Product Performance Report Cardiac Rhythm Management A 2006 · 2020-07-21 · Serving our mission...

Product Performance ReportCardiac Rhythm Management

APRIL 2006

As world leaders in the development of state-of-the-art technology for cardiac

rhythm management (CRM) devices, St. Jude Medical appreciates that our products

are implanted in people whose health and well-being depend on their performance.

From product design through patient follow-up, St. Jude Medical employees are

dedicated to product quality and patient safety. In keeping with this commitment, we

publish a product performance report semi-annually to keep the healthcare

community and the patients it serves informed of the overall performance of our

cardiac devices, which include implantable cardioverter defibrillators (ICDs),

pacemakers and implantable pacing and defibrillation leads.

St. Jude Medical also recognizes the value of the industry working together to

provide transparent and consistent information on the performance of CRM products.

Following the 2005 Policy Conference on Pacemaker and ICD Device Performance,

cardiac device companies have worked together through AdvaMed to establish a

“Proposal for Uniform CRM Product Performance Reporting.” This proposal, which

St. Jude Medical has adopted, sets forth the definitions and requirements for product

performance reports and seeks to provide physicians and their patients with a level of

device performance information that is consistent across manufacturers.

As we continually strive to provide transparent and consistent information on the

performance of our products, we are pleased to release this product performance

report with the latest performance information on our ICDs, pacemakers and lead

systems.

Sincerely,

Ben KhosraviExecutive Vice PresidentQuality, Leads Development and Operations

Letter from St. Jude MedicalA P R I L 2 0 0 6

1

3

Table of Contents

INTRODUCTION AND OVERVIEW 5

CARDIAC RESYNCHRONIZATION THERAPY 10

CRT ICDs 10

SUMMARY INFORMATION 14

LEFT HEART LEADS 15

ICDs 16

DUAL CHAMBER 16

SINGLE CHAMBER 25


DEFIBRILLATION LEADS 33

PULSE GENERATORS 37

DUAL CHAMBER 37

SINGLE CHAMBER 55


PACING LEADS 70

BIPOLAR ACTIVE FIXATION 70

BIPOLAR PASSIVE FIXATION 72

UNIPOLAR ACTIVE FIXATION 73

UNIPOLAR PASSIVE FIXATION 74

ADVISORIES AND SAFETY ALERTS 76

INDEX 81

5

Introduction and Overview

Serving our mission

St. Jude Medical’s mission is to make life better through excellence in medical device

technology and services. Toward that effort, we maintain a rigorous approach to

ensuring the quality of our products. The key elements of this effort include:

• Compliance with U.S. and international quality system standards, such as the U.S.

FDA Quality Systems Regulation (21 CFR Part 820) and ISO 13485 (an international

standard for the Quality Management System for medical devices);

• Thorough evaluation of product design, including extensive design verification and

validation, as well as product qualification testing;

• Rigorous control of the design and manufacturing processes;

• Inspection and qualification of externally supplied components and materials;

• Timely analysis of returned products, including extensive malfunction investigation;

• Extensive internal auditing; and

• Continuous improvement programs.

What you’ll find in this report

For all ICDs starting with Photon Micro and for all pacemakers starting with Affinity,

you will find the analysis of data, according to the AdvaMed guidelines, collected

through January 31, 2006, including:

• A graph of survival probability that reflects all device malfunctions known to us

(including normal battery depletion, malfunction with compromised therapy, and

malfunction without compromised therapy);

• A graph of survival probability that excludes normal battery depletion in the

analysis; and

• A table that accompanies each graph and summarizes the data in it.

Additional tables that aggregate and summarize the data in the report can be found

on pages 14 (CRT ICDs), 32 (ICDs) and 68 (Pulse Generators).

6

For ICDs prior to Photon Micro, pacemakers prior to Affinity and all pacing and

defibrillation leads, you will find analysis of the data collected through January 31,

2006, consistent with previous product performance reports.

We have also included a summary of the methods used for measuring product

performance and a summary of the definitions for key terms used in preparing the

report.

MethodologyFor devices that are implanted in the body and have a service life of several years,

measuring performance presents a number of considerations for medical device

manufacturers. St. Jude Medical encourages that all products, once they are taken out

of a patient for any reason, be returned for analysis. There are some situations where

those devices are not always returned. These include, for example, pacing and

defibrillation leads that are not routinely explanted due to the risk to patients of

explanting these devices.

The industry standard method of evaluating product performance is survival analysis,

which estimates the probability that a device will not malfunction during a specified

period of time. This statistical method best represents device performance in general

over a specified period of time.

Here is how St. Jude Medical measures product performance:

For ICDs, pacemakers and leads, we compile cumulative survival data based on the

actuarial (or life-table) method of survival analysis. Product performance is plotted

over a maximum of 20 years, with a minimum of 500 registered implants required for

inclusion in the report, and a minimum sample size for each time period of 200

devices. The data for the analysis covers all documented implants in the United States,

and includes the analysis of all domestically implanted pulse generators returned to

St. Jude Medical. The analysis measures hardware performance to specification, and

does not reflect medical complications such as infection, erosion, muscle stimulation

or inhibition, or units implanted for fewer than 24 hours.

7

“Survival” refers to the proper function of the device, not the survival of the patient,

and is intended to illustrate the calculated probability of device survival at a given

point in time. A survival probability of 99% at five years, for example, indicates that

at five years after implant, the system has a 1% risk of incurring a malfunction and/or

normal battery depletion. All devices within each model family (except where noted)

are included in the calculations.

Lead analysis includes all leads returned to the company, as well as those registered as

complaints but not returned. This method is used to ensure a conservative failure

estimate for lead performance.

Implanted cardiac leads are subjected to constant, complex flexural and torsional

forces, interactions with other leads and/or the pulse generator device, plus other

forces associated with cardiac contractions and patient physical activity, posture, and

anatomical influences. As such, cardiac leads’ functional lifetimes are therefore

limited and indeed, their functional longevity can not be predicted.

Because of the large size of the U.S. data pool, and because in general the same

products are used both in the U.S. and internationally, we consider the data in this

report to be accurately representative of each device’s performance, regardless of

where in the world it was implanted.

Let us know

To maintain the continued accuracy of our performance reporting, we encourage

physicians to notify our Patient Records Department each time a device is removed

from service as a result of device replacement or patient death. Our Patient Records

department can be reached at 888-SJM-CRMD or 818-362-6822. All explanted devices

should be returned for evaluation.

In addition, we are always ready to respond to questions, comments or suggestions.

You can reach us by phone at 888-SJM-CRMD, or on the web at www.sjm.com.

8

DefinitionsWe have used the following definitions in preparing this report. AdvaMed Proposal

definitions were used where applicable, denoted by *.

Estimated Active Implants - The total number of registered implants of a device,

adjusted to reduce the bias attributable to the potential underreporting of:

• Devices removed from service due to malfunction;

• Devices removed from service while in specification, such as devices removed due to

changes in patient condition;

• Devices removed from service due to patient death, and

• Devices removed from service due to normal battery depletion.

Malfunction - Having characteristics that are outside the performance limits

established by the manufacturer while implanted and in service, as confirmed by

laboratory analysis, except changes to characteristics due to normal battery depletion

or induced malfunction. Device damage caused after or during explant is not

considered a malfunction.*

Malfunction with Compromised Therapy - The condition when a device is found to

have “malfunctioned,” as defined above, in a manner that compromised pacing or

defibrillation therapy (including complete loss or partial degradation) while

implanted and in service. Therapy is considered to have been compromised if no

therapy is available or critical patient-protective pacing or defibrillation therapy is not

available.* (A malfunction with compromised therapy does not imply that a patient

has actually experienced a serious complication or death as a result of the malfunction

although it does imply that the potential for a serious complication or death did exist

during the period of the malfunction.)

9

Malfunction without Compromised Therapy - The condition when a device is found to

have “malfunctioned,” as defined above, in a manner that did not compromise pacing

or defibrillation therapy while implanted and in service, as confirmed by laboratory

analysis. Therapy is not compromised as long as the critical patient-protective pacing

and defibrillation therapies are available.

Changes in device setting that occur as intended by the design (for example, reversion

to a designed Safe Mode or Power-On Reset [POR]) that do not result in loss of critical

patient protective therapies but are the reported reasons for explant shall be

categorized as a Malfunction without Compromised Therapy.*

Normal Battery Depletion - The condition where a returned device:

• Reached its elective replacement indicator voltage;

• Tested within electrical specifications, and

• Had an implant duration exceeding 80% of its projected longevity.

*AdvaMed Proposal - Requirements for Uniform Reporting of Clinical Performance of Pulse Generators.

Cardiac Resynchronization Therapy CRT ICDs

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5Years After Implant

Epic™ HF(Model V-338)

Including Normal Battery Depletion

YearSurvival Probability± 1 standard error

199.87%

0.05%

298.83%

0.32%

3 4 5

The Epic™ HF cardiac resynchronization therapy defibrillator was approved for use in June 2004.Survival probability (%) is based on returned product analysis as of January 31, 2006.

3,122 of these devices have been implanted.(Note: Some of these devices are subject to an advisory. See pp. 76-79 for more information.)

Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant


Excluding Normal Battery Depletion


199.92%

0.05%

299.92%

0.05%

3 4 5

10

11

CRT ICDs Cardiac Resynchronization Therapy

Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant



YearSurvival Probability*

± 1 standard error

1 2 3 4 5

The Epic™ HF cardiac resynchronization therapy defibrillator was approved for use in November 2004.Survival probability (%) is based on returned product analysis as of January 31, 2006.

1,806 of these devices have been implanted. (Note: Some of these devices are subject to an advisory. See pp. 76-79 for more information.)

*No survival probability is stated at 1 year due to the device not meeting the required minimum sample size of 200 U.S. implants with 12 consecutive months of data.

Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant




± 1 standard error

1 2 3 4 5

Cardiac Resynchronization Therapy CRT ICDs

Devic

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Atlas®+ HF(Model V-340)



199.91%

0.03%

2 3 4 5

The Atlas®+ HF cardiac resynchronization therapy defibrillator was approved for use in June 2004.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant




199.93%

0.02%

2 3 4 5

12

CRT ICDs Cardiac Resynchronization Therapy

13

Devic

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Pro

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5Years After Implant




1100%

0.00%

2 3 4 5

The Atlas®+ HF cardiac resynchronization therapy defibrillator was approved for use in November 2004.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant




1100%

0.00%

2 3 4 5

14

Cardiac Resynchronization Therapy CRT ICDsSummary Information*

Model

V-338

V-337**

V-340

V-343

Family

Epic HF

Epic HF

Atlas + HF

Atlas + HF

MarketRelease Date

Jun-04

Nov-04

Jun-04

Nov-04

Registered US implants

3122

1806

4912

6107

EstimatedActive

US implants

2701

1712

4481

5920

Malfunctionsw/ Compromised

Therapy

1

0

2

0

Malfunctionsw/o

CompromisedTherapy

2

0

0

0

TotalMalfunctions

3

0

2

0

NormalBattery

Depletion

14

0

1

0

1 year

99.87%

99.91%

100%

2 years

98.83%

3 years 4 years

Model

V-338

V-337**

V-340

V-343

Family

Epic HF

Epic HF

Atlas + HF

Atlas + HF

MarketRelease Date

Jun-04

Nov-04

Jun-04

Nov-04


3122

1806

4912

6107

EstimatedActive

US implants

2701

1712

4481

5920


Therapy

1

0

2

0

Malfunctionsw/o

CompromisedTherapy

2

0

0

0

TotalMalfunctions

3

0

2

0

1 year

99.92%

99.93%

100%

2 years

99.92%

3 years 4 years



Survival Probability


*Based on returned product analysis as of January 31, 2006.**No survival probability is stated at 1 year due to the device not meeting the required minimum sample

size of 200 U.S. implants with 12 consecutive months of data. Please refer to the individual device graphsfor data up to one year.

15

Left Heart Leads Cardiac Resynchronization Therapy

Data is current as of January 31, 20063,696 of these leads have been implanted.

(Approval date: June 2004)

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

QuickSite® (Model 1056K)Unipolar Polyurethane/Silicone Left Heart Lead


199.68%

0.07%

2 3 4 5

16

ICDs dual-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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y

Years After Implant

Atlas® DR(Model V-242)



199.91%

0.10%

2 3 4 5

The Atlas®+ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




1100.00%

0.00%

2 3 4 5

17

dual-chamber ICDs

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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y

Years After Implant

Atlas®+ DR(Model V-243)



199.93%

0.04%

299.93%

0.04%

3 4 5

The Atlas®+ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Atlas®+ DR(Model V-243)



199.95%

0.01%

299.95%

0.04%

3 4 5

18

ICDs dual-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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y

Years After Implant

Epic™+ DR(Model V-236)



199.96%

0.04%

299.83%

0.04%

3 4 5

The Epic™+ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in April 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




199.96%

0.04%

299.96%

0.04%

3 4 5

19

dual-chamber ICDs

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant




199.94%

0.05%

2 3 4 5

The Epic™+ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant




199.94%

0.05%

2 3 4 5

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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bab

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y

Years After Implant

Epic™ DR(Model V-235)



199.95%

0.02%

299.93%

0.04%

399.78%

0.09%

4 5

The Epic™ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in July 2002. Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




199.97%

0.02%

299.93%

0.04%

399.84%

0.07%

4 5

ICDs dual-chamber

20

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




1100%

0.00%

2 3 4 5

The Epic™ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2003. Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Years After Implant




1100%

0.00%

2 3 4 5

dual-chamber ICDs

21

ICDs dual-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




199.88%

0.03%

299.65%

0.07%

398.79%

0.15%

4 5

The Atlas® DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in December 2001.This model is no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.8,898 of these devices have been implanted.

(Note: Some of these devices are subject to an advisory. See pp. 76-79 for more information.)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant




199.88%

0.03%

299.76%

0.06%

399.46%

0.10%

4 5

22

23

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant

Photon® µ DR(Model V-232)



199.84%

0.07%

299.55%

0.09%

397.87%

0.27%

491.58%

0.62%

5

The Photon® µ DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in June 2001.This model is no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant

Photon® µ DR(Model V-232)



199.84%

0.07%

299.65%

0.09%

399.13%

0.18%

497.69

0.33%

5

dual-chamber ICDs

24

The Photon® DR dual-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2000.This model is no longer being manufactured.


45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant

Photon® DR(Model V-230HV)


199.66%

0.10%

296.05%

0.32%

376.39%

0.80%

452.96%

1.16%

5

ICDs dual-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant

Atlas®+ VR(Model V-193)



199.99%

0.01%

299.99%

0.01%

3 4 5

The Atlas®+ VR single-chamber-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in October 2003.

Survival probability (%) is based on returned product analysis as of January 31, 2006. 10,168 of these devices have been implanted.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

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Years After Implant

Atlas®+ VR(Model V-193)



199.99%

0.01%

299.99%

0.01%

3 4 5

single-chamber ICDs

25

ICDs single-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Years After Implant

Epic™+ VR(Model V-196)



199.95%

0.04%

299.95%

0.04%

3 4 5

The Epic™+ VR single-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in April 2003. Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Epic™+ VR(Model V-196)



199.97%

0.03%

299.97%

0.03%

3 4 5

26

single-chamber ICDs

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

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y

Years After Implant

Epic™ VR(Model V-197)



199.94%

0.04%

299.80%

0.08%

399.75%

0.10%

4 5

The Epic™ VR single-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in July 2002. Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Epic™ VR(Model V-197)



199.94%

0.04%

299.80%

0.08%

399.75%

0.10%

4 5

27

28

ICDs single-chamber

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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Years After Implant

Atlas® VR(Model V-199)



199.76%

0.06%

299.51%

0.09%

399.20%

0.13%

4 5

The Atlas® VR single-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in December 2001.This model is no longer being manufactured.



50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

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ival

Pro

bab

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Years After Implant

Atlas® VR(Model V-199)



199.80%

0.05%

299.64%

0.08%

399.50%

0.10%

4 5

29

single-chamber ICDs

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

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ival

Pro

bab

ilit

y

Years After Implant

Photon® µ VR(Model V-194)



199.78%

0.09%

299.56%

0.13%

399.31%

0.16%

498.54%

0.27%

5

The Photon® µ VR single-chamber, rate-responsive implantable cardioverter defibrillator was approved for use in June 2001.This model is no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

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ival

Pro

bab

ilit

y

Years After Implant

Photon® µ VR(Model V-194)



199.78%

0.09%

299.60%

0.12%

399.40%

0.14%

499.15%

0.21%

5

30

ICDs single-chamber

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Profile™

(Models V-186F & V-186HV3)D

evic

e S

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ival

Pro

bab

ilit

y

Years After Implant

The Profile™ series of single-chamber implantable cardioverter defibrillators was approved for use in November 1998.These models are no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.*These devices are not under advisory. 3,684 of these devices were implanted.

**This group of devices is subject to an advisor y. See pp. 76-79 for more information. 2,295 of these devices were implanted.

*YearSurvival Probability± 1 standard error

296.05%

0.33%

455.44%

1.13%

6 8 10

population 2**

population 1*

**YearSurvival Probability

± 1 standard error

294.77%

0.47%

452.06%

1.50%

6 8

The Contour® MD series of single-chamber implantable cardioverter defibrillators was approved for use in October 1998.Survival probability (%) is based on returned product analysis as of January 31, 2006.

4,908 of these devices have been implanted.

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

e S

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Pro

bab

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y

Years After Implant

Contour® MD (Models V-175, V-175AC, V-175B, V-175C & V-175D)


299.05%

0.14%

495.22%

0.37%

670.06%

1.36%

8 10

3131

single-chamber ICDs

The Contour® II series was approved for use in February 1998.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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ival

Pro

bab

ilit

y

Years After Implant

Contour® II (Models V-185, V-185AC, V-185B, V-185C & V-185D)


298.77%

0.29%

495.73%

0.56%

667.96%

1.90%

8 10

32

ICDs Summary Information*

Model

V-242

V-243

V-236

V-239

V-235

V-233

V-240

V-232

V-193

V-196

V-197

V-199

V-194

Family

Atlas DR

Atlas + DR

Epic + DR

Epic + DR

Epic DR

Epic DR

Atlas DR

Photon µ DR

Atlas + VR

Epic + VR

Epic VR

Atlas VR

Photon µ VR

MarketRelease Date

Oct-03

Oct-03

Apr-03

Oct-03

Jul-02

Oct-03

Dec-01

Jun-01

Oct-03

Apr-03

Jul-02

Dec-01

Jun-01


2910

9866

2393

4922

6723

1344

8898

3518

10168

5538

3752

7150

2928

EstimatedActive

US implants

2715

9266

1937

4592

5368

1248

5584

1513

9583

4946

2884

4881

1585


Therapy(not underadvisory)

0

1

0

2

3

0

8

7

0

1

5

6

7


Therapy(under

advisory**)

