5388 Tech Manual

5388FC-198618-001.
QXD
01/29/2001
1:23 PM
Page 1
5388
Dual Chamber Temporary Pacemaker (DDD)
Technical Manual
Caution: Federal law (USA) restricts this device to sale by or on
the order of a physician.
Part # 198618001 Rev B
5388FC-198618-001.QXD
01/29/2001
1:23 PM
Page 2
Inside Front coverFor Position OnlyDo Not Print!
Part # 198618001 Rev B
5388 US ENGLISH UC200102260 EN/CTC
Medtronic
Confidential
5388enm1.tpg Page i Monday, January 29, 2001 12:53 PM
Model 5388
Dual Chamber
Temporary Pacemaker
Technical Manual
Part# 198618-001 Rev B
Medtronic
Confidential
5388enm1.tpg Page ii Monday, January 29, 2001 12:53 PM
Symbols
Explanation of Symbols
Read instruction manual prior to use
Type CF Equipment
Part# 198618-001 Rev B
MEDTRONIC CONFIDENTIAL
5388enm1.bk Page iii Monday, January 29, 2001 1:02 PM
Table of Contents
Symbols
ii
Overview
General Description 1-2
Intended Use 1-5
Contraindications 1-6
Warnings, Precautions, and Adverse Effects
Warnings 2-2
Precautions 2-5
Environmental Precautions 2-9
Adverse Effects 2-11
Controls, Indicators, and Other Features
Controls 3-2
Light-Emitting Diodes 3-11
Upper Screen 3-12
Lower Screen 3-18
Physical Features 3-31
Functional Features 3-34
Timing Violations 3-41
Preparation for Use
Battery Installation 4-2
Disposable Pouch 4-3
Cables 4-4
Connector Setup 4-6
User Guide
Overview 5-2
Indicators 5-4
Basic Operation 5-6
Connector Setup 5-17
Pacing Parameter Adjustments 5-19
5388 Technical Manual

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Thresholds 5-27
Pacing Setup 5-35
RAP (Rapid Atrial Pacing) 5-39
Battery Replacement 5-41
Tables 5-43
Device Maintenance
Cleaning and Sterilization 6-2
Safety and Technical Checks 6-4
Service 6-4
Special Notices 6-5
Specifications
Device Specifications 7-2
Pacemaker Diagnostic Diagrams
About the Chapter A-2
Definitions A-3
Single Chamber Modes A-7
Dual Chamber Modes A-14
Index
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List of Figures
Figure 1-1.
The Medtronic Model 5388 Dual Chamber Temporary Pacemaker and the
Model 5433A or 5433V Patient Cable. 1-2
Figure 3-1.
Controls and Indicators of the Model 5388. 3-3
Figure 3-2.
The Model 5388 Connector Block. 3-32
Figure 3-3.
Ring and Bails on the Back Side of the Model 5388. 3-33
Figure 4-1.
Press battery drawer release button. 4-2
Figure 4-2.
The Model 5409 Disposable Pouch. 4-3
Figure 4-3.
The Model 5433A Atrial Use symbol and the Model 5433V Ventricular Use
symbol. 4-5
Figure 4-4.
Connecting the Model 5433A or 5433V Patient Cable to the Model 5388
Temporary Pacemaker. 4-7
Figure 4-5.
Disconnecting the Model 5433A or Model 5433V Patient Cable from the
Model 5388 Temporary Pacemaker. 4-7
Figure 4-6.
Connecting the pacing lead system to the Model 5433A or 5433V Patient Cable
receptacles. 4-9
Figure 4-7.
Removing the connector pin receptacle seals. 4-10
Figure 4-8.
Connecting connector pins directly to the Model 5388. 4-11
Figure 5-1.
Indicators. 5-4
Figure 5-2.
On/Off. 5-6
Figure 5-3.
Device Shut-Down Message. 5-7
Figure 5-4.
Emergency. 5-8
Figure 5-5.
Lock/Unlock. 5-9
Figure 5-6.
Pause. 5-10
Figure 5-7.
Rate and Output. 5-11
Figure 5-8.
Cables. 5-17
Figure 5-9.
Cable to Device Connections. 5-18
Figure 5-10.
Emergency Connections. 5-18

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Figure 5-11.
Lower Screen Menus. 5-20
Figure 5-12.
Sensitivity. 5-21
Figure 5-13.
Upper Rate. 5-23
Figure 5-14.
PVARP. 5-24
Figure 5-15.
A-V Interval. 5-25
Figure 5-16.
Resetting to Automatic Values. 5-26
Figure 5-17.
Sensing. 5-27
Figure 5-18.
Atrial Undersensing. 5-27
Figure 5-19.
Decrease Rate and Output. 5-29
Figure 5-20.
Decrease Sensitivity. 5-30
Figure 5-21.
Increase Sensitivity. 5-30
Figure 5-22.
Capture. 5-31
Figure 5-23.
Loss of Ventricular Capture. 5-31
Figure 5-24.
Increase Rate, Decrease Output. 5-33
Figure 5-25.
Increase Output. 5-34
Figure 5-26.
Atrial Tracking. 5-36
Figure 5-27.
Dial-A-Mode. 5-37
Figure 5-28.
RAP (Rapid Atrial Pacing). 5-39
Figure 5-29.
Battery Replacement. 5-41
Figure A-1.
Typical Blanking and Refractory Periods. A-5
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Overview
General Description
Intended Use
1-2
1-5
Contraindications
1-6

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Overview
General Description
General Description
The Medtronic Model 5388 is a battery-powered, temporary,
dual chamber pacemaker designed primarily for temporary
antibradycardia pacing therapy. The device provides eight
selectable modes of pacing therapy: DDD, DVI, DDI, DOO, VOO,
VVI, AOO, and AAI. High-rate, burst pacing therapy up to
800 ppm (pulses per minute), for atrial tachyarrhythmias, is
1
available in the asynchronous mode.
BR
NS
Ps F
xrt m
gb sr
n Vn
N krb
prt
gx np
cs
np
T.
The device is typically connected to temporary transvenous,

epicardial or myocardial pacing leads, in a bipolar configuration,
using patient cables (Medtronic Models 5433A and 5433V) or
surgical cables (Medtronic Model 5832 or 5832S).
Figure 1-1. The Medtronic Model 5388 Dual Chamber Temporary

Pacemaker and the Model 5433A or 5433V Patient Cable.
The device operates using a 9-volt alkaline or lithium battery,

installed in the battery drawer at the lower right side of the device.
Note: The Model 5388 is a constant current device. When it emits
a pulse, the current output is maintained at a constant value. This
value is set by the output control and does not vary.
1. Recommended for atrial use only.
1-2
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Overview
General Description
Safety Features
The Medtronic Model 5388 is designed to be reliable, easy to
operate, and comfortable to hold. Safety features of the
Model 5388 include:
Cables with no exposed electrical connections;
Self-test function;
Low Battery indicator;
Lock feature to prevent accidental change of parameters;
Safe, two-step operation to turn the device off;
Runaway rate protection;
Protection from defibrillation shock;
Continuous operation during battery replacement (see

page 7-5);
Reversible battery polarity;
Electrostatic protection;
Minimized susceptibility to electromagnetic and magnetic

interference; and
Rubber seals to cover the connector pin receptacles.

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Overview
General Description
Package Contents
See the enclosed card for a detailed list of package contents. Check
the package prior to use. Damaged packages should be returned
to Medtronic (see back cover for address).
Registration Card
Please complete the registration card and return it to Medtronic,
using the address labels provided.
1-4
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Overview
Intended Use
Intended Use
The Medtronic Model 5388 temporary pacemaker is intended to
be used in conjunction with a cardiac pacing lead system for
temporary single or dual chamber pacing in a clinical
environment. The Model 5388 can be used where short-term
demand (synchronous) or asynchronous pacing is indicated for
therapeutic, prophylactic or diagnostic purposes.
Specific indications for temporary cardiac pacing include, but are
not limited to, the following:
Complete heart block;
Sinus bradycardia;
Sick sinus syndrome;
Bradycardia with congestive heart failure;
Atrial and/or ventricular arrhythmias;
Cardiac arrest;
Support, management, and evaluation of a patient prior to

permanent pacemaker implantation;
Support during permanent pacemaker replacement;
Cardiac complications during invasive or surgical

procedures;
Support following cardiac surgery;
Acute myocardial infarction complicated by heart block; and
High-rate burst pacing for treatment of atrial

tachyarrhythmias.
The Model 5388 can be used to determine sensing thresholds of

temporary and permanently implanted lead systems. When
implanting a permanent pacemaker, however, Medtronic
recommends the use of a Medtronic Pacing System Analyzer.

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Overview
Contraindications
Contraindications
There are no known contraindications to the use of temporary
pacing as a means to control the heart rate. The patients age and
medical condition, however, may dictate the type of temporary
pacemaker and lead system used by the physician.
Atrial Sensing
Pacing modes which allow sensing in the atrium to trigger a
ventricular response are contraindicated in the presence of rapid
atrial arrhythmias such as atrial fibrillation or atrial flutter.
Atrial Pacing
Atrial pacing is ineffective in the presence of atrial fibrillation
or flutter.
Single chamber atrial pacing is contraindicated in the presence of
AV conduction disorders.
Asynchronous Pacing
Asynchronous pacing is contraindicated in the presence of
intrinsic cardiac rhythms.
Atrial High-Rate Burst Pacing Therapy

Atrial high-rate burst pacing therapy is intended for use in the
atrium only. High-rate burst pacing in the ventricle may result in
life-threatening arrhythmias.
1-6
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Warnings,
Precautions, and
Adverse Effects
Warnings
2-2
Precautions
2-5
Environmental
Precautions 2-9
Adverse Effects 2-11

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Warnings
Warnings
Defibrillation/Cardioversion
Defibrillation discharges up to 360 watt-seconds have not affected
the Model 5388 in laboratory tests. However, for maximum safety,
it is recommended that paddles be placed at least 15 cm (6 inches)
away from the Model 5388 or the lead system.
Whenever possible, for the safety of the patient, disconnect the
pacemaker from the lead system before defibrillating or
cardioverting. A relatively low resistance pathway exists between
the positive (+) and negative () electrodes of the implanted lead
system. During defibrillation a large current could flow across this
pathway, causing myocardial damage.
Line-powered Equipment
An implanted lead or lead with extension cable constitutes a
direct, low-resistance current pathway to the myocardium. Due to
the danger of tachyarrhythmias resulting from alternating current
leakage, extreme caution must be taken to properly ground all
line-powered equipment used on or in the vicinity of the patient.
Electrosurgical Units (Cautery)

Electrosurgical units can cause tachyarrhythmias by inducing
current on the leads, and thus should never be used within 15 cm
(6 inches) of the pacemaker/lead system.
2-2
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Warnings
Electromagnetic Interference (EMI)

Pacemakers operating in the demand mode respond to
intracardiac potentials with magnitudes of a few millivolts. This
level of sensitivity makes the pacemaker inherently sensitive to
some external fields. In the presence of excessive levels of
interference, the Model 5388 may inhibit completely or revert to
asynchronous operation, pacing at the rate set by the RATE dial.
It is recommended that the device be set to an asynchronous mode
at a rate higher than the patients intrinsic rate when operated in
the presence of strong electromagnetic interference (EMI).
Sources of excessively strong EMI which may temporarily affect
the operation of the Model 5388 include:
Electrosurgical equipment;
Diathermy equipment;
Some medical telemetry equipment [when operated within

one meter (about three feet) of the pacemaker];
Communication transmitters such as cellular phones,

walkie talkies, and transmitters in emergency transport
vehicles; and
Magnetic Resonance Imaging (MRI) equipment.

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Warnings
Atrial High-Rate Burst Pacing Therapy

Use of high rates in the atrium could result in high-rate
conduction to the ventricle. Defibrillation equipment should be on
standby, immediately available during atrial high-rate burst
pacing therapy.
There is no ventricular back-up pacing during delivery of atrial
high-rate burst pacing therapy.
Connecting the Lead System

To prevent pacing into the vulnerable period of the T-wave, turn
the temporary pacemaker ON and turn A and V OUTPUT down
to the minimum amplitude before connecting the temporary
pacemaker to the patients lead system. Determine sensing
thresholds (see Sensing Threshold on page 5-28) before turning
A and V OUTPUT up to threshold levels.
Handling Implanted Leads

When handling implanted leads (temporary or permanent), the
terminal pins or exposed metal must not be touched nor be
allowed to contact electrically conductive or wet surfaces.
2-4
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Precautions
Precautions
Random Failures
The physician should be aware that operational failure of the
Model 5388 temporary pacemaker can occur as the result of
battery depletion, mishandling, or random component failure.
Possible operational failures of the Model 5388 can include:
No output or erratic output;
No sensing or erratic sensing;
False indicator light signals;
Inappropriate variance of rate, output pulse width, or

output amplitude;
Reversion to asynchronous pacing; and
Loss of control of rate, output, sensitivity or power.
If loss of control of rate, output, sensitivity or power occurs, and it

is not due to a low battery, disconnect the device from the patient
and return it to Medtronic for service.
Batteries
Use of batteries with different physical dimensions from that of
the recommended batteries may result in erratic, or no,
pacing output.
Replace the battery for each new patient, and when the low
battery indicator appears during device operation (see page 3-13).
Check the battery status at least twice daily. Replace alkaline
batteries at least once every week when the temporary pacemaker
is in continuous use.

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Precautions
Pacing Leads and Cables

Improper connection, displacement or fracture of leads or cables
may result in pacemaker system failure.
Pacing System Adjustments

Monitor the patients ECG and blood pressure and keep
defibrillation equipment on standby, immediately available for
emergency use during evaluation of stimulation and sensing
thresholds, pacemaker and pacing lead connections and
adjustments, and atrial high-rate burst pacing therapy.
Bipolar Lead Systems

Bipolar lead systems are recommended because they are less
susceptible to electromagnetic interference. Separation between
the positive (+) electrode and negative () electrode of the same
lead system should not exceed 15 mm (0.6 inches). Also, the atrial
and ventricular lead systems should be positioned so that the
electrodes of one system are a minimum of 4 cm (1.5 inches) from
the electrodes of the other system and are at right angles to
each other.
Unipolar Lead Systems

Unipolar lead systems are not recommended because they are
more susceptible to electromagnetic interference, which may
result in inappropriate pacing. Unipolar lead systems should not
be used in the dual-chambered pacing modes because the current
path of one lead system may interfere with the current path of
the other.
2-6
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Precautions
Atrial Sensing
The atrial sensing threshold should be evaluated to ensure
maximum electrogram amplitude and that an adequate atrial
sensing threshold is obtained prior to programming to a mode
that requires atrial sensing (DDD, DDI, or AAI).
Place the wires on the right atrial free wall, oriented along the
direction of the myocardial fibers, approximately 1 cm apart. It is
important to achieve a sensing threshold of at least 1.0 mV. The
atrial sensitivity should be set to a minimum of one-half the
measured threshold. This ensures a minimum safety margin of 2x
the sensing threshold. Failure to follow this procedure can lead to
delivery of asynchronous pulses.
Sensitivity Settings
Since the sensitivity setting determines the smallest signal that can
be sensed by the pacemaker, set the sensitivity dial to one-half the
mV value of the patients sensitivity threshold (see Sensing
Threshold on page 5-28). This setting will provide a 2x safety
margin to ensure proper sensing.
A more sensitive setting may be chosen to provide a greater safety
margin. However, be aware that setting the sensitivity value too
low (too sensitive) could result in inappropriate sensing of far
field signals (e.g., sensing of R- or T-waves on the atrial channel or
P-waves on the ventricular channel), leading to inappropriate
inhibition of pacing pulses.
High Output and Maximum Sensitivity

Although the pacemaker contains a safety pacing feature that
prevents inappropriate inhibition of ventricular pacing due to
far-field sensing, the simultaneous use of high output and
maximum sensitivity (i.e., the lowest mV value) should
be avoided.

