip of the pacing/sensing electrode
to the distal shocking coil or positive electrode.

Far-field EGMs from distal shocking coil to the device.

Source
Custom EGM Sources
Dynamic Range
 Dynamic Range

• Defines the maximum amplitude of signals that

can be stored without any “clipping” or loss of
amplitude data
• Increasing the range decreases the resolution
• The dynamic range doesn’t affect device
sensing
Tachyarrhythmia Event EGM Triggers

• EGM storage may be triggered by any of 3

programmable event triggers:
• Detection (Default)
• Diagnosis
• Therapy
Event Triggers
 Event Triggers

• Detection (nominal)
• Stores upon initial satisfaction of programmed rate
criteria
• Diagnosis
• Stores upon initial satisfaction of both the
programmed rate criteria and applicable qualifiers
• Therapy
• Stores upon delivery of the episodes initial therapy
Duration of the Pre-Trigger
 Duration of the Pre-Trigger

• Duration of pre-trigger is the number of

seconds of EGM to be recorded before the
storage trigger
• 2 - 16 sec for two channels
• 2 - 32 sec for one channel
Maximum Duration
 Maximum Duration

• Maximum duration of stored events

• 32 seconds
• 1 minute (Default)
• 2 minutes
• 4 minutes
• The Maximum duration is timed from the
beginning of the pre-trigger
 Maximum Duration

• Storage of an EGM stops:

• Four seconds after sinus redetection
OR
• The maximum duration times out
• Whichever occurs first
• First In / First Out
 Maximum Duration
Pre-Trigger 16 Sec.

Therapy RTS 4 Sec.

Detection

Total Duration
31 Seconds
Event Parameters
 EGM Events Stored

• The events that will cause an electrogram to be

stored can be programmed
EGM Events Stored
 EGM Events Stored
• Fib
• MTD
• MTF
• Tach B
• Tach A
• Tach
• Dependant on device configuration
• Programmable On (nominal) or Off
 Special EGM Events Stored

• Special programmable events can be selected

that will cause an electrogram to be stored
Special EGM Events Stored
 Special EGM Events Stored
• Entrance into Mode Switch
• Exit from Mode Switch
• PMT Termination
• Programmable On or Off (nominal)
• The device will store a maximum of two
EGM’s for each of the special EGM events
• Special EGM’s are 16 seconds long
• 12 second pre-trigger
• 4 second post-trigger
Non Programmable Special
EGMs
Non Programmable Special EGM’s

• There are four Non Programmable Special

EGMs
• They are Always “ON”
• PC Shock delivery
• Stores all
• Successful Template Verification
• Maximum of 2 stored
Non Programmable Special EGM’s
• Entry to magnet reversion
• Triggered when magnet applied
• Maximum of 2 stored
• Exit from Atrial or Ventricular noise reversion
• Maximum of 2 stored
• All are 16 seconds in duration
• 12 seconds pre-trigger
• 4 seconds post-trigger
Electrogram Markers
Electrogram Markers
Electrogram Markers
 Interval Classification

• S = Sinus Interval
• T = Tach Interval
• Tach Interval in a Single Tach Zone
• Tach A Interval in 2 Tach Zone
• TB = Tach B Interval
• Only in a 2 Tach Zone
• F = Fib Interval
 Interval Classification

• B = Brady Interval
• Nothing shown under interval
• Trashed or Unbinned beat
• R = Reconfirmation, you’ll see this when the
device is charging
• * = Charging for a shock
• RS = Return to Sinus, episode over
Interval Classification
 Trashed or Unbinned Intervals

• In this example the Interval is Fib but the Interval

Average is Sinus
Interval Classification
Interval Classification
 Access to Stored Electrograms

• The stored electrograms can be viewed from

either
• The Episodal Diagnostics
OR
• The Stored electrogram directory
 Episodal Diagnostics

• These are the diagnostics that are specific to an

individual tachycardia episode
• If there is an electrogram associated with that
episode a button will appear on the bottom of
the screen
Episodal Diagnostics
 EGM Display

• Pressing the Display EGM button will display

the electrogram on the programmer screen
• The electrogram can be advanced by using the
scroll buttons
EGM Display
EGM Display
EGM Display
EGM Display
EGM Display
EGM Display
 Episodal Diagnostics

• The electrogram can be printed by pressing the

print button while the electrogram is being
displayed
EGM Workshop
EGM #1
 EGM #1 Interpretation

• Spontaneous episode of VT
• Notice the disassociation from the atrium
• The device detected and delivered the first
programmed tachycardia therapy,
antitachycardia pacing, ATP
• This converted the patient.
EGM #2
EGM #2 (Continued)
EGM #2 (Continued)
 EGM #2 Interpretation
• Spontaneous episode of VT
• Notice the disassociation from the atrium
• The device detected and delivered the first
programmed tachycardia therapy,
antitachycardia pacing (ATP)
• This was not successful so the second therapy
was given – again ATP
• This converted the patient.
EGM #3
EGM #3 (Continued)
 EGM #3 Interpretation

• Spontaneous episode of VF
• Notice the disassociation from the atrium
• The device detected and delivered the first
programmed fibrillation therapy, a shock.
• This converted the patient.
EGM #4
EGM #4 (Continued)
EGM #4 (Continued)
EGM #4 (Continued)
 EGM #4 Interpretation
• Spontaneous episode of VT
• Notice the disassociation from the atrium
• The device detected and delivered the first
programmed fibrillation therapy, a shock.
• This was not successful and actually placed the
patient into what looks like VF.
• The second therapy was given, again, a shock.
• This converted the patient.
Summary
 Summary

• Stored Electrograms give the clinician a

recording of what took place during an episode
• The data to be stored is programmable
• Programming changes can be made based on
the information gathered