0

0

0

0

0

0

13

7

0

0

0

16

4

Malfunctionsw/o

CompromisedTherapy

0

1

1

0

3

0

14

33

1

0

2

6

7

TotalMalfunctions

0

2

1

2

6

0

35

47

1

1

7

28

18

NormalBattery

Depletion

1

1

1

0

2

0

89

122

0

1

0

18

11

1 year

99.91%

99.93%

99.96%

99.94%

99.95%

100%

99.88%

99.84%

99.99%

99.95%

99.94%

99.76%

99.78%

2 years

99.93%

99.83%

99.93%

99.65%

99.55%

99.99%

99.95%

99.80%

99.51%

99.56%

3 years

99.78%

98.79%

97.87%

99.75%

99.20%

99.31%

4 years

91.58%

98.54%

Model

V-242

V-243

V-236

V-239

V-235

V-233

V-240

V-232

V-193

V-196

V-197

V-199

V-194

Family

Atlas DR

Atlas + DR

Epic + DR

Epic + DR

Epic DR

Epic DR

Atlas DR

Photon µ DR

Atlas + VR

Epic + VR

Epic VR

Atlas VR

Photon µ VR

MarketRelease Date

Oct-03

Oct-03

Apr-03

Oct-03

Jul-02

Oct-03

Dec-01

Jun-01

Oct-03

Apr-03

Jul-02

Dec-01

Jun-01


2910

9866

2393

4922

6723

1344

8898

3518

10168

5538

3752

7150

2928

EstimatedActive

US implants

2715

9266

1937

4592

5368

1248

5584

1513

9583

4946

2884

4881

1585


Therapy(not underadvisory)

0

1

0

2

3

0

8

7

0

1

5

6

7


Therapy(under

advisory**)

0

0

0

0

0

0

13

7

0

0

0

16

4

Malfunctionsw/o

CompromisedTherapy

0

1

1

0

3

0

14

33

1

0

2

6

7

TotalMalfunctions

0

2

1

2

6

0

35

47

1

1

7

28

18

1 year

100%

99.95%

99.96%

99.94%

99.97%

100%

99.88%

99.84%

99.99%

99.97%

99.94%

99.80%

99.78%

2 years

99.95%

99.96%

99.93%

99.76%

99.65%

99.99%

99.97%

99.80%

99.64%

99.60%

3 years

99.84%

99.46%

99.13%

99.75%

99.50%

99.40%

4 years

97.69%

99.15%





*Based on returned product analysis as of January 31, 2006.**St. Jude Medical. ICD Memory Chip Component Anomaly (advisory). October 7, 2005.

33

Defibrillation Leads

Data is current as of January 31, 2006.1,972 of these leads have been implanted.

(Approval date: March 2003)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Riata® (Model 1582)Active Fixation Single-Coil ICD Lead


199.34%

0.21%

298.02%

0.52%

3 4 5

Data is current as of January 31, 20065,424 of these leads have been implanted.

(Approval date: April 2004)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Riata®i (Model 1590 & 1591)Active Fixation Dual-Coil ICD Lead


1100%

0.00%

2 3 4 5

34




50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Riata® (Models 1570 & 1571)Passive Fixation Dual-Coil ICD Leads


199.88%

0.04%

299.76%

0.06%

399.61%

0.12%

4 5



50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

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ival

Pro

bab

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y

Years After Implant

Riata® (Model 1580 & 1581)Active Fixation Dual-Coil ICD Leads


199.84%

0.02%

299.68%

0.04%

399.34%

0.07%

4 5


35

Data is current as of January 31, 2006.This lead model is no longer being manufactured.

4,448 of these leads have been implanted.(Approval date: November 1999)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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Pro

bab

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y

Years After Implant

TVL®-ADX (Model 1559)Active Fixation Single-Coil ICD Lead


299.47%

0.12%

497.68%

0.26%

6 8 10

Data is current as of January 31, 2006.These lead models are no longer being manufactured.

12,345 of these leads have been implanted.(Approval date: September 1997)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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Pro

bab

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y

Years After Implant

SPL® (Models SP01, SP02, SP03 & SP04)Passive Fixation Dual-Coil ICD Leads


299.72%

0.05%

499.40%

0.08%

699.00%

0.12%

898.68%

0.17%

10


299.56%

0.11%

499.17%

0.17%

698.34%

0.26%

897.82%

0.33%

10


3,478 TVL® RV leads have been implanted, and 909 TVL® SVC leads have been implanted.(Approval dates: RV01, RV02, SV01, SV02, SV03–May 1996; RV03–April 1997; RV06, RV07–July 2000)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

e S

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Pro

bab

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y

Years After Implant

TVL® RV (Models RV01, RV02, RV03, RV06 & RV07)

TVL® SVC (Models SV01, SV02 & SV03) Passive Fixation Single-Coil ICD LeadsR

V


± 1 standard error

2

99.75%

0.18%

4

98.85%

0.41%

698.85%

0.41%

898.85%

0.41%SV

C


36

37

dual-chamber Pulse Generators

Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Frontier™ II(Model 5586)



± 1 standard error

1 2 3 4 5

The Frontier™ dual-chamber, rate-responsive pulse generator was approved for use in August 2004. Survival probability (%) is based on returned product analysis as of January 31, 2006.

859 of these devices have been implanted.*No survival probability is stated at 1 year due to the device not meeting the required

minimum sample size of 200 U.S. implants with 12 consecutive months of data.

Devic

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ival

Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Frontier™ II(Model 5586)



± 1 standard error

1 2 3 4 5

38

Pulse Generators dual-chamber

Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx DR(Model 5380)



199.95%

0.01%

299.86%

0.03%

3 4 5

The Identity® ADx DR dual-chamber, rate-responsive pulse generator was approved for use in March 2003. Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx DR(Model 5380)



199.96%

0.01%

299.92%

0.03%

3 4 5

39


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx XL DR (Model 5386)Identity® ADx XL DC (Model 5286)



199.95%

0.02%

299.91%

0.02%

3 4 5

The Identity® ADx XL DR dual-chamber, rate-responsive pulse generator and the Identity® ADx XL DC dual-chamber pulse generator were approved for use in March 2003.


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx XL DR (Model 5386)Identity® ADx XL DC (Model 5286)



199.95%

0.02%

299.92%

0.02%

3 4 5

40


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Integrity® ADx DR(Models 5360 & 5366)



199.95%

0.03%

299.95%

0.03%

3 4 5

The Integrity® ADx DR dual-chamber, rate-responsive pulse generator was approved for use in May 2003. Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Integrity® ADx DR(Models 5360 & 5366)



199.95%

0.03%

299.95%

0.03%

3 4 5

41


Devic

e S

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Verity® ADx XL DR (Model 5356)Verity® ADx XL DR M/S (Model 5357M/S); Verity® ADx XL DC (Model 5256)



199.93%

0.03%

299.93%

0.03%

3 4 5

The Verity® ADx XL DR and the Verity® ADx XL DR M/S dual-chamber, rate-responsive pulse generatorsand the Verity® ADx XL DC dual-chamber pulse generator were approved for use in May 2003.


Devic

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Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Verity® ADx XL DR (Model 5356)Verity® ADx XL DR M/S (Model 5357M/S); Verity® ADx XL DC (Model 5256)



199.93%

0.03%

299.93%

0.03%

3 4 5

42


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity®

(Model 5370)Including Normal Battery Depletion


199.93%

0.01%

299.79%

0.02%

399.43%

0.05%

498.00%

0.20%

5

The Identity® dual-chamber, rate-responsive pulse generator was approved for use in November 2001.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity®

(Model 5370)Excluding Normal Battery Depletion


199.95%

0.01%

299.88%

0.02%

399.80%

0.03%

499.61%

0.06%

5

43


Devic

e S

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Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® XL(Model 5376)



199.93%

0.01%

299.85%

0.02%

399.79%

0.03%

499.71%

0.05%

5

The Identity® XL dual-chamber, rate-responsive pulse generator was approved for use in November 2001.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® XL(Model 5376)



199.93%

0.01%

299.85%

0.02%

399.84%

0.02%

499.82%

0.03%

5

44


Devic

e S

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Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® µ DR(Model 5336)



299.66%

0.04%

496.37%

0.16%

6 8 10

The Integrity® µ DR dual-chamber, rate-responsive pulse generator was approved for use in December 2000.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® µ DR(Model 5336)



299.83%

0.03%

499.50%

0.05%

6 8 10

4545


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® AFx DR(Models 5342 & 5346)



299.87%

0.02%

499.73%

0.03%

6 8 10

The Integrity® AFx DR model 5342 dual-chamber, rate-responsive pulse generator was approved for use in April 2000. The Integrity® AFx DR model 5346 dual-chamber, rate-responsive pulse generator was approved for use in July 2001.


Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® AFx DR(Models 5342 & 5346)



299.88%

0.02%

499.80%

0.02%

6 8 10

4646


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Entity® DR (Model 5326)Entity® DC (Model 5226)



299.86%

0.03%

499.54%

0.06%

699.18%

0.11%

8 10

The Entity® DR dual-chamber, rate-responsive pulse generator and the Entity® DC dual-chamber, pulse generator were approved for use in June 1999.


Devic

e S

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Entity® DR (Model 5326)Entity® DC (Model 5226)



299.89%

0.02%

499.80%

0.03%

699.78%

0.04%

8 10

4747


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Affinity® DR (Models 5330 & 5331)Affinity® DC (Model 5230)



299.73%

0.02%

499.41%

0.03%

698.83%

0.06%

8 10

The Affinity® DR model 5330 dual-chamber, rate-responsive pulse generator was approved for use in January 1999.The Affinity® DC model 5230 dual-chamber pulse generator and the Affinity® DR model 5331 dual-chamber, rate-responsive

pulse generator were approved for use in June 1999. Survival probability (%) is based on returned product analysis as of January 31, 2006. 65,333 of these devices have been implanted.


Devic

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Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Affinity® DR (Models 5330 & 5331)Affinity® DC (Model 5230)



299.75%

0.02%

499.59%

0.03%

699.44%

0.04%

8 10

4848


Devic

e S

urv

ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Affinity® VDR(Models 5430)



1100%

0.00%

2100%

0.00%

3100%

0.00%

499.59%

0.00%

5

The Affinity® VDR single-lead, dual-chamber, rate-responsive pulse generator was approved for use in April 2000.Survival probability (%) is based on returned product analysis as of January 31, 2006.