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Precautions
Electrostatic Discharge (ESD)

The pacing lead(s) provides a low-impedance pathway to the
heart. Therefore, it is recommended that attending health care
professionals discharge any static electricity by touching a large
metal or conductive, grounded surface prior to touching the
patient, the cable, the leads or the pacemaker. Also, neutralize any
static electricity from the patient by touching the patient away
from (i.e., distal to) the leads.
Retrograde Conduction
If retrograde P-waves are being sensed outside the ratedependent, automatic Post-Ventricular-Atrial-Refractory Period
(PVARP) setting, manually increase the PVARP until the
retrograde waves fall inside the PVARP. Failure to follow this
procedure may lead to a pacemaker mediated tachycardia (PMT).
Termination of Pacing
Abrupt termination of pacing stimuli may result in intervals of
asystole before an intrinsic rhythm is reestablished. Prior to
terminating pacing, set the pacemaker to a demand mode, then
gradually reduce the pacing rate below the patients intrinsic rate.
PAUSE Key
Use the PAUSE key with care, since the patient is without pacing
support (for a maximum of 10 seconds at a time) when PAUSE is
pressed and held.
A-V Interval
Programming long A-V intervals may result in pacing the
ventricle during the vulnerable period of ventricular
repolarization, thus precipitating ventricular arrhythmias in
unstable patients.
2-8
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Environmental Precautions
The Model 5388 has been carefully designed and tested to ensure
reliability during normal use. However, electronic devices are
susceptible to many environmental stresses. Precautions should
be taken to avoid damage to the unit, including (but not limited
to) the precautions listed in this chapter.
Do not drop the unit or handle it in a way that might

physically damage the device. The device may appear to
work appropriately immediately after being dropped or
mishandled, but operational damage may have occurred.
Do not place the Model 5388 in any area where a patient may
interact with it. Tampering with programmed parameters
may have direct and serious patient health effects. The
temporary pacemaker should be placed in an area that
minimizes tampering with the device by unauthorized
personnel (patients, visitors, etc.).
Avoid spilling fluid on the unit. The Model 5388 was

carefully designed to minimize leakage, but fluid incursion
may still occur. Medtronic recommends the use of a
protective cover such as the Model 5409 plastic pouch to
minimize fluid incursion.
Avoid contaminating the safety cable receptacle and

connector pin receptacles with blood or other body fluids.
Always use safe electrostatic discharge (ESD) procedures; this

device could be adversely affected by ESD.
Do not open the device. The seam joining the unit is designed
to minimize fluid incursion and may not be effective if
improperly opened and resealed. Furthermore, removing the
label on the back of the unit may compromise the ESD barrier.
Opening this unit will void the warranty (see the warranty
information packaged with the device).
Do not sterilize the Model 5388 by gamma irradiation or

steam (autoclave). See Cleaning and Sterilization on
page 6-2 for more information.

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Rapid temperature changes may affect proper operation.

Always allow the temperature of the device to stabilize in the
environment in which the device will be used before
attachment and operation (see page 7-5 for recommended
storage and operation temperatures).
Prolonged storage or operation of the device in high humidity

may affect proper operation. Allow the device to completely
dry after exposure to humidity.
Other environmental factors may impact proper performance of

the unit in the hospital setting. Use of appropriate environmental
health and safety practices will help prevent environmental
damage to the unit.
2-10
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Adverse Effects
Adverse Effects
Temporary Pacemakers
Potential adverse effects related to the use of temporary external
pacemakers such as the Model 5388 include, but are not limited to:
Asystole following abrupt cessation of pacing;
Inhibition or reversion in the presence of strong

electromagnetic interference; and
Initiation of a tachyarrhythmia or acceleration of an

existing tachyarrhythmia.
Atrial High-Rate Burst Pacing

Atrial high-rate burst pacing may result in the onset of
tachycardia, acceleration of an existing tachycardia, or fibrillation.
Application of temporary atrial high-rate burst pacing should be
performed in a carefully monitored and controlled patient
environment. Monitor the patients ECG and blood pressure, and
keep defibrillation equipment on standby, immediately available
for emergency use.
Dual Chamber Modes

In the DVI, DDI, and DDD modes, the ventricular sense amplifier
may sense the atrial pacing pulse. Reducing the atrial amplitude,
the ventricular sensitivity, and/or repositioning the electrodes
may be necessary to avoid this situation.
Safety Margins
Determine an adequate safety margin for sensing and pacing in
both the ventricle and atrium (see Chapter 5). Failure to do so may
result in inappropriate pacing.

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Adverse Effects
Lead Systems
Potential adverse effects related to the use of pacing lead systems
used in conjunction with the Model 5388 temporary pacemaker
include, but are not limited to:
Inappropriate lead connections;
Inadvertent disconnection of the lead system;
Lead fracture or displacement causing intermittent or

complete loss of capture and/or sensing; and
Perforation and tamponade.
Other potential adverse effects related to the use of any implanted

lead system include, but are not limited to:
Myocardial irritability resulting in fibrillation;
Infarction;
Pericarditis;
Body rejection phenomena (local tissue reaction);
Muscle and nerve stimulation; and
Infection.
Nerve or muscle stimulation can be caused by pacing lead contact

with the nerve or muscle tissue and/or by high-output settings.
The stimulation may be controlled by repositioning or replacing
the electrode, or by reducing the output pulse amplitude.
2-12
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5388enm1.c03 Page 1 Monday, January 29, 2001 1:18 PM
Controls, Indicators,
and Other Features
Controls
3-2
3-11
Light-Emitting Diodes
Upper Screen
3-12
Lower Screen 3-18

Physical Features
3-31
Functional Features
Timing Violations
3-34
3-41

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Controls
Controls
The dials and keys used to control the functions and parameter
settings of the Model 5388 are described below.
Note: All adjustments to the RATE, A (Atrial) OUTPUT, and
V (Ventricular) OUTPUT dials take effect within the next two
pacing cycles.
Lock/Unlock Key
This key allows the user to lock and unlock the upper screen
parameter values, RATE, A OUTPUT, and V OUTPUT (see Lock
Feature on page 3-34).
When the upper screen is unlocked, press this key to lock the upper
screen parameters at their current settings. The backlight will turn
off and the lock indicator appears in the upper right-hand corner
of the upper screen. Pressing this key while a lower menu is active
causes the device to exit the menu.
Note: If this key is not pressed, the device automatically locks the
parameters on the upper screen 60 seconds after the last device
adjustment, with the exception of Menu 3. When in Menu 3 (Rapid
Atrial Pacing), the device waits five minutes before locking.
When the upper screen is locked, press this key to unlock the upper
screen, allowing the upper screen parameters to be adjusted again.
The backlight turns on, unless the low battery indicator is flashing
(see Low Battery Indicator on page 3-13).
3-2
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Controls
22
2
1.
Pace/Sense LEDs
2.
Lock/Unlock Key
21
3
+
20
3.
Lock Indicators
4.
Rate Dial
5.
Atrial Output Dial
6.
Ventricular Output Dial
7.
Menu Parameter Dial
8.
Parameter Selection Key
9.
Menu Selection Key
A +V A +V
DDI
19
80
30
18
RATE
16
A OUTPUT
15
V OUTPUT
120
200
ppm
3
5
17
OFF
10. Pause Key
OFF
11. Power On Key
0.1
0.1
10
10
20
mA
20
25
mA
12. Power Off Key

13. Emergency/Asynchronous
Pacing Key
14. Lower Screen

15. Ventricular Output Graphics
14
16. Atrial Output Graphics

9
17. Upper Screen

18. Rate Graphics
19. Setup Indicators
10
ASYNC.
13
20. DDI Indicator

21. Low Battery Indicator
12
22. Setup Labels
Dual Chamber
Temporary Pacemaker
11
Figure 3-1. Controls and Indicators of the Model 5388.

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Controls
ON Key
f
ON
Press the ON key once to power the device up. The device first
senses, then begins sensing and pacing in both chambers
(DDD mode).
The upper screen and the backlight illuminate and a self-test is
initiated (see Self-test on page 3-35). After the self-test is
successfully completed the following occurs:
If the battery has sufficient power, the device begins sensing
and pacing in both the atrium and ventricle at the following
nominal parameter values:
Table 3-1. Power-on values.

Base RATE
80 ppm
A OUTPUT and V OUTPUT
10 mA
1.0 ms*
1.5 ms*
Atrial pulse width

Ventricular pulse width
V SENSITIVITY
0.5 mV
2.0 mV
A TRACKING
ON
UPPER RATE
110 ppm
300 ms
170 ms
A SENSITIVITY
PVARP
A-V INTERVAL (paced)
* Pulse width is not adjustable.
For a description of atrial tracking, see page 3-22.

These parameters are set to the automatic, rate-dependent values (see
Device Specifications on page 7-3).
3-4
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Controls
If the battery is nearing depletion, the low-battery indicator

is displayed.
If the battery is depleted, the LEDs may come on (see LightEmitting Diodes on page 3-11) while ON is pressed, but the
device will not operate.
When the upper screen is locked, press the ON key once to unlock the
upper screen (see Lock/Unlock Key on page 3-2). The backlight
comes on and the upper screen parameters may be adjusted. The
device continues to pace at the currently selected values.
When the device is pacing asynchronously, to return the device to
demand (synchronous) pacing:
Press the ON key once if the asynchronous pacing message (see

page 3-7) is displayed in the lower screen.
Press the ON key twice if the asynchronous pacing message is

not displayed in the lower screen. (After the first press of the
ON key, the asynchronous pacing message appears).
The device begins pacing synchronously at the following values:

Table 3-2. ON key synchronous values.
RATE
current setting
A OUTPUT and V OUTPUT
current settings
A SENSITIVITY
V SENSITIVITY
0.5 mV (nominal)*
2.0 mV (nominal)*
* If the corresponding OUTPUT is not OFF.

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Controls
OFF Key
To turn the device off, press the OFF key twice within 5 seconds.
(After the first press, a message appears in the lower screen telling
the user to press OFF a second time to turn the device off.)
OFF
The backlight turns off, the screens blank, and three LEDs
illuminate, then turn off, when OFF is pressed the second time.
To SHUT DOWN,
Press OFF again.
Note: If the OFF key is pressed once when the upper screen
parameters are locked:
The backlight illuminates and the upper screen unlocks,

allowing the parameters to be adjusted.
The lower screen displays the message telling the user to press
OFF a second time (Ignoring this message allows the device to
continue pacing at the currently selected values).
EMERGENCY (ASYNC.) Key

EMERGENCY
ASYNC.
This key allows immediate access to high-output, dual-chamber

asynchronous pacing (DOO) at any time, including when the
device is off.
Note: Asynchronous pacing can also be reached by adjusting
A and V SENSITIVITY on Menu 1 (see Menu 1 on page 3-19).
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Controls
To initiate dual-chamber asynchronous pacing, press the EMERGENCY/

key once at any time (i.e., while the device is on, off, in a
Menu or locked). The device will pace at the following values:
ASYNC.
Table 3-3. Emergency values.

RATE
current setting, or
80 ppm if device was off
A OUTPUT
20 mA
25 mA
V OUTPUT
A SENSITIVITY
V SENSITIVITY
ASYNC (i.e., no sensing)

ASYNC (i.e., no sensing)
A TRACKING,
UPPER RATE, PVARP
not applicable
A-V INTERVAL
automatic rate-dependent, or
current manual setting
Note: If the device is locked when EMERGENCY/ASYNC. is pressed,

the upper screen parameters unlock, the backlight turns on and
the device immediately begins to pace at emergency values.
The RATE, A OUTPUT, and V OUTPUT can be adjusted using the three
upper dials. The A-V INTERVAL can be manually adjusted or
allowed to adjust automatically with the RATE (see A-V Interval
on page 3-22).
ASYNCHRONOUS
PACING
To Resume
The message to the left appears in the lower screen.
Synchronous Pacing
Press ON
Note: The asynchronous pacing message disappears after one

minute. The message reappears anytime the ON key is pressed
(see ON Key on page 3-4) during asynchronous pacing.
To resume demand (synchronous) pacing, press the ON key (see ON
Key on page 3-4), or access Menu 1 and adjust A SENSITIVITY and/
or V SENSITIVITY (see page 3-20 or page 3-21).

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Controls
PAUSE Key
This key interrupts pacing and sensing to allow the user to view
the patients intrinsic rhythm.
PAUSE
PACEMAKER
PAUSE
Caution: Pacing
and Sensing
are suspended.
Caution: Use the PAUSE key with care, since the patient is without
pacing support (for a maximum of 10 seconds at a time) when
PAUSE is pressed and held.
When the PAUSE key is pressed and held, the device stops pacing and
sensing for a maximum of 10 seconds. The message to the left
appears in the lower screen, reminding the user that pacemaker
operation is suspended.
To suspend device operation for up to another 10 seconds, release,
then press and hold the PAUSE key again. Repeat this as many
times as required.
When the PAUSE key is released, the device first senses, then resumes
pacing at the programmed parameters. The device also senses
before pacing if PAUSE times out at 10 seconds.
If the PAUSE key is pressed when the upper screen is locked, pacing and
sensing are suspended, as described above, and the upper screen
parameters unlock.
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Controls
MENU Key
The MENU key is used to activate and page through the Menus on
the lower screen, from Menu 1 to Menu M.
MENU
If pressed when the upper screen is locked, the Menu screen becomes
active, and the upper screen parameters unlock.
SELECT Key
The SELECT key is only active when the Menu screens are active.
SELECT
In Menus 1 and 2 Use the SELECT key to scroll through the

parameters continuously, from top to bottom and back to the top.
In Menu 3 (Rapid Atrial Pacing) Press and hold the SELECT key
to deliver a Rapid Atrial Pacing burst (see page 3-28).
In Menu M (DIAL-A-MODE) Use the SELECT key to activate a new
mode (see page 3-30).

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Controls
Rate Dial
The top dial is used to set the base rate at which pacing pulses are
delivered, in pulses-per-minute (ppm) (see RATE on page 3-15).
Atrial Output Dial

The Atrial Output dial is the second dial from the top. It is used to
set the current amplitude, in milliamps (mA), of the atrial pacing
pulse [see A (Atrial) OUTPUT on page 3-16].
Ventricular Output Dial

The Ventricular Output dial is the third dial from the top. It is used
to set the current amplitude, in mA, of the ventricular pacing
pulse [see V (Ventricular) OUTPUT on page 3-17].
Menu Parameter Dial

The Menu Parameter Dial is the fourth dial from the top. It is used
to adjust the parameters displayed on the Menu Screens
(see Lower Screen on page 3-18).
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All light-emitting diodes (LEDs) are illuminated during the
Power-on Self-test.
PACE LEDs
There are two green LEDs at the top of the device, marked PACE.
The green LED next to the A flashes each time the device
delivers a pacing pulse on the atrial channel.
The green LED next to the V flashes each time the device
delivers a pacing pulse on the ventricular channel.
Note: These LEDs indicate delivery of a pacing pulse but do not

necessarily indicate that the pacing pulse has initiated
cardiac stimulation.
SENSE LEDs
There are two orange LEDs at the top of the device, marked SENSE.
The orange LED next to the A illuminates when events are

sensed on the atrial channel. The A SENSE LED flashes when
the device detects events inside and outside the atrial
refractory period.
The orange LED next to the V illuminates when events are

sensed on the ventricular channel. The V SENSE LED flashes
only when the device detects an event outside the
refractory period.

