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These Boston Scientific Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) are indicated for patients with heart failure who receive stable optimal pharmacologic therapy (OPT) for heart failure and who meet any one of the following classifications:
Moderate to severe heart failure (NYHA Class III–IV) with EF ≤ 35% and QRS duration ≥ 120 ms
Left bundle branch block (LBBB) with QRS ≥ 130 ms, EF ≤ 30%, and mild (NYHA Class II) ischemic or nonischemic heart failure or asymptomatic (NYHA Class I) ischemic heart failure
There are no contraindications for this device.
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the system. Such damage can result in patient injury or death. For single patient use only. Do not reuse, reprocess, or resterilize. Reuse, reprocessing, or resterilization may compromise the structural integrity of the device and/or lead to device failure, which, in turn, may result in patient injury, illness, or death. Reuse, reprocessing, or resterilization may also create a risk of contamination of the device and/or cause patient infection or cross-infection, including, but not limited to, the transmission of infectious disease(s) from one patient to another. Contamination of the device may lead to injury, illness, or death of the patient. Program the pulse generator Tachy Mode to Off during implant, explant or postmortem procedures to avoid inadvertent high-voltage shocks. Always have sterile external and internal defibrillator protection available during implant. If not terminated in a timely fashion, an induced tachyarrhythmia can result in the patient's death. Ensure that an external defibrillator and medical personnel skilled in CPR are present during post-implant device testing should the patient require external rescue. Advise patients to seek medical guidance before entering environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI device scanning. Strong magnetic fields may damage the device and cause injury to the patient. Do not subject a patient with an implanted pulse generator to diathermy since diathermy may cause fibrillation, burning of the myocardium, and irreversible damage to the pulse generator because of induced currents. Do not use atrial-tracking modes in patients with chronic refractory atrial tachyarrhythmias. Tracking of atrial arrhythmias could result in VT or VF. Do not use atrial-only modes in patients with heart failure because such modes do not provide CRT. LV lead dislodgment to a position near the atria can result in atrial oversensing and LV pacing inhibition. Physicians should use medical discretion when implanting this device in patients who present with slow VT. Programming therapy for slow monomorphic VT may preclude CRT delivery at faster rates if these rates are in the tachyarrhythmia zones. Do not kink leads. Kinking leads may cause additional stress on the leads, possibly resulting in lead fracture. Do not use defibrillation patch leads with the CRT-D system, or injury to the patient may occur. Do not use this pulse generator with another pulse generator. This combination could cause pulse generator interaction resulting in patient injury or lack of therapy delivery. For specific models, when using a subpectoral implantation, place the pulse generator with the serial number facing away from the ribs. Implanting the pulse generator subpectorally with the serial number facing the ribs may cause repetitive mechanical stress to a specific area of the titanium case, potentially leading to a component failure and device malfunction.
For information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization, storage and handling; implant and device programming; follow-up testing; explant and disposal; environmental and medical therapy hazards; hospital and medical environments; home and occupational environments. Advise patients to avoid sources of electromagnetic interference (EMI) because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
Potential adverse events from implantation of the CRT-D system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, and component failure. Patients may develop psychological intolerance to a pulse generator system and may experience fear of shocking, fear of device failure, or imagined shocking. In rare cases, severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/precautions, and adverse events.
Rx only.(Rev. N)
ICDs are intended to provide ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. ICDs with atrial therapies are also intended to provide atrial antitachycardia pacing and atrial defibrillation treatment in patients who have or are at risk of developing atrial tachyarrhythmias.
Use of ICD systems is contraindicated in: Patients whose ventricular tachyarrhythmias may have reversible cause, such as 1) digitalis intoxication, 2) electrolyte imbalance, 3) hypoxia, or 4) sepsis, or whose ventricular tachyarrhythmias have a transient cause, such as 1) acute myocardial infarction, 2) electrocution, or 3) drowning. Patients who have a unipolar pacemaker.
Read the product labeling thoroughly before implanting the pulse generator to avoid damage to the ICD system. Such damage can result in patient injury or death. Program the pulse generator ventricular Tachy Mode to Off during implant, explant or postmortem procedures to avoid inadvertent high-voltage shocks. Always have sterile external and internal defibrillator protection available during implant. If not terminated in a timely fashion, an induced tachyarrhythmia can result in the patient’s death. Ensure that an external defibrillator and medical personnel skilled in cardiopulmonary resuscitation (CPR) are present during post-implant device testing should the patient require external rescue. Patients should seek medical guidance before entering environments that could adversely affect the operation of the active implantable medical device, including areas protected by a warning notice that prevents entry by patients who have a pulse generator. Do not expose a patient to MRI device scanning. Strong magnetic fields may damage the device and cause injury to the patient.
Do not subject a patient with an implanted pulse generator to diathermy since diathermy may cause fibrillation, burning of the myocardium, and irreversible damage to the pulse generator because of induced currents. Do not use atrial tracking modes (or an AVT device) in patients with chronic refractory atrial tachyarrhythmias. Tracking of atrial arrhythmias could result in VT or VF. (Applies to dual-chamber devices only.) Do not use this pulse generator with another pulse generator. This combination could cause pulse generator interaction resulting in patient injury or lack of therapy delivery. Do not kink leads. Kinking leads may cause additional stress on the leads, possibly resulting in lead fracture. For specific models, when using a subpectoral implantation, place the pulse generator with the serial number facing away from the ribs. Implanting the pulse generator subpectorally with the serial number facing the ribs may cause repetitive mechanical stress to a specific area of the titanium case, potentially leading to a component failure and device malfunction.