663 of these devices have been implanted.

Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Affinity® VDR(Models 5430)



1100%

0.00%

2100%

0.00%

3100%

0.00%

4100%

0.00%

5

The Tempo® D series of dual-chamber pulse generators and the Tempo® DR series of dual-chamber, rate-responsive pulse generators were approved for use in August 1997. The Meta™ DDDR pulse generator

was approved for use in April 1997. These models are no longer being manufactured.Survival probability (%) is based on returned product analysis as of January 31, 2006.*This group of devices is not under advisory. 1,035 of these devices were implanted.

**This group of devices is subject to an advisory. See pp. 76-79 for more information. 2,583 of these devices were implanted.

Devic

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Pro

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0 42 6 8 1050%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Years After Implant

Meta™ DDDR (Model 1256D)Tempo® D (Model 2902); Tempo® DR (Model 2102)


± 1 standard error

298.35%

0.26%

491.30%

0.72%

684.88%

1.03%

Population 1*

Population 2**


299.31%

0.28%

497.77%

0.54%

696.20%

0.71%

8 10

The Meta™ DDDR dual-chamber, rate-responsive pulse generator was approved for use in April 1997. This model is no longer being manufactured.


(Note: These devices are subject to an advisory. See pp. 76-79 for more information.)

Devic

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Pro

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Meta™ DDDR(Model 1256)


298.10%

0.28%

493.63%

0.56%

691.98%

0.66%

890.77%

0.74%

10

Years After Implant

49


50


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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Pro

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Years After Implant

Trilogy® DC+(Model 2318)


± 1 standard error

299.67%

0.10%

498.79%

0.30%

698.28%

0.38%

Population 1* Population 2**


2100%

0.00%

499.44%

0.28%

699.10%

0.52%

8 10

The Trilogy® DC+ series of dual-chamber pulse generators was approved for use in January 1997.This model is no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.*This group of devices is not under advisory. 611 of these devices were implanted.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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Pro

bab

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Years After Implant

Trilogy® DR+(Models 2360 & 2364)


299.83%

0.04%

499.54%

0.07%

698.95%

0.12%

8 10


± 1 standard error

299.56%

0.03%

498.82%

0.05%

697.60%

0.08%

896.90%

0.10%

Population 1*

Population 2**

The Trilogy® DR+ series of dual-chamber, rate-responsive pulse generators was approved for use in September 1996.These models are no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.*These devices are not under advisory. 11,679 of these devices were implanted.

**These devices are subject to an advisory. See pp. 76-79 for more information. 57,945 of these devices were implanted.

The Trilogy® DR dual-chamber, rate-responsive pulse generator was approved for use in June 1995.This model is no longer being manufactured.



The Trilogy® DC dual-chamber pulse generator was approved for use in June 1995.This model is no longer being manufactured.



50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

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Years After Implant

Trilogy® DR(Model 2350)


399.47%

0.05%

696.53%

0.17%

993.96%

0.28%

12 15

0 42 6 8 1050%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Devic

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Pro

bab

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Years After Implant

Trilogy® DC(Model 2308)


299.65%

0.11%

498.48%

0.24%

696.66%

0.41%

893.15%

0.73%

10

51


The Paragon™ III series of dual-chamber pulse generators was introduced in October 1994. These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

bab

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Years After Implant

Paragon™ III(Models 2304, 2314 & 2315)


399.47%

0.13%

697.50%

0.33%

994.18%

0.70%

12 15

The Paragon™ II series of dual-chamber pulse generators was introduced in April 1989. This model is no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

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Years After Implant

Paragon™ II(Model 2016)


499.08%

0.06%

895.76%

0.17%

1291.83%

0.32%

16 20

52


The Paragon™ series of dual-chamber pulse generators was introduced in September 1988.These models are no longer being manufactured.


The Synchrony® III series of dual-chamber, rate-responsive pulse generators was released in February 1993.These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

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bab

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Years After Implant

Paragon™

(Models 2010, 2011 & 2012)


499.31%

0.07%

897.57%

0.16%

1294.75%

0.31%

1693.48%

0.46%

20

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

bab

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Years After Implant

Synchrony® III(Models 2028 & 2029)


399.39%

0.04%

694.02%

0.15%

988.91%

0.28%

1288.06%

0.35%

15

53


The AddVent® single-lead, dual-chamber pulse generator was approved for use in May 1999.This model is no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.353 of these devices have been implanted.

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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Years After Implant

AddVent®

(Model 2060)


199.71%

0.29%

299.31%

0.49%

398.88%

0.65%

4 5

The Synchrony® II series of dual-chamber, rate-responsive pulse generators was released in June 1990.These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

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Pro

bab

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Years After Implant

Synchrony® II(Models 2022 & 2023)


498.94%

0.05%

895.19%

0.13%

1291.78%

0.22%

16 20

54


55

single-chamber Pulse Generators

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx SR(Model 5180)



199.94%

0.02%

299.91%

0.05%

3 4 5

The Identity® ADx SR single-chamber, rate-responsive pulse generator was approved for use in May 2003. Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® ADx SR(Model 5180)



199.98%

0.02%

299.94%

0.04%

3 4 5

56

Pulse Generators single-chamber

Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Verity® ADx XL SR (Model 5156)Verity® ADx XL SR M/S (Model 5157M/S); Verity® ADx XL SC (Model 5056)



199.98%

0.02%

299.98%

0.02%

3 4 5

The Verity® ADx XL SR and Verity® ADx XL SR M/S single-chamber, rate-responsive pulse generators and the Verity® ADx XL SC single-chamber pulse generator were approved for use in May 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Verity® ADx XL SR (Model 5156)Verity® ADx XL SR M/S (Model 5157M/S); Verity® ADx XL SC (Model 5056)



199.98%

0.02%

299.98%

0.02%

3 4 5

57


Devic

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Pro

bab

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y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® SR(Model 5172)



199.97%

0.01%

299.85%

0.03%

399.72%

0.06%

4 5

The Identity® SR single-chamber, rate-responsive pulse generator was approved for use in November 2001.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Identity® SR(Model 5172)



199.98%

0.01%

299.91%

0.03%

399.87%

0.04%

4 5

5858


Devic

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ival

Pro

bab

ilit

y

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Integrity® ADx SR(Model 5160)



1100%

0.00%

2 3 4 5

The Integrity® ADX SR single-chamber, rate-responsive pulse generator was approved for use in May 2003.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Years After Implant

Integrity® ADx SR(Model 5160)



1100%

0.00%

2 3 4 5

Devic

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Pro

bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® µ SR(Model 5136)



299.88%

0.03%

499.46%

0.11%

6 8 10

The Integrity® µ SR single-chamber, rate-responsive pulse generator was approved for use in December 2000.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® µ SR(Model 5136)



299.96%

0.02%

499.75%

0.07%

6 8 10

59


6060


Devic

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Pro

bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® SR(Model 5142)



299.93%

0.03%

499.91%

0.03%

6 8 10

The Integrity® SR single-chamber, rate-responsive pulse generator was approved for use in April 2000.Survival probability (%) is based on returned product analysis as of January 31, 2006.


Devic

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Pro

bab

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Integrity® SR(Model 5142)



299.94%

0.03%

499.92%

0.03%

6 8 10

61

Devic

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Pro

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Affinity® SR(Models 5130 & 5131)



299.78%

0.03%

499.62%

0.05%

699.53%

0.06%

8 10

The Affinity® SR model 5130 single-chamber, rate-responsive pulse generator was approved for use in January 1999. The Affinity® SR model 5131 single-chamber, rate-responsive pulse generator was approved for use in June 1999.



Devic

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Years After Implant

Affinity® SR(Models 5130 & 5131)



299.81%

0.03%

499.71%

0.04%

699.67%

0.05%

8 10

61


62


The Microny® model 2425T single-chamber, rate-responsive pulse generator was approved for use in December 2000.The Microny® models 2525T and 2535K single-chamber, rate-responsive pulse generators were approved for use in April 2001.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

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Pro

bab

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y

Years After Implant

Microny®

(Models 2425T, 2525T & 2535K)


199.92%

0.04%

299.88%

0.06%

399.88%

0.06%

499.78%

0.12%

5

The Regency® SC+ series of single-chamber pulse generators was approved for use in May 1998.Survival probability (%) is based on returned product analysis as of January 31, 2006.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

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Pro

bab

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y

Years After Implant

Regency® SC+(Models 2400L & 2402L)


299.93%

0.07%

499.81%

0.14%

699.63%

0.23%

8 10

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Population 1*

Population 2**

The Tempo® V single-chamber pulse generator and the Tempo® VR single-chamber, rate-responsive pulse generator were approvedfor use in August 1997. These models are no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.*This group of devices is not under advisory. 604 of these devices were implanted.


Devic

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Years After Implant

Tempo® V (Model 1102)Tempo® VR (Model 1902)


299.60%

0.29%

498.71%

0.59%

6 8 10

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Population 1* Population 2**

The Trilogy® SR+ series of single-chamber, rate-responsive pulse generators was approved for use in March 1997.These models are no longer being manufactured.

Survival probability (%) is based on returned product analysis as of January 31, 2006.*This group of devices is not under advisory. 5,796 of these devices were implanted.


Devic

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Years After Implant

Trilogy® SR+(Models 2260 & 2264)


299.82%

0.06%

499.68%

0.09%

699.63%

0.10%

8 10


± 1 standard error

299.55%

0.06%

499.23%

0.09%

698.86%

0.12%

898.83%

0.13%


± 1 standard error

298.61%

0.36%

495.45%

0.81%

689.51%

1.53%

63


64


The Trilogy® SR single-chamber, rate-responsive pulse generator was approved for use in June 1995.This model is no longer being manufactured.