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Upper Screen
Upper Screen
The upper screen displays:
Indicators:
A +V A +V
DDI
80
30
120
RATE
OFF
0.1
10
Low Battery Indicator
Pacemaker Setup Indicators
Lock Indicators
DDI Indicator
200
ppm
20
A OUTPUT
mA
HIGH OUTPUT
Parameters for basic pacing:
OFF
0.1
10
V OUTPUT
20
25
mA
RATE
(Atrial) OUTPUT
(Ventricular) OUTPUT
When the device is off, the upper screen is blank, except for the
number lines, which are painted on the glass.
When the device is on, the numerical and graphical values for the
parameters appear, and the screen is illuminated by a backlight.
The backlight remains on while parameters are adjusted but is
turned off 60 seconds after the last adjustment even while Menu 3
(RAP) is active [see Menu 3 (Rapid Atrial Pacing) on page 3-28].
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Upper Screen
Indicators
This indicator comes on and flashes when the battery reaches
replacement time.
When the Low Battery indicator begins to flash during device operation,
the device will operate satisfactorily for a minimum of 24 hours at
or below a RATE of 70 ppm, nominal OUTPUTs, and with the lower
screen inactive (Nominal Values on page 7-4). The backlight
will not illuminate once the low battery indicator appears.
To extinguish the Low Battery indicator, replace the low battery (see
Battery Installation on page 4-2) with a recommended new
9-Volt battery.
Pacemaker Setup Indicators

PACE
The PACE and SENSE labels painted on the light gray bar above the
upper screen, and the A and V indicators that appear on the screen
below the labels communicate to the user which chambers
(A for atrium, V for ventricle) the device is currently set to pace
and/or sense. These indicators can be used to determine the
current pacing mode (see Model 5388 Pacing Setup Table. on
page 5-43).
SENSE
A +V A +V
Note: The Setup Indicators do not indicate actual device

interaction with the heart.

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Upper Screen
Lock Indicators
To UNLOCK RATE,
A OUTPUT, and
A [ ] appears when the upper screen parameters are locked. If

upper dials are turned while the parameters are locked, this
indicator remains on, and a [ ] and a flashing [
] appear in the
upper screen between RATE and A OUTPUT. The message to the left
appears in the lower screen.
V OUTPUT,
The lower screen message and the two icons in the center of the
upper screen disappear after approximately 15 seconds if nothing
is done to unlock the upper screen parameters. All three indicators
disappear when the parameters are unlocked (see Lock Feature
on page 3-34).
Press
DDI Indicator
A +V A +V
DDI
This indicator appears below the Pacemaker Setup Indicators

when the device is pacing and sensing in both chambers, but
A (Atrial) TRACKING is turned OFF [see A (Atrial) TRACKING
on page 3-22].
Parameters
The RATE, A OUTPUT, and V OUTPUT settings are displayed both
numerically and graphically. The line next to each dial shows the
range available for that parameter. Line segments appear,
showing where, within the range, the parameter is set. The
settings numerical value appears just below the segmented
line graph.
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Upper Screen
RATE
The base pacing rate ranges from 30 to 200 ppm and is
incremented as in Table 3-4.
Table 3-4. Rate Increments.
Range
Increment
30 to 50 ppm
5 ppm
50 to 100 ppm
2 ppm
100 to 200 ppm
5 ppm
Turn the top dial clockwise to increase RATE, and counterclockwise to decrease RATE.
The (nominal) RATE setting at which the device powers up is
80 ppm.
A +V A +V
30
RATE
80
120
200
For rates above 120 ppm, the line segments become taller and
wider to warn the user that RATE is set above the typical range.
ppm
Note: The rate-dependent parameters UPPER RATE, PVARP, and

A-V INTERVAL are automatically adjusted each time RATE is adjusted
unless they are manually set (see Menu 2 on page 3-23).

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Upper Screen
A (Atrial) OUTPUT
The atrial output ranges from 0.1 to 20 mA, and is incremented as
in Table 3-5.
Table 3-5. Atrial Output Increments.
Range
Increment
0.1 to 0.4 mA
0.1 mA
0.4 to 1.0 mA
0.2 mA
1.0 to 5 mA
0.5 mA
5 to 20 mA
1.0 mA
Turn the dial clockwise to increase A OUTPUT. Turn the dial

counterclockwise to decrease or turn A OUTPUT OFF. The space
above OFF fills in when A OUTPUT is turned OFF.
When A OUTPUT is set to OFF, both the atrial output and the atrial
sensitivity are turned off (i.e., there is no atrial pacing or sensing).
If A OUTPUT is turned back on within approximately seven
seconds, atrial sensitivity is set to the previously selected value. If
A OUTPUT is OFF for longer than approximately seven seconds,
atrial sensitivity is set to the nominal value of 0.5 millivolts (mV)
when A OUTPUT is turned back on.
Note: A SENSITIVITY can be adjusted from Menu 1 on the lower
screen [see A (Atrial) SENSITIVITY on page 3-20].
At power up, A OUTPUT is 10 mA (nominal), A SENSITIVITY is
0.5 mV (nominal), and pulse width is fixed at 1.0 ms.
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Upper Screen
V (Ventricular) OUTPUT
The ventricular output ranges from 0.1 to 25 mA, and is
incremented as in Table 3-6.
Table 3-6. Ventricular Output Increments
Range
Increment
0.1 to 0.4 mA
0.1 mA
0.4 to 1.0 mA
0.2 mA
1.0 to 5 mA
0.5 mA
5 to 25 mA
1.0 mA
Turn the dial clockwise to increase V OUTPUT. Turn the dial

counterclockwise to decrease or turn V OUTPUT to OFF. The space
above OFF fills in when V OUTPUT is turned OFF.
If V OUTPUT is set above 20 mA, the line segments becomes taller
and wider and an icon with the message, HIGH OUTPUT, appears
above the taller segments.
HIGH OUTPUT
OFF
0.1
10
V OUTPUT
20
25
mA
When V OUTPUT is set to OFF, both the ventricular output and the
ventricular sensitivity are turned off (i.e., there is no ventricular
pacing or sensing). If V OUTPUT is turned back on within
approximately 7 seconds, ventricular sensitivity is set to the
previously selected value. If V OUTPUT is OFF for longer than
approximately 7 seconds, ventricular sensitivity is set to the
nominal value of 2.0 millivolts (mV) when V OUTPUT is turned
back on.
Notes:
can be adjusted using Menu 1 on the lower
screen [see V (Ventricular) SENSITIVITY on page 3-21].
V SENSITIVITY
V OUTPUT
is set to OFF when the SELECT key is pressed for

RAP delivery [see Menu 3 (Rapid Atrial Pacing) on
page 3-28]. V OUTPUT returns to its previous value when
SELECT is released.
At power-up V OUTPUT is 10 mA (nominal), V SENSITIVITY is

2.0 mV (nominal), and pulse width is fixed at 1.5 ms.

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Lower Screen
Lower Screen
Functions
The Lower Screen has two functions:
DDD
0.5 mV
A Sensitivity
10
0.4
V Sensitivity
2.0 mV
A-V Interval
170 mS
A Tracking
ON
To display warnings and instructions, and
To provide access to the four Menus:
MENU 1:
Allows adjustment of A (Atrial) and

the A-V INTERVAL, and
A (Atrial) TRACKING.
V (Ventricular) SENSITIVITY,
MENU 2:
MENU 3:
MENU M: DIAL-A-MODE allows direct selection of DDD, DVI,
Allows adjustment to the rate-dependent

parameters UPPER RATE, PVARP, A-V INTERVAL, and to a
feature called SETTING.
Allows access to Rapid Atrial Pacing (RAP).
DOO, or VVI mode.
Controls
The controls for the Menus and their parameters are:
MENU PARAMETER
SELECT
MENU
dial.
key, and
key.
While the Menus in the lower screen are in use, the upper screen
remains unlocked, and the upper screen parameters may be
adjusted at any time using the corresponding dial.
Press [
3-18
] to exit the Menus.
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Lower Screen
Status Line
The NASPE and British Pacing and Electrophysiology Group
(NBG) code is displayed at the top of every Menu and is updated
when parameter adjustments cause a mode change (see page 5-44
and Pacemaker Diagnostic Diagrams on page A-1 for
information on NBG codes).
The phrase *MANUAL appears at the top of every Menu screen
if one or more of the three rate-dependent parameters are
manually adjusted (see SETTING on page 3-27).
Note: Once activated, if Menu 1, 2, M, and the upper screen
parameters remain unchanged for over 60 seconds, the menu goes
blank. Menu 3 goes blank five minutes after the last adjustment or
RAP delivery.
Menu 1
This Menu provides access to the:
Atrial sensitivity (A SENSITIVITY),
Ventricular sensitivity (V SENSITIVITY),
A-V Interval (A-V INTERVAL), and
Atrial tracking option (A TRACKING).
These parameters are displayed both numerically and graphically.

Parameters that do not apply to the current chambers being paced
and sensed are less visible (i.e., grayed out) and are not selectable.
To change grayed-out parameters, the chambers being paced and
sensed (i.e., the pacing mode) must first be changed (see Model
5388 Pacing Setup Table. on page 5-43).

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Lower Screen
A (Atrial) SENSITIVITY
Unless manually adjusted, the atrial sensitivity (A SENSITIVITY) is set
to the nominal value of 0.5 mV.
When selected, the A SENSITIVITY may be adjusted between 0.4 and
10 mV by turning the MENU PARAMETER dial.
Turn the dial clockwise to increase A SENSITIVITY (the mV value
decreases), and counterclockwise to decrease A SENSITIVITY (the
mV value increases). The change will take effect within the next
two pacing cycles.
DVI
ASYNC
A Sensitivity
10
0.4
V Sensitivity
2.0 mV
A-V Interval
170 mS
A SENSITIVITY can be turned off, allowing the pacemaker to pace

asynchronously in the atrium, by turning the MENU PARAMETER
dial counterclockwise until the term, ASYNC, appears.
The Setup Indicators at the top of the upper screen reflect the
change by the absense of the A under SENSE, and the A SENSE
LED will no longer flash.
The NBG code at the top of the lower screen also reflects the
change in mode (i.e., chamber(s) paced and sensed).
A Tracking
Note: Modes that are punctuated by !? should be avoided or

adjusted to a clinically useful mode.
A SENSITIVITY is
automatically set to ASYNC when:

is pressed,
EMERGENCY
RAP is delivered, or
DVI or DOO mode is selected from Menu M.
Note: A SENSITIVITY is inaccessible when A OUTPUT is turned

to OFF.
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Lower Screen
V (Ventricular) SENSITIVITY
Unless manually adjusted, ventricular sensitivity (V SENSITIVITY) is
set to the nominal value of 2.0 mV.
When selected, the sensitivity may be adjusted between 0.8 and
20 mV by turning the MENU PARAMETER dial.
Turn the dial clockwise to increase V SENSITIVITY (the mV value
decreases), and counterclockwise to decrease V SENSITIVITY (the
mV value increases). The change will take effect within the next
two pacing cycles.
can be turned off, allowing the pacemaker to pace
asynchronously in the ventricle, by turning the MENU PARAMETER
dial counterclockwise until the term, ASYNC, appears.
V SENSITIVITY
DOO
ASYNC
A Sensitivity
ASYNC
V Sensitivity
20
A-V Interval
10
0.8
The Setup Indicators at the top of the upper screen reflect the
change by the absence of the V under SENSE, and the V SENSE
LED will no longer flash.
The NBG code at the top of the lower screen also reflects the
change in pacing mode (i.e., chamber(s) paced and sensed).
170 mS
A Tracking
Note: Modes that are punctuated by !? should be avoided or

adjusted to a clinically useful mode.
V SENSITIVITY
is automatically set to ASYNC when:

is pressed, or
EMERGENCY
DOO mode is selected from Menu M.
Note: V SENSITIVITY is inaccessible when V OUTPUT is turned

to OFF.

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Lower Screen
A-V Interval
A-V INTERVAL may be adjusted from 20 to 300 ms in increments of
10 ms (see A-V Interval on page 3-26).
A (Atrial) TRACKING
This feature is only accessible or applicable when the device is set
to sense and pace in both chambers. When ON, A (Atrial)
TRACKING causes the device to pace the ventricle in synchrony
with intrinsic atrial depolarizations.
When A TRACKING is ON (DDD mode), each sensed event on the
atrial lead not only inhibits the scheduled atrial pacing pulse, but
also triggers an A-V INTERVAL.
DDI
A Sensitivity
0.5 mV
V Sensitivity
2.0 mV
A-V Interval
170 mS
A Tracking
OFF
OFF ON
Warning: If a patient is prone to atrial arrhythmias, atrial tracking

could lead to the development of ventricular arrhythmias (see
Contraindications on page 1-6).
When A TRACKING is OFF (DDI mode), an atrial sense does not
trigger an A-V INTERVAL. The ventricle is paced at the selected RATE.
To turn A TRACKING OFF, use SELECT to highlight the parameter,
then turn the MENU PARAMETER dial counterclockwise until OFF
replaces ON. Turn the MENU PARAMETER dial clockwise to turn A
TRACKING ON.
Note: A TRACKING can be manually turned OFF only from DDD

mode. A TRACKING can be manually turned ON only from DDI
mode. However, A TRACKING is automatically set to ON when the
mode changes from DDI to any other mode, regardless of its
applicability in the new mode.
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Lower Screen
Menu 2
This Menu allows manual adjustment of these dual chamber, ratedependent parameters:
UPPER RATE,
PVARP
A-V INTERVAL
SETTING, which is a toggle between automatic and manual

settings for the rate-dependent parameters.
(post-ventricular atrial refractory period),

(appears on Menu 1 also), and
When not manually adjusted, these parameters are automatically set

to a factor of the base pacing rate (see Nominal Values on
page 7-4).
When manually set, the rate-dependent parameters do not change
with adjustments to the RATE.
If further increase of the RATE would cause a timing violation

with the UPPER RATE, a warning message appears on the lower
screen, and RATE is not allowed to be increased until UPPER
RATE is increased (see Timing Violations on page 3-41).
If further increase or decrease of the RATE would cause a

timing violation with the A-V INTERVAL or PVARP, a warning
message appears on the lower screen and RATE is not allowed
to be adjusted until A-V INTERVAL and/or PVARP are adjusted
(see Timing Violations on page 3-41).

