ANZCDACC Advisory Notice 21st Decemember 2016 – Medtronic Claria MRI™ CRT-D SureScan™ and Amplia MRI™ CRT-D SureScan™ Cardiac Resynchronization Therapy Defibrillators (CRT-D) Models DTMB2D1 DTMB2D4 DTMB2QQ DTMA2D1 DTMA2Q1 DTMA2QQ DTMA2D4

Device:  Medtronic  Claria MRI™ CRT-D SureScan™ and Amplia MRI™ CRT-D SureScan™ Cardiac Resynchronization Therapy Defibrillators (CRT-D) Models DTMB2D1 DTMB2D4 DTMB2QQ DTMA2D1 DTMA2Q1 DTMA2QQ DTMA2D4

 Advisory Grade TGA: Hazard Alert (Recall for product correction)

ANZDACC Advisory Grade: Routine

Number at risk in Australia 10 devices and New Zealand 26 devices

Risk: A device software issue that may occur with the above models which may lead to loss of LV pacing with a particular sequence of programming. The result is RV pacing only and potentially worsening heart failure.  As of 10th November 2016, Medtronic reports two “non-critical” events related to this issue. A review of Medtronic’s available data reveals an overall occurrence rate of 0.38%.

Description: This software issue leading to loss of LV pacing occurs when devices are programmed from Managed Ventricular Pacing (MVP) mode to a pacing mode with AdaptivCRT™ enabled. The LV pacing part is not activated despite the device indicating it is.

Presentation: Patients experiencing loss of left ventricular pacing can present with heart failure symptoms or worsening heart failure.

Advice: A software update will be released at a future date to rectify this issue. Otherwise until then routine follow-up is recommended (Home Monitoring where appropriate could also be utilised) and at this follow-up it is important to establish that LV pacing is occurring:

The following programming and assessment is suggested by Medtronic

If the CRT setting is currently programmed to Adaptive Bi-V and LV or Adaptive Bi-V, review rate histogram CRT Pacing percentages (CRT Pacing: Bi-V and LV).

If Bi-V and LV pacing percentages Since Last Session are both near 0%, then the device has encountered the programming sequence and has lost LV pacing. Then it is suggested to perform the following programming steps to restore the device to its expected operating state with AdaptivCRT enabled: Select the CRT parameter window, select Nonadaptive CRT, and select PROGRAM. Select the CRT parameter window, select the desired AdaptivCRT setting (Adaptive Bi-V and LV or Adaptive Bi-V), and select PROGRAM