50%0 3 6 9 12 15

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%D

evic

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Pro

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Years After Implant

Trilogy® SR(Models 2250)


399.60%

0.06%

699.13%

0.11%

998.41%

0.18%

12 15

The Solus® II series of single-chamber, rate-responsive pulse generators was introduced in February 1993.These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

bab

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Years After Implant

Solus® II(Models 2006 & 2007)


399.45%

0.05%

696.12%

0.16%

991.60%

0.34%

12 15

The Solus® series of single-chamber, rate-responsive pulse generators was introduced in June 1990.These models are no longer being manufactured.


0 3 6 9 12 1550%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Devic

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Pro

bab

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Years After Implant

Solus®

(Models 2002 & 2003)


399.69%

0.04%

698.62%

0.10%

997.44%

0.16%

1296.38%

0.24%

15

The Phoenix® III series of single-chamber pulse generators was introduced in October 1994.These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

bab

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Years After Implant

Phoenix® III(Models 2204 & 2205)


399.69%

0.08%

698.66%

0.22%

997.30%

0.48%

12 15

65


66


The Phoenix® 2 series of single-chamber pulse generators was introduced in July 1990.These models are no longer being manufactured.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

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Pro

bab

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y

Years After Implant

Phoenix® 2(Models 2005, 2008 & 2009)


399.59%

0.05%

698.64%

0.10%

996.80%

0.21%

1294.85%

0.34%

15

68

Pulse Generators Summary Information*

Model

5586

5380

5386/5286

5360/5366

5356/5357/5256

5370

5376

5336

5342/5346

5326/5226

5330/5331/5230

5430

5180

5156/5157/5056

5172

5160

5136

5142

5130/5131

Family

Frontier II

Identity ADx DR

Identity ADx XL DR/DC

Integrity ADx DR

Verity ADX XL DR/

DR(M/S) / DC

Identity

Identity XL

Integrity µ DR

Integrity AFx DR

Entity DR/DC

Affinity DR/DC

Affinity VDR

Integrity ADx SR

Verity ADX XL SR/

SR(M/S) / SC

Identity SR

Integrity ADx SR

Integrity µ SR

Integrity SR

Affinity SR

Market Release Date

Aug-04

Mar-03

Mar-03

May-03

May-03

Nov-01

Nov-01

Dec-00

Apr-00/Jul-01

Jun-99

Jan-99/Jun-99

Apr-00

May-03

May-03

Nov-01

May-03

Dec-00

Apr-00

Jan-99/Jun-99


859

35373

33958

7474

8568

53478

45706

29000

46991

21740

65333

663

10449

5576

18850

2025

11684

10388

28582

Estimated Active US implants

815

32564

32116

6938

7863

41852

38793

17014

32509

13010

37250

390

9201

4928

13944

1764

6766

5921

13553


Therapy(not under advisory)

0

0

1

0

0

5

6

6

4

3

14

0

0

0

1

0

0

1

4

Malfunctionsw/o Compromised

Therapy(under

advisory**)

0

0

0

0

0

0

0

0

0

0

64

0

0

0

0

0

0

0

17

Malfunctions w/oCompromised

Therapy

0

2

8

3

4

26

23

27

34

16

81

0

1

2

8

0

2

2

25

TotalMalfunctions

0

2

9

3

4

31

29

33

38

19

159

0

1

2

9

0

2

3

46

Normal BatteryDepletion

0

3

0

0

0

149

15

484

66

58

342

1

2

0

18

0

17

2

36



Model

5586

5380

5386/5286

5360/5366

5356/5357/5256

5370

5376

5336

5342/5346

5326/5226

5330/5331/5230

5430

5180

5156/5157/5056

5172

5160

5136

5142

5130/5131

Family

Frontier II

Identity ADx DR


Integrity ADx DR

Verity ADX XL DR/

DR(M/S) / DC

Identity

Identity XL

Integrity µ DR

Integrity AFx DR

Entity DR/DC

Affinity DR/DC

Affinity VDR

Integrity ADx SR

Verity ADX XL SR/

SR(M/S) / SC

Identity SR

Integrity ADx SR

Integrity µ SR

Integrity SR

Affinity SR

Market Release Date

Aug-04

Mar-03

Mar-03

May-03

May-03

Nov-01

Nov-01

Dec-00

Apr-00/Jul-01

Jun-99

Jan-99/Jun-99

Apr-00

May-03

May-03

Nov-01

May-03

Dec-00

Apr-00

Jan-99/Jun-99


859

35373

33958

7474

8568

53478

45706

29000

46991

21740

65333

663

10449

5576

18850

2025

11684

10388

28582

Estimated Active US implants

815

32564

32116

6938

7863

41852

38793

17014

32509

13010

37250

390

9201

4928

13944

1764

6766

5921

13553


Therapy(not under advisory)

0

0

1

0

0

5

6

6

4

3

14

0

0

0

1

0

0

1

4

Malfunctionsw/o Compromised

Therapy(under

advisory**)

0

0

0

0

0

0

0

0

0

0

64

0

0

0

0

0

0

0

17

Malfunctions w/oCompromised

Therapy

0

2

8

3

4

26

23

27

34

16

81

0

1

2

8

0

2

2

25

TotalMalfunctions

0

2

9

3

4

31

29

33

38

19

159

0

1

2

9

0

2

3

46

69

Pulse Generators Summary Information*Including Normal Battery Depletion


Model

5586

5380

5386/5286

5360/5366

5356/5357/5256

5370

5376

5336

5342/5346

5326/5226

5330/5331/5230

5430

5180

5156/5157/5056

5172

5160

5136

5142

5130/5131

Family

Frontier II†

Identity ADx DR


Integrity ADx DR

Verity ADX XL DR/

DR(M/S) / DC

Identity

Identity XL

Integrity µ DR

Integrity AFx DR

Entity DR/DC

Affinity DR/DC

Affinity VDR

Integrity ADx SR

Verity ADX XL SR/

SR(M/S) / SC

Identity SR

Integrity ADx SR

Integrity µ SR

Integrity SR

Affinity SR

1 year

99.95%

99.95%

99.95%

99.93%

99.93%

99.93%

99.87%

99.92%

99.92%

99.81%

100%

99.94%

99.98%

99.97%

100%

99.96%

99.98%

99.88%

2 years

99.86%

99.91%

99.95%

99.93%

99.79%

99.85%

99.66%

99.87%

99.86%

99.73%

100%

99.91%

99.98%

99.85%

99.88%

99.93%

99.78%

3 years

99.43%

99.79%

98.82%

99.80%

99.75%

99.63%

100%

99.72%

99.76%

99.91%

99.72%

4 years

98.00%

99.71%

96.37%

99.73%

99.54%

99.41%

99.59%

99.46%

99.91%

99.62%

5 years

93.53%

99.52%

99.30%

99.07%

99.82%

99.57%

6 years

99.18%

98.83%

99.53%

7 years

98.55%

8 years


Model

5586

5380

5386/5286

5360/5366

5356/5357/5256

5370

5376

5336

5342/5346

5326/5226

5330/5331/5230

5430

5180

5156/5157/5056

5172

5160

5136

5142

5130/5131

Family

Frontier II†

Identity ADx DR


Integrity ADx DR

Verity ADX XL DR/

DR(M/S) / DC

Identity

Identity XL

Integrity µ DR

Integrity AFx DR

Entity DR/DC

Affinity DR/DC

Affinity VDR

Integrity ADx SR

Verity ADX XL SR/

SR(M/S) / SC

Identity SR

Integrity ADx SR

Integrity µ SR

Integrity SR

Affinity SR

1 year

99.96%

99.95%

99.95%

99.93%

99.95%

99.93%

99.89%

99.92%

99.93%

99.82%

100%

99.98%

99.98%

99.98%

100%

99.98%

99.98%

99.89%

2 years

99.92%

99.92%

99.95%

99.93%

99.88%

99.85%

99.83%

99.88%

99.89%

99.75%

100%

99.94%

99.98%

99.91%

99.96%

99.94%

99.81%

3 years

99.80%

99.84%

99.69%

99.84%

99.82%

99.70%

100%

99.87%

99.89%

99.92%

99.77%

4 years

99.61%

99.82%

99.50%

99.80%

99.80%

99.59%

100%

99.75%

99.92%

99.71%

5 years

99.20%

99.75%

99.78%

99.49%

99.88%

99.69%

6 years

99.78%

99.44%

99.67%

7 years

99.37%

8 years


*Based on returned product analysis as of January 31, 2006.**St. Jude Medical. Affinity unsecured resistor connection (advisory). February 2000.

†No survival probability is stated at 1 year due to the device not meeting the required minimum sample size of 200 U.S.implants with 12 consecutive months of data. Please refer to the individual device graphs for data up to one year.

70

Pacing Leads bipolar active fixation



50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Tendril® SDX (Models 1488T & 1488TC)Bipolar Active Fixation Silicone Leads


299.75%

0.01%

499.64%

0.02%

6 8 10


(Approval date: June 2003)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Tendril® SDX (Model 1688T)Bipolar Active Fixation Silicone Lead


199.77%

0.02%

299.68%

0.03%

3 4 5

71

bipolar active fixation Pacing Leads

Data is current as of January 31, 2006.The Tendril® lead models 1148 and 1188T are no longer being manufactured.

296,697 of these leads have been implanted.(Approval dates: 1148–June 1993; 1188T–June 1994; 1388T–June 1997; 1388TC–March 1998)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Tendril® (Models 1148 & 1188T); Tendril® DX (Models 1388T & 1388TC)Bipolar Active Fixation Silicone Leads


399.46%

0.01%

698.97%

0.02%

998.34%

0.05%

1297.75%

0.16%

15


28,031 of these leads have been implanted.(Approval dates: 1018T–February 1988; 1028T–July 1990)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Fast-Pass® (Models 1018T & 1028T)Bipolar Active Fixation Silicone Leads


498.96%

0.07%

898.18%

0.10%

1297.70%

0.12%

1697.23%

0.19%

20

72

Pacing Leads bipolar passive fixation

Data is current as of January 31, 2006.The Passive Plus® lead models 1136T, 1142T, 1146T, 1222T, 1226T, 1236T, 1242T and 1246T are no longer being manufactured.