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Lower Screen
During manual adjustments, if a rate-dependent parameter is

adjusted to a point where further adjustment would cause a
timing violation (see Timing Violations on page 3-41), a
warning message will overwrite the Menu for 10 seconds. During
those 10 seconds, either:
Adjust the RATE, or
Press the MENU key to activate Menu 2 and adjust the ratedependent parameter.
After 10 seconds the message will disappear, and the device will
continue operating at the currently selected parameter values.
Upper Rate
This parameter is designed to set the maximum ventricular pacing
rate allowed while tracking the atrium. At sensed atrial rates
above the UPPER RATE, a Wenckebach-type response results (see
page 3-39). This parameter is adjustable only in dual chamber
modes with atrial tracking.
Unless manually adjusted, this parameter is limited to the range of
110 to 230 ppm and is determined by the RATE setting using the
following formula:
UPPER RATE
= RATE + 30 ppm
When selected on Menu 2, however, the UPPER RATE can be adjusted

to values from 80 to 230 ppm incremented as follows:
Table 3-7. Upper Rate increments.
3-24
Rate
Increment
80 to 130 ppm
2 ppm
130 to 230 ppm
5 ppm
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Lower Screen
PVARP (Post Ventricular Atrial Refractory Period)

This parameter sets the length of time following a ventricular
event during which atrial sensing does not affect pacemaker
timing. PVARP is designed to prevent the device from responding
to atrial sensing of ventricular activities such as far-field R-waves,
PVCs, and retrograde conduction.
Unless manually adjusted, this parameter is determined by the base
pacing rate as shown in Table 3-8.
Table 3-8. Default PVARP settings.
Rate
PVARP
100 ppm
300 ms
105 to 150 ppm
250 ms
155 to 180 ppm
225 ms
>180 ppm
200 ms
The PVARP can be manually adjusted to any value, from 150 ms to

500 ms in 10 ms increments, that does not cause a timing violation
(see Timing Violations on page 3-41).
Note: If PVARP is set to 150 ms, atrial events may not be sensed
due to the tolerance allowed for blanking after a paced event (see
Blanking on page 7-4)

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Lower Screen
A-V Interval
Displayed on both Menu 1 and Menu 2, the A-V Interval after an
atrial pace (i.e., PAV, or A-V INTERVAL) is the amount of time, in
ms (milliseconds), that the pacemaker waits between the delivery
of an atrial pacing pulse and delivery of the corresponding
ventricular pacing pulse.
Note: The A-V Interval after an atrial sensed event (i.e., SAV) is not
programmable. The SAV is automatically set to a value 30 ms less
than the A-V INTERVAL.
Unless manually adjusted, A-V INTERVAL is set to a value determined
by the RATE setting. It can never be shorter than 50 ms or longer
than 250 ms, as determined by the following formula:
A-V INTERVAL ms
= 300 (1.67 x RATE ppm)
The final value is rounded off to the nearest higher multiple of 10,
within the automatic range (i.e., 50, 60, 70, . . . 230, 240, 250). For
example, at a RATE of 70 ppm, the A-V INTERVAL would be rounded
to 190 ms.
When selected on Menu 1 or 2, however, the A-V INTERVAL can be
manually set to values from 20 to 300 ms (in 10 ms increments)
that do not cause a timing violation (see Timing Violations on
page 3-41).
Note: If A-V INTERVAL is set shorter than 50 ms, ventricular events
may not be sensed during that interval, due to ventricular
blanking after an atrial event.
3-26
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Lower Screen
SETTING
This feature sets the A-V INTERVAL, UPPER RATE, and PVARP to
automatic, rate-dependent settings (see Auto on page 7-3).
*MANUAL
DDD
Upper Rate
110 ppm
PVARP
300 mS
A-V Interval
SETTING
SETTING is inaccessible (grayed-out) when the device is using

automatic settings. When a Menu 2 parameter (or A-V INTERVAL on
Menu 1) has been manually adjusted:
*200 mS
MANUAL
MANUALAUTO
The word MANUAL appears to the right of SETTING and

at the top of the lower screen with an asterisk (*),
An asterisk (*) appears next to the value of each setting which

has been manually adjusted, and
SETTING
becomes accessible.
To change A-V INTERVAL, UPPER RATE, and PVARP back to automatic,

rate-dependent settings, select SETTING and turn the MENU
PARAMETER dial clockwise until AUTO replaces MANUAL.
The user can use the MENU PARAMETER dial to alternate between
AUTO and MANUAL parameter settings, as long as SETTING
remains selected (turn the dial counterclockwise to reinstate
*MANUAL values). Previous MANUAL settings are lost if the
user sets the parameters to AUTO and then adjusts an upper or
lower screen parameter.
Note: The rate-dependent parameter values are immediately
updated on the screen and go into effect at the next appropriate
event when switching SETTING from AUTO to MANUAL, or
MANUAL to AUTO.

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Lower Screen
Menu 3 (Rapid Atrial Pacing)

DDD
320 ppm
RAP
80
Press
440
800
This Menu enables the Rapid Atrial Pacing (RAP) feature, but the
device continues to operate at the RATE, A OUTPUT, V OUTPUT, and
mode on the upper screen until the SELECT key is pressed.
SELECT
to DELIVER
RAPID ATRIAL
PACING
3
When Menu 3 is accessed, the RAP screen displays either:
the most recent RAP rate used, or
the nominal RAP rate of 320 ppm if RAP has not been used
since the device has been powered ON.
The RAP rate is displayed numerically and graphically, and can be

adjusted between or during RAP delivery by turning the
MENU PARAMETER dial.
When SELECT is pressed and held, the device waits a maximum of
two pacing cycles, then begins pacing asynchronously in the
atrium (AOO) at the selected RAP rate.
When SELECT is released, the device stops delivering RAP and
resumes operation at the non-RAP settings, within three seconds.
The device senses before pacing when resuming operation in a
demand mode.
A OUTPUT may be adjusted during RAP delivery. V OUTPUT is OFF
and not accessible during RAP delivery. V OUTPUT returns to its
previous value when SELECT is released.
3-28
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Lower Screen
Notes:
If the device should continue to deliver RAP after the SELECT

key is released, press OFF or EMERGENCY to stop RAP. Return
the device for service.
If A OUTPUT is OFF prior to RAP delivery, A OUTPUT is set to

10 mA when SELECT is pressed. In this case, A OUTPUT may be
adjusted during RAP delivery, but returns to OFF when
SELECT is released.
The backlight turns off 60 seconds after the last adjustment or

RAP delivery, but the upper screen parameters do not lock
and Menu 3 does not blank. Each time an upper dial or the
SELECT key is used, the backlight turns on again.
The upper screen parameters do not lock, and the lower

screen does not blank until five minutes after the last
adjustment or RAP delivery.
To exit Menu 3 (RAP) before five minutes have passed, press the
[
] key or the MENU key.

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Lower Screen
Menu M (Dial-A-Mode)
This Menu allows the user to select:
AAI
DDD
DIAL-A-MODE
DDDDVIDOOVVI
Press
SELECT
to ACTIVATE
DDD, DVI, DOO, or VVI pacing mode.
When the mode is underlined, the message to the left appears and
an arrow points to the SELECT key.
new Mode
M
Turn the MENU PARAMETER dial to underline the desired mode.
Press the SELECT key.
The new mode is activated within the next two cycles. The PACE
and SENSE LEDs, the Setup Indicators at the top of the upper
screen, and the NBG code at the top of the Menu screens reflect
this change.
The new mode will retain the current setting of all applicable
parameters of the previous mode, if no timing violations occur. If
timing violations occur, the rate-dependent parameters will be set
to automatic values (see Timing Violations on page 3-41).
Parameters that did not apply in the previous mode will be set to
nominal values in the new mode (see Pacing Mode Transitions
on page 3-40).
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Physical Features
Physical Features
Battery
Battery Drawer The battery drawer, located on the lower right
side of the device, accepts a standard 9-volt alkaline or lithium
battery (see Battery Type on page 7-5).
Battery Life Battery life is typically 9 days, minimally 7 days,
continuous operation for an alkaline battery or approximately
16 days continuous operation for a lithium battery, when RATE is
set at 70 ppm and all other parameters are at nominal values (see
Nominal Values on page 7-4).
Battery Drawer Release Button Press the button at the lower
end of the device to open the battery drawer.
Reversible Battery Polarity The polarity is marked inside the
battery drawer; however, the device will also function properly if
the battery is installed with the polarity reversed.
Continued Operation After Battery Removal If the battery is
removed, the device will continue to operate for 15 seconds,
typical (seeOperation After Battery Removal on page 7-5),
under the following conditions: RATE of 70 ppm or less, A OUTPUT
and V OUTPUT of 10 mA or less, backlight off, and lower
screen blank.
Note: If the battery is removed while the backlight is on or the
lower screen is active, the device may shut down immediately
depending upon the battery level.

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Physical Features
Connector Block
Located at the top end of the device, the connector block has
sockets which accept patient and surgical cables (Medtronic
Patient Cable Models 5433A and 5433V and Medtronic Surgical
Cable Models 5832 and 5832S). Chamber designations are marked
A for atrium and V for Ventricle. The sockets are also color-coded
blue for atrium and white for ventricle.
The connector block also has openings for the direct connection of
heartwires or leads from 0.38 mm to 2.28 mm (0.015 inch to
0.09 inch) in diameter and from 12.67 mm to 22.8 mm (0.5 inch to
0.9 inch) in length. These connector pin receptacles are covered
with removable rubber seals to minimize contamination.
Chamber designations are marked A for atrium and V for
ventricle. The receptacles are also color-coded blue for atrium and
white for ventricle.
Figure 3-2. The Model 5388 Connector Block.
3-32
Caution: The connector pin receptacles are to be used in

emergency situations only. They have no locking mechanism, so
the retention force within the receptacles varies with pin diameter
and length.
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Physical Features
Attachment Ring and Bails

The attachment ring and bails are located on the back of the
device. The ring is used to attach the device to an IV pole and the
bails are used to attach the device either to the patient or to the
bed. When not in use, both the ring and the bails fold flat against
the back of the device.
1
1.
Ring
2.
Bails
2
Figure 3-3. Ring and Bails on the Back Side of the Model 5388.

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Functional Features
Functional Features
Lock Feature
This safety feature is intended to prevent inadvertent adjustment
of the upper screen parameters RATE, A OUTPUT, and V OUTPUT.
When the upper screen is locked, turning the upper screen dials
does not change the upper screen parameter values.
The upper screen parameters will lock:
60 seconds after the last parameter adjustment has been

made, or
When the [
] key is pressed.
When the upper screen is locked, the backlight turns off and a
padlock [ ] appears in the upper right corner of the upper screen.
To UNLOCK RATE,
A OUTPUT, and
V OUTPUT,
If the upper dials are turned while the parameters are locked, the [ ]
remains on, the backlight illuminates, and a [ ] and a
flashing [
] appear in the center of the upper screen. The lower
screen displays the message to the left.
To unlock the upper parameters, press the [
] key.
Press
If no action is taken to unlock the upper screen, and no other dial

movements occur, the icons in the center of the upper screen
disappear, the lower screen blanks, and the backlight turns off.
When the upper screen unlocks, all lock indicators on the upper
screen disappear, the backlight illuminates, and the RATE,
A OUTPUT, and V OUTPUT values can be changed again by turning
the upper dials.
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Functional Features
Notes:
When the upper screen unlocks the backlight will not

illuminate if the low battery indicator is on.
If the ON, OFF, EMERGENCY/ASYNC., PAUSE, or MENU key is

pressed while the upper screen is locked, the upper screen
parameters will unlock. However, changes in device
operation and parameters may occur depending upon which
key was pressed (see page 3-4 through page 3-9).
Self-test
When the Model 5388 is turned on, the device takes approximately
four seconds to complete the power-on self-test and initialize the
screens. The self-test includes a check of the SELECT, OFF, PAUSE,
MENU, and LOCK keys, and critical internal circuits. The PACE and
SENSE LEDS light one at a time during the Power-on Self-test.
During the self-test, information in the display buffer from the
previous use of the device will appear on the upper display. This
information is cleared during screen initialization and nominal
values are restored.
Note: Pressing a key while the self-test is in process can cause the
Model 5388 to fail the self-test, and display error code, 0004. The
device may interpret the pressed key as being stuck and,
therefore, malfunctioning. If a key is pressed during the self-test,
remove and re-insert the battery to clear the error code. If the
self-test fails again, remove the battery and return the device to
Medtronic for service (see the addresses on the back cover of
the manual).
During screen initialization the low battery indicator may appear.
This does not indicate that the battery is low, unless the backlight
does not turn on and the indicator remains visible during
device operation.
Sensing begins after successful completion of the self-test. Pacing
begins approximately one second after sensing, if not inhibited by
a sensed event.

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Functional Features
Should the device fail the self-test, one of the PACE or SENSE LEDS
remains on and no output pulses are issued. Failure codes may be
displayed on the lower screen. Remove the battery and return the
device for service (see the addresses on the back cover of
the manual).
Note: Each time the MENU key is pressed the device checks the
SELECT key. If the SELECT key is found to be stuck, the menus will
not advance. Shut the device down by pressing OFF twice and
return the device for service.
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Functional Features
Blanking and Refractory Periods

Blanking Periods
Blanking is the interval following a paced or sensed event during
which the device sense amplifier is disabled.
Blanking following paced events lasts longer than blanking
following sensed events (see the specifications on Blanking on
page 7-4).
Refractory Periods
The refractory period is the interval during which a sensed event
does not affect pacing timing. However, an event sensed inside
refractory but outside blanking (i.e., a refractory sense) restarts
blanking and refractory periods (see the Pacemaker Diagnostic
Diagrams).
During refractory, a sensed event in the atrium causes the A SENSE
LED to flash. However, a refractory sensed event in the ventricle
does not cause the V SENSE LED to flash.
Atrial Refractory The two types of atrial refractory periods in
the Model 5388 are:
Atrial Refractory Period, which is initiated by an atrial sense

or pace, and
Post-Ventricular Atrial Refractory Period (PVARP), which is

initiated by a ventricular sense or pace.
Ventricular Refractory The Model 5388 uses one type of

ventricular refractory period:
Ventricular Refractory Period, which is initiated by a

ventricular pace or sense.

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Functional Features
Reversion Operation
This safety feature is designed to prevent inappropriate pacing
therapy during continuous interference, such as noise or
arrhythmias. When sensed events are continuously detected by
the pacemaker, the device reverts to predetermined modes until
the interference stops.
This response occurs when refractory sensed events are
continuously detected.
In single-chamber pacing, continuous refractory sensing will
cause AAI to revert to AOO, and VVI to revert to VOO.
In dual-chamber pacing, continuous refractory sensing in the
atrium causes the device to inhibit atrial pacing pulses.
Continuous refractory sensing in the ventricle causes the device to
pace asynchronously in the ventricle.
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Functional Features
Ventricular Safety Pacing

This feature is intended to prevent improper inhibition of
ventricular pacing pulses if a non-ventricular event (e.g., crosstalk, noise) is sensed by the ventricular lead. This feature functions
when the device is operating in a mode that senses and paces in
the ventricle, and paces in the atrium (DVI, DDI, and DDD).
If a ventricular sensed event is detected outside the 20 ms
blanking window, but within 110 ms after an atrial paced event, a
ventricular safety pacing (VSP) pulse is delivered 110 ms after the
atrial pace if the A-V INTERVAL is greater than 110 ms. The
ventricular pacing pulse is delivered at the A-V INTERVAL if the
A-V INTERVAL is less than 110 ms (see Pacemaker Diagnostic
Diagrams). The V PACE LED and the V SENSE LED flash within
15 ms of each other.
Wenckebach Response
In DDD mode, when the intrinsic atrial rate increases beyond the
UPPER RATE, the device continues to lengthen the SAV interval
until a P-wave falls within the PVARP, and thus is not sensed.
Because the P-wave is not sensed, the SAV interval is not started,
and a ventricular pace is not issued.