For information on precautions, refer to the following sections of the product labeling: clinical considerations; sterilization, storage and handling; implantation and device programming; follow-up testing; explant and disposal; environmental and medical therapy hazards; home and occupational environments. Advise patients to avoid sources of electromagnetic interference (EMI) because EMI may cause the pulse generator to deliver inappropriate therapy or inhibit appropriate therapy.
Potential adverse events from implantation of the ICD system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure related, psychologic intolerance to an ICD system—patients susceptible to frequent shocks despite antiarrhythmic medical management/imagined shocking, and component failure. In rare cases, severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/ precautions, and adverse events.
Rx only.(Rev. M)
ICD leads provide pacing and rate sensing and deliver cardioversion and defibrillation shocks for ICD systems.
Use of ICD leads are contraindicated in: patients who have a unipolar pacemaker, patients with a hypersensitivity to a single dose of approximately 1.0 mg of dexamethasone sodium phosphate and/or 1.0 mg of dexamethasone acetate, patients with mechanical tricuspid heart valves.
Do not attempt to use the lead system with any device other than a commercially available ICD with which it has been tested and demonstrated safe and effective. Potential adverse consequences include, but are not limited to, undersensing of cardiac activity and failure to deliver necessary therapy.
The safety and efficacy of the tip electrode placement above midseptum has not been clinically established (extendable retractable helix leads). Lead fracture, dislodgment, abrasion and/or incomplete connection can cause a periodic or continual loss of rate sensing, possibly resulting in inappropriate delivery of a PG shock or inadequate delivery of conversion energy. The lead is not designed to tolerate excessive flexing, bending or tension. This could cause structural weakness, conductor discontinuity and/or lead dislodgment. Failure to obtain appropriate electrode position may result in higher defibrillation thresholds or may render lead unable to defibrillate a patient whose tachyarrhythmia(s) might otherwise be convertible by an ICD system. In order to deliver defibrillation therapy, the single-coil lead must be implanted with a separate defibrillation electrode. Boston Scientific CRM recommends using the single-coil lead with a pectorally implanted device that uses the metallic housing as a defibrillation electrode. When connecting the lead to ECD cables and/or the ICD PG it is very important that proper connections are made. Damage to the heart could result if a high-voltage defibrillating pulse were to be delivered through the pace/sense tip electrode. Use of any component of the lead system to assist in the delivery of external-source rescue shocks could cause extensive tissue damage. Do not kink, twist, or braid the lead terminals as doing so could cause lead insulation abrasion damage.
Refer to the lead product labeling for cautions specific to handling, implanting and testing the lead. Failure to observe these cautions could result in incorrect lead implantation, lead damage, and/or harm to the patient. It has not been determined whether the warnings, precautions, or complications usually associated with injectable dexamethasone sodium phosphate/acetate apply to the use of the low concentration, highly localized, controlled-release device. For a listing of potentially adverse effects, refer to the Physician’s Desk Reference. Tricuspid valvular disease may be exacerbated by the presence of a lead. Use medical judgment when deciding to place a lead in a patient with triscuspid valvular disease. The lead and its accessories are intended only for one-time use. Do not reuse.
Potential adverse events from implantation of the ICD lead system include, but are not limited to, the following: allergic/physical/physiologic reaction, death, erosion/migration, fibrillation or other arrhythmias, lead or accessory breakage (fracture/insulation/lead tip), hematoma/seroma, inappropriate or inability to provide therapy (shocks/pacing/sensing), infection, procedure-related, and component failure. In rare cases, severe complications or device failures can occur.
Refer to the product labeling for specific indications, contraindications, warnings/ precautions, and adverse events.
Rx only.(Rev. J)
The LATITUDE Patient Management system is intended for use to remotely communicate with a compatible pulse generator from Boston Scientific CRM and transfer data to a central database.
The LATITUDE system is contraindicated for use with any pulse generator other than a compatible pulse generator from Boston Scientific CRM. Not all Guidant or Boston Scientific pulse generators are compatible with the LATITUDE system. For contraindications for use related to the Guidant or Boston Scientific pulse generator, refer to the System Guide for the pulse generator being interrogated.
The LATITUDE system is designed to notify clinicians within 24 hours if new pulse generator alert conditions are detected by the Communicator. Alert notifications are based on clinician-configured alert settings. Pulse generator data is typically available for review on the LATITUDE system within 15 minutes of a successful interrogation. However, data availability and alert notification can take up to 24 hours or the next business day. Note that pulse generator data will not be available and alert notification cannot occur if:
The Communicator is unplugged or is not able to connect to the LATITUDE system through an active phone line.
The pulse generator and the Communicator cannot complete a telemetry session. This session must be initiated by the patient if he or she has a pulse generator that uses inductive telemetry.
The Communicator is damaged or malfunctions.
The patient is not compliant with prescribed use or is not using the LATITUDE system as described in the patient manual.
Up to two weeks may elapse before LATITUDE first detects the conditions mentioned above. Additional time may be required for clinic notification and resolution of the condition. During this time, no new patient data, device data, or alert notifications since the last successful data transmission are available. Alert notifications are not intended to be used as the sole basis for making decisions about patient medical care. Alerts can be verified by viewing information on the LATITUDE clinician website and reviewing supporting diagnostic information stored in the implanted device.
None known.
Refer to the product labeling for specific instructions for use.
Rx only.(Rev. K)