366,204 of these leads have been implanted.(Approval dates: 1136T, 1142T, 1146T–June 1994; 1222T, 1226T, 1236T, 1242T, 1246T–April 1990; 1336T–August 1999;

1342T, 1346T–January 1998)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Passive Plus®(Models 1136T, 1142T, 1146T, 1222T, 1226T, 1236T, 1242T & 1246T)

Passive Plus® DX (Models 1336T, 1342T & 1346T)

Bipolar Passive Fixation Silicone Leads


499.61%

0.01%

899.24%

0.02%

1298.71%

0.05%

16 20


(Approval date: April 2003)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 1 2 3 4 5

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

IsoFlex® S (Models 1642T & 1646T)Bipolar Passive Fixation Silicone Leads


199.81%

0.03%

299.71%

0.04%

3 4 5

73

bipolar passive fixation and unipolar active fixation Pacing Leads

Data is current as of January 31, 2006.The Tendril® lead model 1188K is no longer being manufactured.

1,330 of these leads have been implanted.(Approval dates: 1188K–June 1995; 1388K–June 1997)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Tendril® (Model 1188K); Tendril® DX (Model 1388K)Unipolar Active Fixation Silicone Leads


299.66%

0.17%

499.35%

0.25%

698.73%

0.40%

898.07%

0.55%

10


19,678 of these leads have been implanted.(Approval date: June 1989)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Permathane® ACE (Models 1036T & 1038T)Bipolar Passive Fixation Polyurethane Leads


499.60%

0.05%

898.99%

0.09%

1298.13%

0.16%

16 20

74

Pacing Leads unipolar active fixation and unipolar passive fixation

Data is current as of January 31, 2006.The Passive Plus® lead models 1135K, 1143K, 1145K, 1235K, 1243K and 1245K are no longer being manufactured.

4,481 of these leads have been implanted.(Approval dates: 1135K, 1143K, 1145K–July 1994; 1235K, 1243K, 1245K–August 1995;

1343K, 1345K–June 1998)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 3 6 9 12 15

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Passive Plus® (Models 1135K, 1143K, 1145K, 1235K, 1243K & 1245K)Passive Plus® DX (Models 1343K & 1345K)

Unipolar Passive Fixation Silicone Leads


399.73%

0.08%

699.35%

0.16%

998.65%

0.34%

12 15

Data is current as of January 31, 2006.This lead model is no longer being manufactured.

1,737 of these leads have been implanted.(Approval date: June 1987)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Fast-Pass® (Model 1007)Unipolar Active Fixation Silicone Lead


498.88%

0.28%

897.96%

0.39%

1297.80%

0.45%

1697.57%

0.50%

20

75

unipolar passive fixation Pacing Leads


23,901 of these leads have been implanted.(Approval dates: 1015M–August 1991; 1025M–August 1982)

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 4 8 12 16 20

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

ACE (Models 1015M & 1025M)Unipolar Passive Fixation Silicone Leads


499.54%

0.05%

898.94%

0.08%

1298.65%

0.11%

1698.19%

0.15%

20

Data is current as of January 31, 2006.This lead is no longer being manufactured.655 of these leads have been implanted.


50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

0 42 6 8 10

Devic

e S

urv

ival

Pro

bab

ilit

y

Years After Implant

Permathane® ACE (Model 1035M)Unipolar Passive Fixation Polyurethane Lead


299.84%

0.16%

499.84%

0.16%

699.58%

0.31%

899.58%

0.31%

10

76

The following table summarizes recalls, advisories and safety alerts regarding St. Jude Medical devices. These advisories have been previouslycommunicated to physicians. For more information please contact St. Jude Medical Technical Services at 1-800-722-3774.

Model Identification Advisory Follow-Up Recommendations at Time of Advisory

6/13/05Class IITwo anomalies have been identified:1. Due to a device software anomaly, it is possible

that when the device’s battery is nearing itselective replacement indicator (ERI), a chargingcycle may be skipped.

2. After a capacitor charge, if a rate responsivepacing mode (e.g., DDDR, VVIR, etc.) isprogrammed “On”, this “noise” may beinterpreted by the device’s accelerometer(activity sensor) as physical activity, causing atemporary increase in the pacing rate that maypersist after charging is completed.

Two anomalies were discovered during routine product monitoring. Neither of theseanomalies presents a significant clinical risk to your patients, and no clinicalcomplications have been reported to St. Jude Medical. Both are easily corrected byperforming a simple, automated software download to the device. This potentially affectsapproximately 30,000 implanted ICDs in the United States and includes the followingmodel numbers:Epic DR/HF (V-233/V-337/V-338), Epic Plus DR/VR/HF (V-236/V-239/V-196/V-239T/V-196T/V-350), Atlas DR (V-242), and Atlas Plus DR/VR/HF (V-243/V-193/V-193C/V-340/V-341/V-343). The first anomaly can occur when one of the affected devices attempts todeliver multiple shocks in rapid succession. Due to a device software anomaly, it ispossible that when the device’s battery is nearing its elective replacement indicator (ERI),a charging cycle may be skipped. If this were to occur, the first shock will always bedelivered as programmed and, if needed, the next shock in the programmed sequencewould be delivered after a delay of only two to four seconds. A skipped charge wouldresult in less than the full number of programmed shocks being available for deliveryduring that episode, but all delivered shocks would be at their programmed energy. Thisbehavior was discovered as an incidental finding during analysis of one returned devicethat had delivered a large number of high voltage shocks over a short time period.A second anomaly is caused by electrical “noise” generated as a result of the charging ofthe device’s high voltage capacitors. After a capacitor charge, if a rate responsive pacingmode (e.g., DDDR, VVIR, etc.) is programmed “On”, this “noise” may be interpreted bythe device’s accelerometer (activity sensor) as physical activity, causing a temporaryincrease in the pacing rate that may persist after charging is completed. The degree andduration of the rate increase will depend on a variety of factors, but the rate will neverexceed the programmed Maximum Sensor Rate, and the device will gradually return tothe appropriate rate. The anomalous behavior, which has been observed during theperformance of manual capacitor maintenance, has been traced back to a componentsupplied to St. Jude Medical by one vendor; therefore, only the subset of the devicemodels listed above that were manufactured with the affected component (device serialnumbers below 141000 for any model) will exhibit this behaviorSt. Jude Medical has developed programmer software that will automaticallydetect the affected ICDs and download device software that will correct the“skipped charge” anomaly and mitigate the response to electrical noise. Oncethe upgrade is performed, the potential for a skipped charge will be eliminated.Additionally, once the upgrade is performed if a rate responsive mode is programmed“On”, devices with serial numbers below 141000 will have their rate response functionssuspended for the time period during which the electrical noise could be present (i.e.,while significant residual voltage remains on the high voltage capacitors); non-rateresponsive pacing at the programmed base rate will continue to be provided asappropriate. This period during which rate response is suspended may last anywhere froma few minutes up to approximately 90 minutes. If rate responsive pacing was ongoingprior to charging, the pacing rate will gradually decrease to the base pacing rateaccording to the normal rate response recovery algorithm and will remain there whilerate responsive pacing is suspended. The rate response behavior for devices with serialnumbers greater than 141000 will not be affected by the software download.The software download for potentially affected devices will automatically be initiated thenext time the patient’s device is interrogated with the v4.8.5 programmer software. Sincea skipped charge is more likely to occur in devices that are closer to their electivereplacement indicator (ERI), St. Jude Medical recommends that if the next patient follow-up is not scheduled to occur within the next 6 months that the patient be seen withinthis time period.In addition, if devices are programmed to pacing settings that result in high currentconsumption, such as high output bi-ventricular pacing, consideration should be given toscheduling the patient for a follow-up visit within 3 months if it is not scheduled to occurwithin that time period. As always, St. Jude Medical defers to your clinical judgment onany decisions regarding the management of your patients.

Epic DR/HF (V-233/V-337/V-338),Epic Plus DR/VR/HF (V-236/V-239/V-196/V-239T/V-196T/V-350),Atlas DR (V-242), and Atlas PlusDR/VR/HF (V-243/V-193/V-193C/V-340/V-341/V-343).

Advisories and Safety Alerts

10/7/05Class IIA particular vendor-supplied memory chip can beaffected at a low frequency rate by backgroundlevels of atmospheric ionizing cosmic radiation(“background cosmic radiation”). The anomaly cantrigger a temporary loss of pacing function andpermanent loss of defibrillation support.

In the unlikely event that a device chip is affected by background cosmic radiation, the highcurrent drain condition will deplete the battery voltage rapidly. This can result in loss ofoutput for a period up to approximately 48 hours. During this period, the patient would bewithout pacing or defibrillation therapy. After this initial period, the battery will reach avoltage level at which the device will enter its “Hardware Reset Mode.” This safety mode isdesigned to preserve the device’s ability to provide VVI pacing support. A device that hasbeen reset to the Hardware Reset Mode will operate in the VVI mode at 60 ppm, but willnot be capable of providing tachycardia detection or therapy. This will be noted by awarning message on the programmer screen upon device interrogation.

To assist in your patient care and following discussions with our independent MedicalAdvisory Board, St. Jude Medical recommends:• If it is not already your current practice, physicians should perform routine device

monitoring every 3 months for patients with the affected models listed above.• In determining whether additional patient management or follow up may be needed,

consider the low failure rate for the anomaly and the unique medical needs and situationof each individual patient, including whether the patient is pacemaker dependent or athigh risk for life-threatening arrhythmias.

• If a patient’s device is found in the Hardware Reset Mode, you should arrange for devicereplacement as soon as possible.