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Functional Features
Pacing Mode Transitions

The Model 5388 switches modes in accordance with the
following guidelines:
3-40
When switching from an atrial-only mode to a mode

involving an A-V Interval (which could be as short as 20 ms),
the first ventricular pacing pulse will be inhibited to avoid
pacing into a T-wave.
A complete cycle of the current mode is allowed to expire

before implementing a new mode.
The device senses before pacing when switching from an

asynchronous mode to a synchronous mode.
UPPER RATE is implemented immediately after switching to

DDD mode.
Parameters that did not apply in the previous mode will be set
to nominal (or rate-dependent) values in the new mode.
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Timing Violations
Timing Violations
If the relationship between two or more parameters reaches a
point where improper pacing could occur, further change in the
conflicting direction is prevented.
A summary of the timing violations not allowed by the
5388 follows.
Mode Changes
During a mode change, if one or more of the rate-dependent
parameters was manually set in the previous mode to a value
that will cause improper pacing to occur in the new mode, then
the device changes the parameter to its automatic,
rate-dependent setting.
Parameter Adjustments
During adjustments of the rate-dependent parameters, if the user
tries to set the parameters to values that violate timing rules, a
warning message will overwrite the Menu and stay on for 10
seconds (see the following paragraphs for the specific messages).
During those 10 seconds, either:
Adjust the RATE, or
Press the MENU key to activate Menu 2 and adjust the ratedependent parameter or set the device to automatic settings,
using SETTING (see SETTING on page 3-27).
After 10 seconds, if no adjustments are made, the message will

disappear, the lower screen will remain blank, and the device will
continue operating at the selected values.

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Timing Violations
UPPER RATE vs. SAV and PVARP

WARNING
Pacemaker block
point reached.
The total atrial refractory period (TARP), which is

SAV Interval + PVARP, cannot be longer than the Upper Rate
Interval, or the device will reach the 2:1 block point before being
limited by the UPPER RATE. This condition is prevented by the
following formula:
Adjust RATE or
parameters
on Menu 2.
SAV Interval + PVARP < UPPER RATE Interval

During manual adjustment of RATE, or the rate-dependent
parameters, the device will limit adjustment at the block point and
display the warning message to the left.
Minimum V-A interval

WARNING
Pacemaker block
point reached.
Adjust RATE or
parameters
on Menu 2.
The minimum V-A interval required by the Model 5388 when

operating in DOO mode is 70 ms. This condition is preserved
using the following formula:
A-V INTERVAL
+ 70 ms RATE Interval
The minimum V-A interval required by the Model 5388 when

operating in DVI mode is 180 ms. This condition is preserved
using the following formula:
A-V INTERVAL
+ 180 ms RATE Interval
During manual adjustment of RATE, or the rate-dependent

parameters, the device will limit adjustment at the block point and
display the warning message to the left.
Note: This limit only occurs in DVI or DOO mode. In DDD and
DDI modes the RATE vs. A-V INTERVAL and PVARP block point
maintains the 180 ms minimum.
3-42
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Timing Violations
RATE versus A-V INTERVAL and PVARP

A window must be provided in dual-chamber modes for atrial
sensing. The formula used to allow for this window is:
WARNING
Pacemaker block
point reached.
A-V INTERVAL
+ PVARP + 30 ms RATE Interval
If the RATE is increased after the rate-dependent parameters have

been manually adjusted, the device will limit increase of the RATE
at the block point and display the warning message to the left.
Adjust RATE or
parameters
on Menu 2.
Turn the RATE down, or access Menu 2 and adjust the manually set
parameter, or set the device to automatic using SETTING (see
SETTING on page 3-27).
RATE versus UPPER RATE

The RATE and UPPER RATE can be set to the same value. However,
the RATE cannot be set higher than the UPPER RATE, nor can the
UPPER RATE be set lower than the RATE.
WARNING
RATE cannot
exceed UPPER
RATE.
If the user tries to set the RATE above the UPPER RATE or vice versa,
then the message to the left appears in the lower screen:
Adjust RATE or
UPPER RATE
on Menu 2.
Turn the RATE down, or access Menu 2 and increase UPPER RATE or
set UPPER RATE to automatic, using SETTING (see SETTING on
page 3-27).
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Timing Violations
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Preparation for Use
Warning: Properly ground all line-powered

equipment used on or in the vicinity of the patient (see
Warnings on page 2-2).
Caution: Monitor the patients ECG and blood
pressure and keep defibrillation equipment on
standby, immediately available for emergency use
during pacing lead insertion and
pacemaker connection.
Battery Installation 4-2

Disposable Pouch
Cables
4-3
4-4
Connector Setup
4-6

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Preparation for Use

Battery Installation
Battery Installation
To install (or replace) the battery, press the battery drawer release
button until the battery drawer opens (see Figure 4-1). Remove
the old battery and replace it with a new 9-Volt type 6LR61 or
type 6F22E, or NEDA 1604A (Eveready 522 or equivalent)
alkaline battery or a NEDA 1604LC (Ultralife U9VL or equivalent)
lithium battery. Make sure the drawer clicks shut.
Note: Use of other than the recommended batteries may result in
one of the following conditions: (1) less than 24 hours of operation
after the low-battery indicator comes on, (2) degraded pacemaker
performance, and/or (3) overall reduced battery life.
Caution: Use of batteries with different physical dimensions from

that of the recommended batteries may result in erratic, or no,
pacing output.
Note: Medtronic does not recommend replacing the battery while
the pacemaker is turned on.
Note: The battery should be removed when the device is stored
for extended intervals.
NT
ZX.
Figure 4-1. Press battery drawer release button.
4-2
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Preparation for Use

Disposable Pouch
Disposable Pouch
Description
The Model 5409 Disposable Pouch is designed to protect and hold
the Model 5388 Temporary Pacemaker. The pouch consists of a
see-through plastic pocket mounted on an attachment panel. The
pouch should be disposed of after one patient use. The pouch
can be hung from an IV stand, secured to the patient or the
patients bed (Figure 4-2.1), or secured to an ambulatory patient
with the addition of velcro straps (Figure 4-2.2), which may be
ordered from Medtronic (see the Medtronic Instrument
Accessories catalog).
PACE
A SENSE
PACE
PACE
V SENSE
SENSE
SELECT
MENU
EMERGENCY
PAUSE
A S Y NC
OFF
ON
MEDTRONIC 5388
Dual Chamber
Temporary Pacemaker
Figure 4-2. The Model 5409 Disposable Pouch.
Procedure for Use

Insert the temporary pacemaker into the pouch, bottom end first,
with the front of the pacemaker facing away from the attachment
panel. Fold the flip-over top over itself to secure the temporary
pacemaker in the pouch. Insert the patient cable connector plugs
through the slits in the pouch and insert them into the
temporary pacemaker.
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Preparation for Use

Cables
Cables
Medtronic Models 5433A and 5433V
Patient Cables
The Patient Cable Models 5433A and 5433V are designed to
connect atrial and ventricular pacing lead systems to the
Medtronic Model 5388 Temporary Pacemaker for temporary,
external pacing.
The Patient Cable Models 5433A and 5433V have recessed, nonexposed pins. They are reusable, supplied non-sterile, and should
be sterilized prior to use, using either steam (reliable up to
25 autoclave cycles) or ethylene oxide (see Sterilization on
page 6-3).
The lead connector assembly at one end of each cable accepts
endocardial or myocardial pacing lead connector pins 0.38 mm to
2.41 mm (0.015 inch to 0.095 inch) in diameter. The terminal
connector at the other end of each cable is designed to mate with
the output terminal on the Model 5388 pacemaker.
Do not expose the cables to storage temperatures above
66C (150F) or below -40C (-40F).
4-4
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Preparation for Use

Cables
The two cables are identical except for color coding and markings:
The Model 5433A, for atrial use, has a blue connector block
and blue band around the terminal pin block. One side of the
connector block carries a symbol denoting Atrial Use (see
Figure 4-3.1).
The Model 5433V, for ventricular use, has a white connector

block and white band. One side of the connector block carries
a symbol denoting Ventricular Use (see Figure 4-3.2).
1
1.
Atrial Use
2.
Ventricular Use
Figure 4-3. The Model 5433A Atrial Use symbol and the Model 5433V
Ventricular Use symbol.

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Preparation for Use

Connector Setup
Connector Setup
Connecting or disconnecting the
Model 5433A or 5433V Patient Cable to
or from the Model 5388
w
Warning: Connect the patient cable to the temporary pacemaker

before connecting the leads to the patient cable.
Caution: Do not hang the Model 5388 by the cables. The

attachment ring or bails should be used when mechanical support
of the pacemaker is necessary.
Notes:
The Patient Cable Models 5433A and 5433V are supplied

non-sterile. They should be cleaned and sterilized according
to the instructions in Chapter 6 (see Cleaning on page 6-3).
Carefully inspect the patient cable for visible signs of wear

or damage.
To connect the cable to the Model 5388:

With the Model 5388 pacemaker turned off, fully insert the
appropriate (atrial or ventricular) patient cable connector
plug into the appropriate Model 5388 connector receptacle
(marked A or V) until it clicks (see Figure 4-4).
Note: The click verifies that the plug is completely inserted
into the receptacle. Pull gently on the plug after insertion to
ensure a good connection.
4-6
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Preparation for Use

Connector Setup
Figure 4-4. Connecting the Model 5433A or 5433V Patient Cable to the
Model 5388 Temporary Pacemaker.
To disconnect the cable from the Model 5388:

1. To disconnect the patient cable from the device, press the
connector release button on the patient cable plug (see
Figure 4-5).
Figure 4-5. Disconnecting the Model 5433A or Model 5433V Patient

Cable from the Model 5388 Temporary Pacemaker.
2. Gently pull the plug from the receptacle.
Caution: It is important to keep hands and gloves free of blood

and body fluids while connecting or disconnecting the
Model 5433A or 5433V patient cable and/or pacing leads to the
Model 5388 pacemaker to avoid contaminating difficult to
clean areas.

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Preparation for Use

Connector Setup
Connecting the Pacing Lead System to the

Model 5433A or 5433V Patient Cable
Note: Carefully inspect the leads for visible signs of wear
or damage.
1. Loosen the patient cable connector knobs by twisting each
knob counterclockwise until resistance is felt.
2. Insert the lead connector pins into the patient cable
receptacles as shown (see Figure 4-6). It is important to
connect each lead system to the appropriate patient cable
(atrial or ventricular).
For bipolar systems Insert each connector pin into the
appropriate receptacle (marked + and ). Bipolar lead
systems may exhibit different threshold values depending on
the polarity of the lead connections.
3. Finger tighten each terminal knob clockwise until snug.
Gently pull on each lead conductor to verify a
secure connection.
Caution: Bipolar lead systems are recommended over unipolar

systems because they are less susceptible to electromagnetic
interference (see Bipolar Lead Systems and Unipolar Lead
Systems on page 2-6).
For unipolar systems
One lead system (single chamber) Insert the cardiac lead
connector pin into the negative () receptacle of the cable.
Insert the connector pin of the indifferent electrode (or
ground) into the positive (+) receptacle of the cable.
Two lead systems (dual chamber) Insert the connector pin of
each cardiac lead into the negative () receptacle of the
appropriate cable. Insert the connector pin of the indifferent
electrode into the positive (+) receptacle of one patient cable.
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Preparation for Use

Connector Setup
Then connect the indifferent electrode to the positive

receptacle of the other patient cable, using a jumper cable.
Note: Failure to use a jumper cable will result in no pacing
or sensing in the chamber not jumpered to the
indifferent electrode.
Figure 4-6. Connecting the pacing lead system to the Model 5433A or
5433V Patient Cable receptacles.

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Preparation for Use

Connector Setup
Connecting the Pacing Lead System

Directly to the Model 5388 Pacemaker
w
Warning: Do not connect heartwires or leads directly to the

Model 5388 except in emergency situations.
Caution: There is no locking mechanism within the connector pin

receptacles to hold connector pins securely in place; consequently,
use the Model 5433A or 5433V patient cable whenever possible
(see Connecting the Pacing Lead System to the Model 5433A or
5433V Patient Cable on page 4-8).
Caution: The connector pins must be at least 12.67 mm

(0.5 inches) in length.
Caution: It is recommended that exposed pins and wires be

covered to prevent contact with each other, or with electrically
conductive or wet surfaces.
1. Remove each connector pin receptacle seal by gripping the
rubber handle and pulling it away from the device.
Figure 4-7. Removing the connector pin receptacle seals.
2. Push the connector pins into the holes on the connector block
as shown (see Figure 4-8).
Caution: DO NOT insert the pins into the receptacle for the
patient cable.
For bipolar systems Insert each pin into the proper
receptacle (marked + and ) of the appropriate chamber
(marked A or V). Bipolar lead systems may exhibit
4-10
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Preparation for Use

Connector Setup
different threshold values depending on the polarity of the

lead connections.
Figure 4-8. Connecting connector pins directly to the Model 5388.
Caution: Bipolar lead systems are recommended over unipolar

systems because they are less susceptible to electromagnetic
interference (see Bipolar Lead Systems and Unipolar Lead
Systems on page 2-6).
3. To remove the pins, simply pull them out.
Caution: It is important to keep hands and gloves free of blood

and body fluids while connecting or disconnecting the temporary
pacing leads to the Model 5388 pacemaker to avoid contaminating
difficult to clean areas.

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Preparation for Use

Connector Setup
4-12
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User Guide
Overview
Indicators
5-2
5-4
Basic Operation
5-6
Connector Setup
5-17
Pacing Parameter
Adjustments 5-19
Thresholds 5-27
Pacing Setup 5-35
RAP (Rapid Atrial
Pacing) 5-39
Battery Replacement
5-41
Tables 5-43

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User Guide
Overview
Overview
Features
5-2
Single chamber pacing AOO, VOO, AAI, VVI
Dual chamber pacing DDD, DDI, DVI, DOO
Easy-to-view rate and output settings
Easy-to-view setup indicators show in which chamber(s)

the device is set to pace and/or sense.
Pace and sense indicators show pacemaker interaction with

the heart
Low battery indicator indicates when to replace the battery
Three dial operation provides therapy for most

patient needs
Rate-dependent parameters rate adjustment automatically

sets Upper Rate, PVARP, and A-V Interval
LOCK/UNLOCK key safeguards against unintentional

parameter changes
Lower screen messages aid in device operation
Menu screens for adjusting additional parameters,

including sensitivity, rate-dependent parameters; for
RAP (Rapid Atrial Pacing); and for directly selecting four
modes: DDD, DVI, DOO and VVI
PAUSE key suspends pacing and sensing so patients

intrinsic rhythm can be viewed
EMERGENCY key starts dual chamber asynchronous (DOO)

pacing at maximum output
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User Guide
Overview
What is Dual Chamber Pacing?

A pacemaker is able to sense the hearts electrical activity and
determine if it is necessary to stimulate the heart to contract or
beat. A dual chamber pacemaker has the ability to sense and
pace in both chambers of the heart the atrium and the ventricle.
The Medtronic Model 5388 Temporary Pacemaker is a dual
chamber temporary pacemaker. When first turned on, it senses the
hearts intrinsic activity. If it senses normal contractions in the
atrium or ventricle, pacing is inhibited. If it senses no intrinsic
activity in a chamber, pacing occurs in that chamber.

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Indicators
Indicators
Pace/Sense LEDs
Low Battery
Indicator
A +V
A +V
DDI
30
RATE
DDI Indicator
80
120
Setup
ppm
Indicators
Padlock Icon
200
Figure 5-1. Indicators.
Pace/Sense LEDs
One set of pace/sense LEDs is for the atrium; the other for the
ventricle. The green pace LED flashes each time the device
delivers a pacing stimulus. The orange sense LED flashes each
time the device senses the patients heartbeat.
Setup Indicators
The setup indicators identify in which chamber(s) the device is
setup to pace and in which chamber(s) the device is setup to sense
,
A
V , or A +V .

When the battery voltage is low, the low battery indicator appears
and the backlights do not turn on.
When the low battery indicator appears during device operation,
the battery should be replaced as soon as possible. (The device
operates adequately for approximately 24 hours after the low
battery indicator first appears.)
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Indicators
DDI Indicator
This indicator appears while the device is pacing in the DDI mode.
When the device is in DDD mode (dual chamber pacing and
sensing), manually turning off A (Atrial) TRACKING changes the
mode to DDI.
Lock Indicator
The padlock icon appears when the three upper dials are locked,
indicating that RATE and OUTPUT cannot be adjusted. If you turn
the RATE, A OUTPUT, or V OUTPUT dial, the upper screen displays
another padlock symbol along with a flashing key symbol. The
lower screen displays a message that tells you how to unlock the
upper dials for RATE and OUTPUT.

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Basic Operation
Basic Operation
On/Off
ASYNC.
Dual Chamber
Temporary Pacemaker
Figure 5-2. On/Off.
When you press the ON key, the pacemaker performs a power-on

self-test that lasts about four seconds.
If the battery voltage is low, the battery indicator appears and

the backlights do not turn on.
If the device fails the self-test, the device remains on but does
not pace.
If the device passes the self-test, the upper and lower screens
initialize, the backlights turn on, and dual chamber pacing
and sensing begin at these nominal values:
Table 5-1. Nominal Values at Power-On.
RATE
80 ppm
A-V INTERVAL
170 ms
A OUTPUT
10 mA
A SENSITIVITY
0.5 mV
V OUTPUT
10 mA
V SENSITIVITY
2.0 mV
UPPER RATE
110 ppm
Note: During the self-test, information in the display buffer from

the previous use of the device will appear on the upper display.
This information is cleared during screen initialization and
nominal values are restored.
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User Guide
Basic Operation
To Turn Device On
Press the ON key.
Note: Pressing the EMERGENCY key also turns the device on.
To Turn Device Off

Press the OFF key twice within five seconds.
Note: After you press OFF the first time, the following
message appears on the lower screen as a reminder to press
the OFF key a second time within five seconds.
To SHUT DOWN,
Press OFF again.
Figure 5-3. Device Shut-Down Message.

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Basic Operation
Emergency Pacing
Pressing the EMERGENCY key initiates high output dual chamber
asynchronous pacing at these parameter values:
Table 5-2. Emergency Pacing Values.
Current setting
(or 80 ppm) if
device is off
when
RATE
A-V INTERVAL
Current setting
(or 170 ms if
device is off
when
EMERGENCY
EMERGENCY
key is pressed)
key is pressed)
A OUTPUT
20 mA
A SENSITIVITY
ASYNC.
V OUTPUT
25 mA
V SENSITIVITY
ASYNC.
To Initiate Emergency Pacing

ASYNC.
Dual Chamber
Temporary Pacemaker
Figure 5-4. Emergency.
Press the EMERGENCY key (device may be on or off).

Note: Press the ON key to resume dual chamber demand
(synchronous) pacing:
RATE, A OUTPUT, and V OUTPUT will remain at the values

displayed at the time that ON is pressed.
A SENSITIVITY
and V SENSITIVITY will return to the

nominal values.
Note: Regardless of which mode the device was

operating in before Emergency pacing, pressing the ON
key during Emergency, DOO mode, pacing sets the device
to DDD mode pacing. If necessary, adjust the parameters
to set the device to a different mode.
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Basic Operation
Lock/Unlock
The LOCK/UNLOCK key locks and unlocks the three upper dials.
When the upper dials are locked, the padlock icon appears and the
rate, atrial output, and ventricular output cannot be adjusted.
Also, the screen backlight is turned off.
A +V A +V
30
80
120
RATE
200
ppm
Figure 5-5. Lock/Unlock.
Press the LOCK/UNLOCK key to unlock the upper dials before

adjusting rate or output.
Press the LOCK/UNLOCK key to lock the upper dials after
adjusting rate, output, and other pacing parameters.
Notes:
To prevent unintentional parameter changes, the upper

dials automatically lock 60 seconds after the last
parameter adjustment.
The ON, OFF, MENU, EMERGENCY, and PAUSE keys also

unlock the upper dials.
The lock icon and flashing key icon appear in the middle
of the screen if dials are turned while the upper screen
is locked.
Viewing the Patients Intrinsic Rhythm

The recommended method for viewing the patients intrinsic
rhythm is to reduce the pacing rate. Another option, however, is
to use the PAUSE key.

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Basic Operation
To Pause
ASYNC.
Dual Chamber
Temporary Pacemaker
Figure 5-6. Pause.
Press and hold the PAUSE key.

Pacing and sensing are suspended for ten seconds unless you
release the PAUSE key sooner.
Note: To pause up to ten seconds again, release the PAUSE key;
then press and hold the PAUSE key again. (This is a
safety feature.)
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Basic Operation
Rate and Output Adjustments

80
30
120
RATE
OFF
0.1
10
20
A OUTPUT
OFF
0.1
200
ppm
10
V OUTPUT
mA
20
25
mA
Figure 5-7. Rate and Output.
The upper dials are used to adjust the pacing rate (ppm), atrial
output (mA), and ventricular output (mA). The upper screen
displays a numerical value and segmented line graph that reflects
the current setting for each dial.

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Basic Operation
To Adjust Rate
Turn the RATE dial clockwise to increase the rate;
counterclockwise to decrease the rate.
Rate range: 30 ppm to 200 ppm
Note: When the rate is set higher than 120 ppm, the bar size
on the segmented line graph gets taller and thicker.
To Adjust Atrial Output

Turn the A OUTPUT dial clockwise to increase atrial output;
counterclockwise to decrease atrial output or set to OFF.
Atrial output range: 0.1 mA to 20 mA
To Adjust Ventricular Output

Turn the V OUTPUT dial clockwise to increase ventricular
output; counterclockwise to decrease ventricular output or
set to OFF.
Ventricular output range: 0.1 mA to 25 mA
Note: When V OUTPUT is set higher than 20 mA, the bar size
on the segmented line graph gets taller and thicker and the
HIGH OUTPUT icon appears.
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Basic Operation
Demand Pacing
During demand (synchronous) pacing, output is inhibited when
the pacemaker senses intrinsic activity. This minimizes
competition between the paced rhythm and the intrinsic activity
of the heart.
Note: Be sure to determine sensitivity thresholds (see page 5-28),
or asychronous pacing may occur.
When the device is off, pressing the ON key immediately initiates
dual chamber demand pacing. To quickly change from dual
chamber to single chamber demand pacing, set either A OUTPUT or
V OUTPUT to OFF.
To Set To Dual Chamber Demand Pacing

1. Check the Setup Indicators. If they are A +V A +V , skip to
step 3, as the device is already setup to pace and sense in
both chambers.
2. Turn A OUTPUT and V OUTPUT on.
If sensing is off in both chambers, press ON twice to resume
dual chamber demand pacing.
Pacing and sensing occurs in both chambers.
0.5 mV, and V SENSITIVITY is 2.0 mV.
A SENSITIVITY is
If sensing is off in only one chamber, refer to Sensitivity on

page 5-21.
3. Turn the A OUTPUT and V OUTPUT dials to adjust output to
appropriate values.
Resulting Setup Indicators: A +V A +V

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Basic Operation
To Set To Demand Pacing In The Atrium

1. Verify the Setup Indicators are A +V A +V . These indicate
the device is setup to pace and sense in both chambers.
2. Turn the V OUTPUT dial counterclockwise until OFF
is highlighted.
Pacing and sensing occur only in the atrium.
Resulting Setup Indicators: A
To Set To Demand Pacing In The Ventricle

1. Verify the Setup Indicators are A +V A +V . These indicate
the device is setup to pace and sense in both chambers.
2. Turn the A OUTPUT dial counterclockwise until OFF
is highlighted.
Pacing and sensing occur only in the ventricle.
Resulting Setup Indicators:
Note: When A OUTPUT or V OUTPUT is turned back on, sensitivity

returns to the nominal value.
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Basic Operation
Asynchronous Pacing
Patients best suited for asynchronous (non-sensing) modes have:
An intrinsic rate consistently below the pacing rate.

or
No intrinsic activity.
Caution: Because it may compete with the intrinsic activity of the

heart, asynchronous pacing may result in tachyarrhythmia. Use
caution when setting the device to asynchronous modes.
Pressing the EMERGENCY key immediately initiates dual chamber
asynchronous pacing. To quickly set the device to single chamber
asynchronous pacing, press the EMERGENCY key and turn either
A OUTPUT or V OUTPUT to OFF.
To Set To Dual Chamber Asynchronous Pacing

1. Press the EMERGENCY key.
The ASYNCHRONOUS PACING message appears.
2. Adjust A OUTPUT and V OUTPUT to provide adequate safety
margins to assure capture.
Pacing occurs in the atrium and ventricle. No sensing occurs.
Resulting Setup Indicators: A +V

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Basic Operation
To Set To Asynchronous Pacing In The Atrium

2. Turn the V OUTPUT dial counterclockwise until OFF
is highlighted.
Pacing occurs only in the atrium. No sensing occurs.
3. Adjust A OUTPUT to provide an adequate safety margin.
Resulting Setup Indicators: A
To Set To Asynchronous Pacing In The Ventricle

2. Turn the A OUTPUT dial counterclockwise until OFF
is highlighted.
Pacing occurs only in the ventricle. No sensing occurs.
3. Adjust V OUTPUT to provide an adequate safety margin.
Resulting Setup Indicators:
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Connector Setup
Connector Setup
Model 5832
Model 5433A/
5433V
Figure 5-8. Cables.
Notes:
Connect the cable to the temporary pacemaker before

connecting the lead system to the cable.
Do not connect the Model 5388 to the lead system if the Model
5388 is turned on and is operating at an output amplitude that
could cause capture.
1. Plug the Model 5433A and Model 5433V patient cables into
appropriate sockets at the top end of device (see Figure 5-9).
or
Plug a pair of Model 5832 or Model 5832S surgical cables into
appropriate sockets at the top end of device (see Figure 5-9).
One socket is marked A (atrium); the other V (ventricle).
Note: To disconnect cable from the device, press connector release
button on cable and pull gently from socket.

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Connector Setup
Figure 5-9. Cable to Device Connections.
2. Connect leads/heartwires to the appropriate cable. Match

positive (+) and negative () leads to positive (+) and
negative () sockets or clips for the atrium and ventricle
(not shown).
Figure 5-10. Emergency Connections.
In an emergency and in the absence of patient or surgical

cables, temporary pacing leads or heartwires plug directly
into the four smaller sockets (two for the atrium; two for the
ventricle) at the top end of device (see Figure 5-10).
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Caution: These are not the primary connector setup

methods because there is no locking mechanism for
the connection.
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Pacing Parameter Adjustments

Menus allow you to manually adjust pacing parameters. The
parameters displayed on menus are based on the currently
programmed pacing mode, rate, and output. Parameters not
selectable are dimmed (i.e., grayed-out) on the menu screen.
The MENU key activates the lower screen and allows you to
page through the four menus listed here (see Figure 5-11):
Menu 1
A Sensitivity/V Sensitivity/A-V Interval/A Tracking
Menu 2
Upper Rate/PVARP/A-V Interval/

SETTING (AUTO-MANUAL)
Menu 3
Rapid Atrial Pacing (RAP)
Menu M
Dial-a-Mode
The SELECT key allows you to scroll through and select

parameters displayed on each menu.
The MENU PARAMETER dial allows you to adjust the value of

the selected parameter.

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DDD
DDD
A Sensitivity
0.5 mV
80
V Sensitivity
10
20
2.0 mV
155
170 mS
A Tracking
ON
300 mS
A-V Interval
170 mS
SETTING
Menu 1:
Pacing Parameters
DDD
Menu 2:
Rate-Based
Pacing Parameters
AAI
320 ppm
RAP
440
Press
230
PVARP
0.8
A-V Interval
80
110 ppm
Upper Rate
800
SELECT
to DELIVER
DOO
DIAL-A-MODE
DDDDVIDOOVVI
Press
SELECT
to ACTIVATE
RAPID ATRIAL
PACING
3
new Mode
M
Menu 3:
Rapid Atrial Pacing
Menu M:
Dial-A-Mode
Figure 5-11. Lower Screen Menus.
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Sensitivity
DDD
A Sensitivity
0.5 mV
V Sensitivity
2.0 mV
20
10
0.8
A-V Interval
170 mS
A Tracking
ON
SELECT
MENU
Figure 5-12. Sensitivity.
To Adjust Atrial/Ventricular Sensitivity

1. Press the MENU key until Menu 1 is displayed.
2. Press the SELECT key until A SENSITIVITY or V SENSITIVITY
is highlighted.
3. Turn the MENU PARAMETER dial clockwise to increase
sensitivity (decrease numerical value); counterclockwise to
decrease sensitivity (increase numerical value). Turn the dial
all the way counterclockwise to reach ASYNC (no-sensing).
Atrial sensitivity range: 0.4 mV - 10 mV and ASYNC.
Ventricular sensitivity range: 0.8 mV - 20 mV and ASYNC.

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Notes:
Setting A SENSITIVITY to ASYNC turns atrial sensing off and

starts asynchronous pacing in the atrium.
Setting V SENSITIVITY to ASYNC turns ventricular sensing off

and starts asynchronous pacing in the ventricle.
The highest number (in mV) for A SENSITIVITY or V SENSITIVITY

is the least sensitive setting; the lowest number (in mV) is the
most sensitive setting.
A SENSITIVITY and V SENSITIVITY are not selectable (grayed-out)
if the corresponding A OUTPUT or V OUTPUT is OFF.
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Rate-Dependent Parameters
UPPER RATE, PVARP,
and A-V INTERVAL are automatically set

whenever RATE is adjusted, or can be manually adjusted from
Menu 2. Adjusting RATE does not change the UPPER RATE, PVARP,
or A-V INTERVAL if these values were manually adjusted from
Menu 2.
To Adjust Upper Rate

2. Press the SELECT key until UPPER RATE is highlighted.
3. Turn the MENU PARAMETER dial clockwise to increase the
upper rate; counterclockwise to decrease the upper rate.
*MANUAL
DDD
*106 ppm
Upper Rate
80
155
230
PVARP
300 mS
A-V Interval
170 mS
SETTING
MANUAL
2
Figure 5-13. Upper Rate.

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To Adjust PVARP
2. Press the SELECT key until PVARP is highlighted.
3. Turn the MENU PARAMETER dial clockwise to lengthen the
PVARP; counterclockwise to shorten the PVARP.
DDD
*MANUAL
*106 ppm
Upper Rate
*310 mS
PVARP
150
325
A-V Interval
SETTING
500
170 mS
MANUAL
Figure 5-14. PVARP.
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To Adjust A-V Interval

1. Press the MENU key until Menu 1 or 2 is displayed.
2. Press the SELECT key until A-V INTERVAL is highlighted.
3. Turn the MENU PARAMETER dial clockwise to lengthen the
A-V INTERVAL; counterclockwise to shorten the A-V INTERVAL.
*MANUAL
DDD
Upper Rate
*106 ppm
PVARP
*310 mS
*200 mS
A-V Interval
20
160
SETTING
300
MANUAL
2
Figure 5-15. A-V Interval.