• You should continue to provide patients with the usual admonitions to keep scheduledappointments and to report all changes in symptoms.

Photon DR (V-230HV) (certain serialnumbers), Photon Micro VR/DR(Models V-194/V-232), Atlas VR/DR(Models V-199/V-240)

77



Tempo 2102 and Meta 1256D 11/04/02Dendritic growth at the battery/hybrid connectioncould cause a short circuit, which in turn couldresult in premature battery depletion.

Decreased reliability has been observed in a group of these devices. The devices in theadvisory population were manufactured at the Telectronics’ manufacturing facility betweenthe second quarter of 1996 and the second quarter of 1997. Premature battery depletionresulting from bridging between adjacent connectors has resulted in no output or notelemetry in 1% of this population of devices to date.The following recommendations are made:Physicians are advised to review patients who have 1256D/2102 pacemakers at an earlydate to evaluate pacemaker function.For patients who are pacemaker dependent, the physician should give considerationto explantation and replacement as soon as practicable.For patients who are not considered pacemaker dependent, the physician shouldconsider replacement only if any abnormal function is identified (such as no output,telemetry loss, telemetry abnormality or premature end of life indication). All remainingnon-pacemaker dependent patients with 1256D/2102 pacemakers should subsequently bereviewed at least every six months.

Identity ADx DR Models 5286, 5380,5386 and 5480

07/31/03Class IIAn anomaly in the pacemaker code, which under acertain set of programmed settings and specificevent timing circumstances could deliver a shortcoupled pacing interval of 300 ms (200 ppm).Consecutive (up to a maximum of 12) shorter thananticipated pacing intervals could be experienced.

St. Jude Medical’s software engineering department has identified an anomaly in thepacemaker code, which under a certain set of programmed settings and specific eventtiming circumstances has a potential to deliver a short coupled pacing interval ofapproximately 300 milliseconds (200 ppm). It is also possible, however unlikely, that apatient could experience consecutive (up to a maximum of 12) shorter than anticipatedpacing intervals. To date, the only clinical observation has been the delivery of asingle short interval. There have been no reports of patient injury as a resultof the shortened pacing interval.In order for the above mentioned shortened pacing interval to potentially occur, theprogrammed settings of the dual chamber device would have to satisfy both of thefollowing conditions:

• Base rate, rate hysteresis or rest rate programmed to 55 ppm or lower• Autocapture programmed ON

Additionally, it should be noted that even with the following settings, the shortened pacinginterval will not occur unless specific internal timing and other conditions are met. If thedevice is programmed to any other combination of settings (e.g. base rate, hysteresis rateand rest rate all at 60 ppm or above, or Autocapture programmed OFF), the scenariodescribed above cannot occur.St. Jude Medical recommends that physicians review their records to identify which, if any,of their patients implanted with a subject device have programmed settings as describedabove. For these patients, they should schedule a pacemaker programming session as soonas possible to temporarily program Autocapture OFF or adjust the base rate, rate hysteresisand rest rate to 60 ppm or above. The root cause of potentially delivering the short pacinginterval has been identified and a downloadable firmware correction has been developedto prevent any future occurrence. The revised firmware will be made available to thephysicians via a new programmer software version immediately following FDA approval.The revised code will be downloaded automatically during pacer interrogation and willtake approximately six seconds. At the time of the FDA approval, all newly manufacturedand distributed products will also have the new pacemaker code.There is no need to consider replacement of the devices as the temporary programmingoutlined above and the forthcoming device firmware update will eliminate the potential forthe described phenomenon from occurring in the future.

During routine product evaluation, St. Jude Medical Quality Assurance identified that asoftware parameter that affects the sensitivity of the reed switch in the listed devices wasbeing set to an incorrect value during manufacturing beginning in late November of lastyear. This has the effect of preventing these devices from entering the magnet mode toinhibit tachy therapy when an external magnet is applied. This is a softwarecontrolled parameter that can be easily corrected via the programmer. Allother bradycardia pacing and tachyarrhythmia detection and therapy features are notaffected in devices subject to this notification. Until the magnet sensitivity parameter iscorrected via the programmer, tachy therapy may not be properly inhibited as iscustomary with placement of an external magnet, but can be inhibited by using theprogrammer to program the device to Defib Off, and then back On as needed.The affected devices were manufactured during a three month period beginningNovember 22, 2004. To date, there have been no field reports of any magnetmode failures, nor have there been any clinical complications reportedassociated with this issue. Magnet mode application is usually used to inhibittachycardia therapy such as when a patient is subjected to electrocautery during asurgical procedure. In order to remedy this situation, in addition to this notification, St.Jude Medical Sales Representatives and Field Clinical Engineers have been provided witha simple software tool that can be used to set, via the programmer, the reed switch’smagnet sensitivity to the proper value. You may contact them to schedule thisreprogramming at the patient’s next scheduled follow-up visit or at your discretion.

3/10/05Class IIA software parameter that affects the sensitivity ofthe reed switch in the listed devices was being setto an incorrect value which could prevent thesedevices from entering the magnet mode to inhibittachy therapy when an external magnet is applied.

Epic (V-197, V-235), Epic+ (V-196,V-236), Epic HF (V-338), Epic+ HF (V-250), Atlas+ (V-193, V-243),Atlas+ HF (V-340), or Atlas (model V-242) ICDs



78

Meta DDDR 1256 6/6/00Class IIIntegrated circuit failure due to electrostaticdischarge during manufacturing resulting in nooutput or sensing anomalies.

This Advisory applies to a well-defined group of Meta 1256 pulse generators, which havebeen observed to exhibit decreased reliability. The following recommendations are made:For patients who are significantly pacemaker dependent. The decision as towhether or not to replace a pulse generator prophylactically remains one of clinicaljudgment. We therefore recommend that you strongly consider replacing these pulsegenerators on a prophylactic basis for all patients who are significantly pacemakerdependent, unless pulse generator replacement is medically contraindicated.For patients who are not considered pacemaker dependent. Again, this is amatter of clinical judgment. In the event a device is not replaced, continued routinemonitoring is advised.

Tempo 1102, 1902, 2102, 2902,and Meta 1256D

6/6/00Class IIDendritic growth at the battery/hybrid connectioncould cause a short circuit, which in turn couldresult in premature battery depletion.

This Advisory applies to a well-defined group of Tempo and Meta 1256D pulse generators,which have been observed to exhibit premature battery depletion. The followingrecommendations are made:For patients who are significantly pacemaker dependent. The decision as towhether or not to replace a pulse generator prophylactically remains one of clinicaljudgment. We therefore recommend that you strongly consider replacing these pulsegenerators on a prophylactic basis for all patients who are significantly pacemakerdependent, unless pulse generator replacement is medically contraindicated.For patients who are not considered pacemaker dependent. Again, this is amatter of clinical judgment. In the event a device is not replaced, continued routinemonitoring is advised.

Profile V-186 7/13/01Class IIFailure of a ceramic capacitor could lead to sensinganomalies/early battery depletion

This Advisory applies to a well-defined group of Profile MD (Model V-186HV3) implantablecardioverter-defibrillators (ICDs) which have been observed to exhibit decreased reliability.These devices had specific modules (subcircuits) manufactured during a five-month periodduring the first half of 1999. Those potentially affected devices that have notexhibited any anomalous behavior within 24 months of manufacture are notat increased risk of failure at a later date. These failures were caused by acomponent anomaly that is limited to a specific, traceable lot (group) of capacitors.If these capacitors fail, two different clinical manifestations may be observed, dependingon the location of the failed capacitors:Low Voltage Module: The devices may exhibit sudden loss of sensing or oversensing ofinternally generated interference (noise) resulting in aborted or delivered shocks. Due tothe potential for sudden loss of sensing, which would prevent the ICD from detectingventricular tachyarrhythmias, device replacement should be considered for patients withdevices incorporating the suspect capacitors in this location. In making this decision, youshould weigh the likelihood that your patient will have one of the few additional devicesexpected to fail against the risk associated with the replacement procedure. For patientswho do not have their devices replaced, St. Jude Medical recommends monthlymonitoring for the remaining months during which additional failures are expected tooccur and every three months thereafter.High Voltage Module: The devices may exhibit premature battery depletion with noother clinical manifestations. While the battery voltage may drop rapidly to a value near orbelow the device’s ERI, it stabilizes for several months at a value at which the devicecontinues to detect arrhythmias and deliver therapy appropriately. In addition, some ofthese devices may exhibit oversensing of internally generated electrical interference (noise),which may result in false detection of tachyarrhythmias. However, during charging, theinterference abates, and the therapy is usually aborted without the delivery ofinappropriate shocks to the patient. Because these devices generally continue to respondappropriately to spontaneous tachyarrhythmias, and because the battery voltage stabilizesfor several months at a level that does not compromise device function, St. Jude Medicalrecommends that patients with devices incorporating suspect capacitors in this location bemonitored monthly for the remaining months during which additional failures are expectedto occur and every three months thereafter.

Tempo 1102, 1902, 2102, 2902 andMeta 1256D

11/04/02Class IIDendritic growth at the battery/hybrid connectioncould cause a short circuit, which in turn couldresult in premature battery depletion.

This Advisory applies to a well-defined group of Tempo and Meta 1256D pulse generatorswhich have been observed to exhibit premature battery depletion. This is an extension of aprevious Tempo/Meta advisory dated 6/6/00. The following recommendations are made:For patients who are significantly pacemaker dependent. The decision as towhether or not to replace a pulse generator prophylactically remains one of clinicaljudgment. We therefore recommend that you strongly consider replacing these pulsegenerators on a prophylactic basis for all patients who are significantly pacemakerdependent, unless pulse generator replacement is medically contraindicated.For patients who are not considered pacemaker dependent. Again, this is amatter of clinical judgment. In the event a device is not replaced, continued routinemonitoring is advised.