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To Reset Rate-Dependent Values To

Automatic Settings
2. Press the SELECT key until SETTING is highlighted.
3. Turn the MENU PARAMETER dial clockwise to display AUTO.
DDD
Upper Rate
110 ppm
PVARP
300 mS
A-V Interval
170 mS
SETTING
AUTO
MANUALAUTO
2
Figure 5-16. Resetting to Automatic Values.
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Thresholds
Thresholds
Threshold values are needed to determine the appropriate
settings for output and sensitivity. Procedures for finding atrial
and ventricular sensing and stimulation thresholds are presented
in this section.
Note: To reduce the risk of competitive pacing, find the sensing
thresholds first (if the patients intrinsic rhythm is adequate).
Sensing Definitions
The ECG below shows intrinsic beats mixed with paced beats. The
pacemaker detects the hearts own beat and does not deliver a
pacing stimulus.
Figure 5-17. Sensing.
The ECG below shows one example of undersensing. The

pacemaker does not detect intrinsic activity and thus paces on or
between beats.
Figure 5-18. Atrial Undersensing.

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Thresholds
Sensing Threshold
The sensing threshold is the least sensitive setting at which the
pacemaker can detect a heartbeat. Monitor the patients ECG and
blood pressure as you follow the procedure to find the atrial and
ventricular sensing thresholds.
Safety Margin
Lead maturation and drug therapy can affect the threshold. To
ensure sensing and accommodate a changing threshold, it is
important to provide at least a 2:1 safety margin. Set
A SENSITIVITY/V SENSITIVITY to a value that is at least one-half to
one-third the sensing threshold value. For example, an
appropriate setting for a patient with a 5.0 mV sensing threshold
is 2.5 mV or less.
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Thresholds
To Find Atrial or Ventricular Sensing

Thresholds
Caution: Pacing-dependent patients will have limited or no
intrinsic rate/rhythm. This procedure should be used only on
patients with adequate intrinsic rhythm.
80
30
120
RATE
OFF
0.1
10
20
A OUTPUT
OFF
0.1
200
ppm
10
mA
20
V OUTPUT
25
mA
Figure 5-19. Decrease Rate and Output.
1. Turn on the temporary pacemaker without connecting it to

the patient lead system.
Caution: Do not connect the temporary pacemaker to the
patient lead system before step 4.
2. Set RATE at least 10 ppm below patients intrinsic rate.
This adjustment ensures non-pacing.
3. Atrial: Set A OUTPUT to 0.1 mA.
or
Ventricular: Set V OUTPUT to 0.1 mA.
This adjustment prevents the risk of competitive pacing.
4. Connect the temporary pacemaker to the patient lead system.

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Thresholds
6. Atrial: A SENSITIVITY is highlighted.

or
Ventricular: Press the SELECT key to highlight V SENSITIVITY.
DDD
A Sensitivity
0.5 mV
V Sensitivity
2.0 mV
20
10
0.8
Figure 5-20. Decrease Sensitivity.
7. Decrease SENSITIVITY: Slowly turn the MENU PARAMETER dial

counterclockwise (increase mV value) until the sense
indicator stops flashing.
The pace indicator flashes continuously, but capture is not likely
because the output value is at minimum.
DDD
A Sensitivity
0.5 mV
V Sensitivity
2.0 mV
20
10
0.8
Figure 5-21. Increase Sensitivity.
8. Increase SENSITIVITY: Slowly turn the MENU PARAMETER dial

clockwise (decrease mV value) until the sense indicator
starts flashing.
The pace indicator stops flashing.
This value is the sensing threshold.
9. Set SENSITIVITY to half (or less) the threshold value.
This setting provides at least a 2:1 safety margin.
10. Restore RATE, A OUTPUT, or V OUTPUT to previous values.
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Thresholds
Capture Definitions
When a pacing pulse captures the heart, it causes the heart to
beat that is, contract and pump blood. The ECG shows a P-wave
or QRS complex after the pulse, as in the example shown here:
Figure 5-22. Capture.
When capture is lost, the ECG shows no heart response after the
pulse, as in the example shown here:
Figure 5-23. Loss of Ventricular Capture.

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Thresholds
Stimulation Threshold
The stimulation threshold is the minimum output (mA) needed to
consistently capture the heart. Monitor the patients ECG and
blood pressure as you follow the procedure to find the atrial and
ventricular stimulation thresholds.
Safety Margin
Lead maturation and drug therapy can affect the threshold. To
achieve consistent capture and accommodate a changing
threshold, it is important to provide at least a 2:1 safety margin. Set
A OUTPUT/V OUTPUT to a value at least 2 to 3 times greater than the
stimulation threshold value. For example, the appropriate output
setting for a patient with a 1.0 mA threshold is 2.0 mA or greater.
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Thresholds
To Find Atrial or Ventricular

Stimulation Thresholds
80
30
120
RATE
OFF
0.1
200
ppm
10
20
A OUTPUT
mA
Atrial or
Ventricular
OFF
0.1
10
V OUTPUT
20
25
mA
Figure 5-24. Increase Rate, Decrease Output.
1. Patient is connected to temporary pacemaker and is being

monitored on ECG.
2. Set RATE at least 10 ppm above patients intrinsic rate.
This adjustment ensures pacing. The pace indicator flashes.
3. Decrease OUTPUT: Slowly turn the OUTPUT dial
counterclockwise until ECG shows loss of capture.
Pace and sense indicators flash intermittently.

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Thresholds
80
30
120
RATE
OFF
0.1
200
ppm
10
20
A OUTPUT
mA
Atrial or
Ventricular
OFF
0.1
10
V OUTPUT
20
25
mA
Figure 5-25. Increase Output.
4. Increase OUTPUT: Slowly turn the output dial clockwise until

ECG shows consistent capture.
The pace indicator flashes continuously; the sense indicator
stops flashing.
This value is the stimulation threshold.
5. Set OUTPUT to a value at least 2 to 3 times greater than the
stimulation threshold value.
This setting provides at least a 2:1 safety margin.
6. Restore RATE to previous value.
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Pacing Setup
Pacing Setup
The Medtronic Model 5388 Temporary Pacemaker can be set to a
single chamber mode (AOO, VOO, AAI, VVI) or a dual chamber
mode (DDD, DDI, DVI, DOO).
To quickly set the device to the desired pacing mode, adjust
OUTPUT (upper dials), SENSITIVITY (Menu 1), and/or A (Atrial)
TRACKING (Menu 1).
The Pacing Setup Table (see page 5-43) provides a quick reference
for selecting a pacing mode. Refer to Basic Operation (see
page 5-6) and Pacing Parameter Adjustments (see page 5-19) for
step-by-step instructions on how to adjust output and sensitivity.

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Pacing Setup
Atrial Tracking
To change from DDD to DDI mode, set A TRACKING to OFF (from
Menu 1). Conversely, to change from DDI to DDD mode, set
A TRACKING to ON (from Menu 1).
DDI
A Sensitivity
0.5 mV
V Sensitivity
2.0 mV
A-V Interval
170 mS
A Tracking
OFF
SELECT
OFF ON
MENU
Figure 5-26. Atrial Tracking.
To Turn Atrial Tracking Off or On

2. Press the SELECT key until A TRACKING is highlighted.
3. DDI mode: Turn the MENU PARAMETER dial counterclockwise
to display OFF.
DDI pacing and sensing begin. The DDI indicator appears.
DDD mode: Turn the MENU PARAMETER dial clockwise to
display ON.
DDD pacing and sensing begin.
Note: A TRACKING can be set to OFF only from DDD mode and set
to ON only from DDI mode.
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Pacing Setup
Dial-A-Mode
Menu M allows you to select DDD, DOO, DVI, or VVI pacing
modes.
AAI
DOO
DIAL-A-MODE
DDDDVIDOOVVI
Press
SELECT
to ACTIVATE
SELECT
new Mode
M
MENU
Figure 5-27. Dial-A-Mode.
To Dial-a-Mode
1. Press the MENU key until Menu M is displayed.
2. Turn the MENU PARAMETER dial to underline desired
pacing mode.
3. Press the SELECT key to activate the selected pacing mode.

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User Guide
Pacing Setup
Pacing in the selected mode begins as follows:

Manually set values for UPPER RATE, PVARP, and A-V INTERVAL
are retained when they apply to the newly selected mode.
Otherwise, the settings are returned to their automatic,
rate-dependent values.
Example: If you change from DVI to DDD mode, the setting for
A-V INTERVAL is retained or carried forward. UPPER RATE and
PVARP are set to their automatic, rate-dependent values.
Nominal or previously programmed settings for OUTPUT
and SENSITIVITY.
Example: If you change from AAI to DDD mode, the value for
is retained; V OUTPUT is set to the nominal value.
A OUTPUT
Previously programmed RATE.
5-38
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User Guide
RAP (Rapid Atrial Pacing)

#
Caution: RAP is for atrial use only. Be sure the leads are
connected to the atrium, not the ventricle, before enabling RAP.
DDD
320 ppm
RAP
80
Press
440
800
SELECT
to DELIVER
RAPID ATRIAL
PACING
3
SELECT
MENU
Figure 5-28. RAP (Rapid Atrial Pacing).
To Deliver Rap
1. Verify that the leads are in contact with the atrium and are
connected to the atrial channel of the device through a
patient or surgical cable.
Screen displays RAP rate (initial rate of 320 ppm or rate last set).
Pacing continues at currently displayed settings.
3. Adjust RAP rate as needed: Turn the MENU PARAMETER dial
clockwise to increase rate; counterclockwise to decrease rate.
Range: 80 ppm - 800 ppm
4. Press and hold SELECT to deliver RAP burst.
AOO pacing begins at displayed RAP rate and current A OUTPUT.
The A PACE LED flashes during delivery of RAP pulses.
Note: There is no ventricular support during RAP.

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User Guide
Note: If A OUTPUT is set to OFF when you press the SELECT key,
RAP is delivered at 10 mA. A OUTPUT returns to the OFF setting as
soon as you release the SELECT key even if you adjust A OUTPUT
during RAP delivery.
To Adjust Rate/Atrial Output During RAP Delivery

1. Continue to press and hold the SELECT key.
2. Turn the MENU PARAMETER dial to adjust RAP rate.
3. Turn the A OUTPUT dial to adjust atrial output.
To Resume Pacing at Upper Screen Settings

Release the SELECT key.
5-40
Caution: RAP may result in tachycardia, acceleration of existing

tachycardia, or fibrillation. Apply high rates under careful patient
monitoring and control. Monitor the patients ECG and blood
pressure, and ensure defibrillation equipment is
immediately available.
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User Guide
Battery Replacement
Battery Replacement
Replace the battery for each new patient, and when the low
battery indicator appears during device operation (see page 3-13).
Use a fresh 9V alkaline or lithium battery (Ultralife U9VL,
Eveready 522, or equivalent).
Check the battery status at least twice daily. Replace alkaline
batteries at least once every week when the temporary pacemaker
is in continuous use.
NT
ZX.
Figure 5-29. Battery Replacement.

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User Guide
Battery Replacement
To Replace Battery
Note: Medtronic does not recommend replacing the battery while
the pacemaker is turned on. However, if during an emergency
situation the battery must be replaced while the device is in use,
ensure that the device is locked (see Lock/Unlock Key on
page 3-2), then replace the battery. Pacing is maintained for 15
seconds, typical, at 70 ppm and nominal outputs (see Operation
After Battery Removal on page 7-5).
1. Turn device off.
2. Press button on the bottom of the device to open
battery drawer.
3. Remove old battery and discard.
4. Insert fresh battery as shown on the diagram inside the
battery drawer.
Note: The device works with the battery polarity reversed.
5. Close battery drawer. Make sure it clicks.
6. Press the ON key to start power-on self-test.
The pace/sense and battery indicators flash briefly. If the device
passes the power-on self-test, dual chamber demand pacing and
sensing begin.
5-42
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1
NA
NA
ASYNC
Off
On
PACE SENSE
VOO
A
NA
On
NA
On
Off
PACE SENSE
AAI
NA
NA
On
Off
On
PACE SENSE
VVI
NA
ASYNC
ASYNC
On
On
A+V
PACE SENSE
DOO
Table 5-3. Model 5388 Pacing Setup Table.
NA
ASYNC
On
On
On
A+V
PACE SENSE
DVI
On
On
On
On
On
A+V A+V
PACE SENSE
DDD
DDI
Off
On
On
On
On
A+V A+V
DDI
PACE SENSE
* Caution: DAD and OOO are accessible modes, but are not recommended. Refer to Controls, Indicators, and Other Features in the
technical manual.
NA
3. Set A Tracking
On
Off
ASYNC
NA
PACE SENSE
AOO
A Sensitivity
V Sensitivity
2. Set Sensitivity
A Output
V Output
1. Set Output
Instructions
Setup Indicators
Tables
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Tables
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5-43
5-44
X
Chamber Sensed
V Ventricle
A Atrium
D Dual (A+V)
O None
X
Chamber Paced
V Ventricle
A Atrium
D Dual (A+V)
O None
O None
D Dual
I Inhibits pacing
T Triggers pacing
Sensed Response
Table 5-4. 3Letter NBG Pacemaker Code (1987).
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User Guide
Tables
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User Guide
Tables
Table 5-5. Rate and Interval Conversion Chart.

Rate
(bpm)
Int
(ms)
Rate
(bpm)
Int
(ms)
Rate
(bpm)
Int
(ms)
30
2000
100
600
390
154
35
1714
110
545
400
150
40
1500
120
500
410
146
45
1333
130
462
420
143
50
1200
140
429
430
140
52
1154
150
400
440
136
54
1111
160
375
450
133
56
1071
170
353
460
130
58
1034
180
333
470
128
60
1000
190
316
480
125
62
968
200
300
490
122
64
938
210
286
500
120
66
909
220
273
510
118
68
882
230
261
520
115
70
857
240
250
530
113
72
833
250
240
540
111
74
811
260
231
550
109
76
789
270
222
560
107
78
769
280
214
570
105
80
750
290
207
580
103
82
732
300
200
590
102
84
714
310
194
600
100
86
698
320
188
610
98
88
682
330
182
620
97
90
667
340
176
630
95
92
652
350
171
640
94
94
638
360
167
650
92
96
625
370
162
98
612
380
158
60,000/ms = bpm or 60,000/bpm = ms

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User Guide
Tables
5-46
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Device Maintenance
Cleaning and
Sterilization 6-2
Safety and Technical
Checks 6-4
Service
6-4
Special Notices 6-5

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Device Maintenance
Cleaning and Sterilization

Model 5388 Temporary Pacemaker
Cleaning
The Model 5388 temporary pacemaker can be cleaned using a
sponge or cloth moistened with water or 70% isopropyl alcohol.
Note: Do not expose the unit to ethers, acetone, or chlorinated
solvents as these may damage the case or labels.
Caution: The Model 5388 must not be immersed in water or

cleaning agents. Severe damage to the device may occur.
Sterilization
The Model 5388 can be exposed to ethylene oxide gas for
disinfection. Due to the variability among sterilizers, precise
sterilization instructions must come from the sterilizer
manufacturer. However, the process should not exceed
temperatures of 52C (125F) nor pressures of 103 kPa (15 PSIG).
Use an acceptable method such as biological indicators for
determining sterilizer effectiveness.
6-2
Caution: Do not sterilize the Model 5388 by gamma irradiation

and do not steam-sterilize (autoclave) the device.
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Device Maintenance
Model 5433A and 5433V Patient Cables

The Model 5433A and 5433V Patient Cables are supplied
non-sterile, and must be sterilized by steam or ethylene oxide
prior to use.
Cleaning
Prior to sterilization, the Model 5433A or 5433V Patient Cable
should be cleaned thoroughly with a mild detergent or
70% isopropyl alcohol to remove all visible blood and body fluids.
The cables may be immersed for cleaning. The cables must be
thoroughly dried after cleaning.
Inspection and testing by a qualified technician should be done
after cleaning to verify proper cable function.
Sterilization
Note: While either of the following sterilization methods is
acceptable, repeated steam sterilization typically causes more
rapid degradation.
Steam Sterilization Remove the cable from the original package
and place the cable in a suitable autoclavable packaging material.
The packaged cable should be autoclaved at:
121C (250F) at 103 kPa (15 PSIG) for 30 minutes, or
132C (270F) at 186 kPa (27 PSIG) for 7 minutes.
Ethylene Oxide Sterilization Remove the cable from the original

package and wrap the cable in packaging permeable to ethylene
oxide. Follow standard method for ethylene oxide sterilization.
Use an acceptable method, such as biological indicators, for
determining sterilizer effectiveness.