79



Affinity 5130L, 5130R, 5330L,5330R, 5230L, 5230R

2/14/00Class IIAn unsecured resistor connection to the hybridcircuit might cause abnormal measured data, falseRRT indication, backup VVI mode, or intermittentloss of output.

This advisory applies to a very specific, well-defined group of Affinity devices that have beenimplanted worldwide. The device may exhibit any or all of the following output anomalies:

• Abnormal measured battery data,• A false recommended replacement (RRT) indication,• Reversion to back-up VVI mode,• Intermittent loss of output. One marker of an affected device that may be apparent

during a routine follow-up interrogation is an abnormally high reading for batterycurrent (taking into consideration the device’s programmed output parameters).If this or an early indication of RRT or reversion to back-up VVI mode is observed,please contact your local St. Jude Medical representative or Technical Services.Although the time course is variable, these behavioral anomalies will occur beforethere is any affect on device output.

Trilogy 2250L, 2260L, 2264L, 2308L,2318L, 2350L, 2360L, 2364L

3/10/00Class IIRisk of malfunction due to an anomaly of thepacemaker’s microprocessor. Typicalmanifestations of this anomaly are dashesobserved on the programmer screen, unexpectedrate variation, abnormally high battery currentdrain, and mode change.

Continued monitoring of Trilogy devices affected by an Advisory issued in July 1999 hasrevealed an additional low level of adverse events. A sub-population of the above models,principally those manufactured before January 1999, is potentially affected by a risk ofmalfunction due to an anomaly of the pacemaker’s microprocessor. To date this has beenreported in only 0.11% of the implanted population. Typical manifestations of thisanomaly are:

• Interrogation/programming difficulties, including the presence of dashes (—) onthe programmer screen for some parameter values after interrogation

• Unexpected rate variations• Abnormally high battery current drain• Mode change

The presence of dashes on the programmer screen is typically caused by partialprogramming of one or more of the programmed parameters and may be corrected byreprogramming. In the event that observed dashes (—-) cannot be resolved byreprogramming, please contact your St. Jude Medical representative, as it may be possibleto resolve the situation non-invasively via special programming and may not be indicativeof a microprocessor anomaly.Considering the low level of incidence of this anomaly, the following steps are recommended:1. Assess the patient population, relative to the potential for an inappropriate mode

change to single-chamber atrial pacing, to determine which patients are pacemaker-dependent and have an inadequate ventricular escape rhythm.

2. Replacement of a device always remains a matter of clinical judgement, including balancingthe clinical risk associated with pacemaker replacement against the risk of devicemalfunction.

3. Almost all microprocessor malfunctions described in this notification were found duringroutine follow-up. This reinforces the importance that pacemaker patients should befollowed regularly in accordance with best prevailing medical practices.

Trilogy 2250L, 2260L, 2264L, 2308L,2318L, 2350L, 2360L, 2364L

7/19/99Class IIPremature battery depletion caused by a currentleakage path that could be created during thelaser welding process to attach the battery to thedevice hybrid

Analysis of the clinical data associated with the failed devices has shown that an earlyincrease in battery impedance could be observed at one or more previous routine follow-up visits prior to reaching RRT. The observed rise in battery impedance is an earlier andmore reliable indicator than the reported battery voltage. The battery depletion, althoughaccelerated, does not occur abruptly and patients can be monitored using the measureddata telemetry in the pacemaker. The following follow-up schedule and device monitoringis advised.1. For patients who have had a follow-up visit at least 12 months after their device was

implanted, check the measured data printout from the last follow-up evaluation. If abattery impedance of “< 1 kOhm” was recorded, continue to monitor the batteryimpedance with your routine follow-up schedule for that patient (6-month intervalsrecommended). If follow-up visits every 6 months is not your routine schedule, then anadditional visit at 18 months should be performed.

2. For patients who have not yet had a follow-up visit at least 12 months after their devicewas implanted, the following is recommended:

• If the patient has had their device implanted for less than 2 months or has nothad a device interrogation with measured data within the last 3 months, anevaluation of the battery impedance is recommended as soon as possible. Thisshould be printed and a copy retained in the patient’s pacemaker or office chart.

• Otherwise, if the battery impedance from the most recent evaluation is “< 1 kOhm,”begin an every 3-month follow-up schedule with respect to measured datatelemetry until that value has been recorded at least 12 months post-implant.Thereafter, continue to monitor the battery impedance with your routine follow-upschedule for that patient (6-month intervals recommended). If follow-up visitsevery 6 months is not your routine schedule, then an additional visit at 18 monthsshould be performed.

If the battery impedance reading is 1 kOhm or higher and the pulse generator has beenimplanted for less than 2 years, it is likely that the system is demonstrating acceleratedbattery depletion. Please contact your local Field Representative or Technical Services.

Cardiac Resynchronization Therapy PgAtlas®+ HF (V-340) 12Atlas®+ HF (V-343) 10Epic™ HF (V-338) 10Epic™ HF (V-337) 11QuickSite® (1056K) 15

ICDsAtlas®+ DR (V-243) 17Atlas® DR (V-240) 22Atlas® DR (V-242) 16Atlas®+ VR (V-193) 25Atlas® VR (V-199) 28Contour® MD (V-175, V-175AC, V-175B,

V-175C, V-175D) 30Contour® II (V-185, V-185AC, V-185B,

V-185C, V-185D) 31Epic™+ DR (V-236) 18Epic™+ DR (V-239) 19Epic™ DR (V-235) 20Epic™ DR (V-233) 21Epic™+ VR (V-196) 26Epic™ VR (V-197) 27Photon® DR (V-230HV) 24Photon® µ DR (V-232) 23Photon® µ VR (V-194) 29Profile™ (V-186F, V-186HV3) 30

Defibrillation LeadsRiata® i (1590, 1591) 33Riata® (1582) 33Riata® (1570, 1571) 34Riata® (1580, 1581) 34SPL® (SP01, SP02, SP03, SP04) 35TVL® RV (RV01, RV02, RV03, RV06, RV07) 36TVL® SVC (SV01, SV02, SV03) 36TVL® -ADX (1559) 35

Pulse GeneratorsAddVent® (2060) 54Affinity® DC (5230) 47Affinity® DR (5330, 5331) 47Affinity® SR (5130, 5131) 61Affinity® VDR (5430) 48Entity® DC (5226) 46Entity® DR (5326) 46Frontier™ II (5586) 37Identity® ADx DR (5380) 38Identity® ADx XL DR (5386) 39Identity® ADx XL DC (5286) 39Identity® (5370) 42Identity® XL (5376) 43Identity® SR (5172) 57Identity® ADx SR (5180) 55Integrity® ADx DR (5360) 40

PgIntegrity® AFx DR (5342, 5346) 45Integrity® µ DR (5336) 44Integrity® SR (5142) 60Integrity® ADx SR (5160) 58 Integrity® µ SR (5136) 59Meta™ DDDR (1256D) 49Meta™ DDDR (1256) 49Microny® (2425T, 2525T, 2535K) 62Paragon™ (2010, 2011, 2012) 53Paragon™ II (2016) 52Paragon™ III (2304, 2314, 2315) 52Phoenix® 2 (2005, 2008, 2009) 66Phoenix® III (2204, 2205) 65Regency® SC+ (2400L, 2402L) 62Solus® (2002, 2003) 65Solus® II (2006, 2007) 64Synchrony® II (2022, 2023) 54Synchrony® III (2028, 2029) 53Tempo® D (2902) 49Tempo® DR (2102) 49Tempo® V (1102) 63Tempo® VR (1902) 63Trilogy® DC (2308) 51Trilogy® DC+ (2318) 50Trilogy® DR (2350) 51Trilogy® DR+ (2360, 2364) 50Trilogy® SR (2250) 64Trilogy® SR+ (2260, 2264) 63Verity® ADx XL DR (5356) 41Verity® ADx XL DR M/S (5357M/S) 41Verity® ADx XL DC (5256) 41Verity® ADx XL SR (5156) 56Verity® ADx XL SR M/S (5157M/S) 56Verity® ADx XL SC (5056) 56

Pacing LeadsACE (1015M, 1025M) 75Fast-Pass® (1018T, 1028T) 71Fast-Pass® (1007) 74IsoFlex® S (1642T, 1646T) 72Passive Plus® (1135K, 1143K, 1145K,1235K,

1243K, 1245K) 74Passive Plus® (1136T, 1142T, 1146T, 1222T, 1226T,

1236T, 1242T, 1246T) 72Passive Plus® DX (1343K, 1345K) 74Passive Plus® DX (1336T, 1342T, 1346T) 72Permathane® ACE (1036T,1038T) 73Permathane® ACE (1035M) 75Tendril® (1148, 1188T) 71Tendril® (1188K) 73Tendril® DX (1388K) 73Tendril® DX (1388T, 1388TC) 71Tendril® SDX (1688T) 70Tendril® SDX (1488T, 1488TC) 70

Index

81

Ordering No. F0063 Printed in USA 04061.5CAUTION: FEDERAL LAW (USA) RESTRICTS THIS DEVICE TO SALE, DISTRIBUTION

AND USE BY OR ON THE ORDER OF A PHYSICIAN.Consult the User’s Manual for information on indications, contraindications, warnings and precautions.

All trademarks are the property of St. Jude Medical, Inc. or one of its subsidiaries.© 2006 St. Jude Medical Cardiac Rhythm Management Division. All rights reserved.

Cardiac Rhythm St. Jude Medical ABManagement Division Veddestavägen 1915900 Valley View Court SE-175 84 JärfällaSylmar, CA 91342 USA SWEDEN1 888 SJM-CRMD + 46 8 474 4000818 362-6822 + 46 8 760 9542 Fax818 362-7182 Fax

www.sjm.com

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Product Performance Report Cardiac Rhythm Management A 2006 · 2020-07-21 · Serving our mission...

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