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Device Maintenance
Safety and Technical Checks
Safety and Technical Checks

Safety and technical checks should be carried out on the
Model 5388 at least once every 12 months and after any
malfunction or accident. Medtronic does not recommend field
repair of the device. For service or repair contact your local
Medtronic representative at the appropriate address or telephone
number listed on the back cover.
Service
Medtronic employs highly trained representatives and engineers
located throughout the world to serve you and, upon request, to
provide training to qualified hospital personnel in the use of
Medtronic products. Medtronic also maintains a professional staff
to provide technical consultation to product users. For medical
consultation, Medtronic can often refer product users to outside
medical consultants with appropriate expertise. For more
information, contact your local Medtronic representative, or call
or write Medtronic at the appropriate address or telephone
number listed on the back cover.
The Medtronic Model 5388 Temporary Pacemaker has been
carefully engineered, manufactured and quality tested to provide
long, trouble-free service. Should service or repair be necessary,
contact your local Medtronic representative at the appropriate
address or telephone number listed on the back cover.
A serial number identifying each individual pacemaker is printed
on the back surface of the device. This serial number should be
referenced in any correspondence regarding this device.
6-4
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Device Maintenance
Special Notices
Special Notices
Special Notice for the Medtronic Model
5388 Temporary Pacemaker
Use of prior Medtronic Temporary Pacemakers has met with some
success in the treatment of certain heart disorders, including heart
block and heart arrhythmias. However Medtronic makes no
warranty that the Model 5388 Temporary Pacemaker will
efficiently restore adequate cardiac function for all patients. For
information regarding common causes of pacing difficulty,
consult other portions of the manual.
Special Notice for the Medtronic Model

5433A or Model 5433V Patient Cable
Cables may be easily damaged by improper handling or use due
to their unavoidably fragile character, which is dictated by the
unusual requirements of their application. Consequently, no
representation or warranty is made that failure or cessation of
function of cables will not occur.
For complete warranty information, see the accompanying cards
encolsed in the package.
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Device Maintenance
Special Notices
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Specifications
Device Specifications

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Specifications
The following specifications apply at 20C (68F) 2C (4F) and
with a 500 ohm ( 1%) load.
Modes
AOO, AAI, VOO, VVI,

DOO, DDD, DDI, DVI*
Base Rate
30 200 ppm 5%
30 50 ppm in 5 ppm increments

Rapid Atrial Pacing Rate
80 800 ppm 5%

Output Amplitude
Atrial
0.1 20 mA 0.1 mA or 10%
0.1 0.4 mA in 0.1 mA increments

5.0 20 mA in 1.0 mA increments
(200-1000 Ohms)
Ventricular
0.1 25 mA 0.1 mA or 10%

(200-1000 Ohms)
Pulse Width (fixed)

Atrial
Ventricular
7-2

5.0 25 mA in 1.0 mA increments
1.0 ms 10%
1.5 ms 10%
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Specifications
Sensitivity**
Atrial
Ventricular
A-V Interval
Auto
ASYNC,
0.4 10 mV 0.3 mV or 25%
0.4 0.8 mV in 0.1 mV increments

3.0 10 mV in 1.0 mV increments
ASYNC,
0.8 20 mV 0.3 mV or 25%

3.0 10 mV in 1.0 mV increments
10 20 mV in 2.0 mV increments
50 250 ms
5 ms or 5% (PAV)
15 ms or 15% (SAV)
Paced A-V (PAV) = 300 (1.67 x

RATE in ppm)
Sensed A-V (SAV) = PAV 30

20 300 ms 5 ms or 5%
Manual
in 10 ms increments
Refractory Period
Atrial
At atrial event
250 ms 10%
At ventricular event
(PVARP)
Auto
(all values are 10%)
Rate range
100 ppm
105 150 ppm
155 180 ppm
>180 ppm
Manual
150 500 ms 10%

in 10 ms increments
PVARP
300 ms
250 ms
225 ms
200 ms
250 ms 10%
Ventricular
Upper Rate
base rate + 30 ppm 10%

80 230 ppm 10%
Auto
Manual
minimum of 110 ppm

80 130 ppm in 2.0 ppm increments
130 230 ppm in 5.0 ppm
increments
Occurs 110 ms after atrial pace, if A-V interval is set to more than
110 ms, or at programmed A-V interval if A-V interval is set to less than
110 ms
Safety Pace

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Specifications
Blanking
Atrial
At atrial pace
DDD, DDI
AAI
At atrial sense
At atrial refractory
sense
At ventricular pace
At ventricular sense
Ventricular
At atrial pace
At ventricular pace
At ventricular sense
Rate Limit
Nominal Values
Mode
Rate
Output Amplitude
Atrial
Ventricular
Pulse Width (fixed)
Atrial
Ventricular
Sensitivity
Atrial
Ventricular
AV Interval
Sensed
Paced
PVARP
Upper Rate
Rapid Atrial Pacing Rate
7-4
A-V Interval
125 ms + 50 ms/-0 ms
AAI
A-V Interval
75 ms + 50 ms/-0 ms
DDD, DDI, AAI
75 ms + 50 ms/-0 ms
DDD, DDI
125 ms + 50 ms/-0 ms
75 ms + 50 ms/-0 ms
20 ms + 5 ms/-10 ms
125 ms + 50 ms/-0 ms
75 ms + 50 ms/-0 ms
A crystal is used to set the pacing rate. If the crystal rate deviates from
the appropriate value, the rate runaway protection circuit resets the
device once. If the crystal rate remains incorrect, the rate runaway
protection circuit turns the device off.
DDD
80 ppm
DOO for Emergency
10 mA
10 mA
20 mA for Emergency
25 mA for Emergency
1.0 ms
1.5 ms
0.5 mV
2.0 mV
Asynchronous for Emergency

Asynchronous for Emergency
140 ms
170 ms
300 ms
110 ppm
320 ppm
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Specifications
Dimensions
Height
Width
Depth (without dials)
Weight (with battery)
21.1 cm (8.3 in.) 15%

8.1 cm (3.2 in.) 15%
3.6 cm (1.4 in.) 15%
510 g (18 oz.) maximum
Temperature
Operating
Storage (without battery)
17C to 33C (64F to 92F)***

-40C to 70C (-40F to 158F)
9 V Alkaline, type 6LR61, type 6F22E, NEDA 1604A
Battery Type
(Eveready 522 or equivalent)

9 V Lithium, NEDA 1604LC (Ultralife U9VL or equivalent)
Battery Life
9 days typical, 7 days minimum (alkaline), or 16 days (lithium), when

the rate is 70 ppm, and all other parameters are at the nominal values
listed above
Operation After Battery

Removal
15 seconds (typical) under the following conditions: RATE of 70 ppm

or less, A OUTPUT and V OUTPUT of 10 mA or less, backlight off, and
lower screen blank.
Safety Standards
International
Canadian
Japanese
IEC 601-1, IEC 601-2-31,Type CF battery powered equipment

CSA 22.2 No. 601.1 Type CF battery powered equipment
JIS T1001, T1002 (1992)
EMC Standards
International
IEC 601-1-2, IEC 801-3, CISPR-11 Class B
* An NBG code followed by ?! indicates a clinically ineffective pacing mode.

20 - 25 mA 10% into 200 - 500 Ohms.
Pulse width is measured at the 50% amplitude points of the leading and trailing edges, excluding the discharge cycle.
**When sensing 40 ms-wide Haversine waveform for ventricular inputs, 30 ms-wide Haversine waveform for atrial
inputs.
When tested with a 1 ms square pulse with sufficient amplitude.
Ventricular blanking after an atrial pace is followed by 16 ms of reduced sensitivity. During this time the device
detects R-waves with amplitudes of at least 5 mV or twice the V SENSITIVITY setting, whichever is greater.
***Within the ranges of 10C to 17C (50F to 64F) and 33C to 43C (92F to 110F) the specification for output is
derated an additional 5%; the specification for sensitivity is derated an additional 7%; and the specification for
rate is not derated.
Typical is the average minimum value at 24 hours after the low battery indicator first appears.
Medtronic does not recommend replacing the battery while the pacemaker is connected to a patient.

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Specifications
7-6
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Pacemaker Diagnostic
Diagrams
About the Chapter

Definitions
A-2
A-3
Single Chamber Modes
A-7
Dual Chamber Modes A-14

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About the Chapter
About the Chapter
About the Chapter
Definitions
A-3
AOO
A-8
VOO
A-9
AAI
A-10
VVI
A-12
Dual Chamber Modes
A-2
A-2
DOO Mode
DVI Mode
DDD Mode
DDI Mode
A-7
A-14
A-14
A-16
A-24
A-41
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Definitions
Definitions
Throughout this manual certain terms and symbols are used that
are defined here for clarity.
The software program operating in the Model 5388 provides the
pacemaker with the capabilities to respond to sensed signals in
unique ways and to produce appropriate output signals. Some of
the most frequently used terms to describe the software program
activity of the Model 5388 are:
Ventricular Safety Pace. A stimulus to the ventricle to prevent
inappropriate inhibition (see Ventricular Safety Pacing on
page 3-39).
VSP
This small diamond is used to signify the end of the

UPPER RATE interval.
A star indicates that the pacemaker has emitted an output pulse to

that chamber.
A circle indicates the pacemaker has sensed an event in

that chamber.
A circle with a slash indicates an event sensed during a refractory

or blanking period.
Premature Ventricular Contraction. A ventricular sensed event
following another ventricular sensed event without any
intervening atrial paced or atrial sensed (inside or outside
refractory) event.
PVC

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Definitions
A-V interval A downward sloped line shows A-V timing

initiated by an atrial output pulse or a sensed atrial event.
V-A interval An upward sloped line shows the V-A interval
initiated by a ventricular output pulse or a sensed ventricular
event. This period, which is not directly programmable, has a
value equal to the programmed base RATE interval minus the
programmed PAV or SAV interval.
Blanking A solid rectangle shows a blanking period, or absolute
refractory period, during which the pacemaker is totally
insensitive to signals.
Refractory An open rectangle shows the refractory period. A
refractory-sensed event does not affect the A-V or V-A interval,
but restarts some blanking and refractory periods.
Reversion window Period between the end of blanking and
the end of refractory. Reversion occurs when the device
senses repeatedly in successive reversion windows, then
paces asynchronously.
A-4
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Definitions
Blanking and Refractory Periods

Blanking Periods
PAAB Period The Post Atrial Atrial Blanking period prevents the
atrial sense amplifier from sensing the atrial pace pulse.
PAVB Period The Post Atrial Ventricular Blanking period
prevents the ventricular sense amplifier from sensing an atrial
pulse (crosstalk).
PVAB Period The Post Ventricular Atrial Blanking period
prevents the atrial sense amplifier from sensing a ventricular
pulse (crosstalk).
PVVB Period The Post Ventricular Ventricular Blanking period
prevents the ventricular sense amplifier from sensing a
ventricular pace pulse.
A-PACE
*
A
ARS
PVAB PVAR PAAB

PAAR
PAAB
V
PAVB
PVVB
PVVR
V-PACE
Figure A-1. Typical Blanking and Refractory Periods.

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Definitions
Refractory Periods
PVARP The Post Ventricular Atrial Refractory Period prevents
atrial sensing of crosstalk (far-field R-wave, retrograde conducted
R-wave), which may trigger PMT (pacemaker-mediated
tachycardia). PVARP also provides a reversion window.
PVVR Period The Post Ventricular Ventricular Refractory period
provides a reversion window.
PAAR Period The Post Atrial Atrial Refractory period is started
only when an atrial event is sensed inside PVARP.
The two A-V intervals are:
PAV Interval Pace A-V interval (A-V INTERVAL) is the A-V interval
after an atrial pace. It is programmable.
SAV Interval Sense A-V interval is the A-V interval after an atrial
sense. This parameter is not programmable and is set to PAV
minus 30 ms.
A-6
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The Model 5388 will pace in four single chamber modes: AOO,
VOO, AAI, and VVI.
AOO and VOO Modes

The asynchronous modes (AOO and VOO) emit a pacing pulse
into one chamber, either the atrium (AOO) or the ventricle (VOO),
at the end of the base rate interval, regardless of any
intrinsic activity.
When pacing in the AOO mode, the pacemaker will pace the
atrium asynchronously at the programmed base RATE. The atrial
and ventricular channels are continuously blanked.
When pacing in the VOO mode, the pacemaker will pace the
ventricle asynchronously at the programmed base RATE. The atrial
and ventricular channels are continuously blanked.
AAI and VVI Modes

In the inhibited (or demand) modes (AAI and VVI), when an
intrinsic beat is sensed outside of a refractory period, and before
timeout of the base rate interval, the pacemaker inhibits the
output pulse. If no intrinsic beat is sensed before the timeout of the
base rate, a pacing stimulus is delivered.
When pacing in the AAI mode, the pacemaker will pace the
atrium at the programmed base RATE in the absence of detected
atrial activity. The ventricular channel is continuously blanked.
When pacing in the VVI mode, the pacemaker will pace the
ventricle at the programmed base RATE in the absence of detected
ventricular activity. The atrial channel is continuously blanked.

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AOO
Intrinsic Atrial
Activity
Programmed
Base Rate
A
A00
V
When the base RATE interval times out, the pacemaker will:
A-8
Restart the base RATE interval, and
Deliver a pacing stimulus to the atrium.
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VOO
PVC
Programmed
Base Rate
A
V00
V
When the base RATE interval times out, the pacemaker will:
Deliver a pacing stimulus to the ventricle.

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AAI
Programmed
Base Rate
Programmed
Base Rate
Restarted
A
AAI
V
Blanking After Sense = 125 ms
Blanking After Pace = 175 ms
Base Rate Interval = 750 ms

Atrial Refractory = 250 ms
If the base RATE interval times out, the pacemaker will:
A-10
Restart the base RATE interval,
Start the atrial refractory and blanking (after pace) periods,

and
Deliver a pacing stimulus in the atrium.
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AAI
Programmed
Base Rate
Noise
Programmed
Base Rate
Restarted
A
AAI
V


Atrial Refractory = 250 ms
If a detected atrial event occurs outside of the atrial refractory

period, the pacemaker will:
Start the atrial refractory and blanking (after sense) periods.
If a detected atrial event occurs within the atrial refractory period,

the pacemaker will:
Not restart the base RATE interval,
Restart the atrial refractory and blanking (after sense) periods.
Note: This action forces asynchronous atrial pacing in the

presence of continuous noise (reversion behavior).
If the atrial event occurs within the atrial blanking period, it is not
sensed, and no action is taken.

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VVI
Programmed
Base Rate
Programmed
Base Rate
Restarted
A
VVI
V

Ventricular Refractory = 250 ms
If the base RATE interval times out, the pacemaker will:
A-12
Restart the base RATE interval,
Start the ventricular refractory and blanking (after pace)

periods, and
Deliver a pacing stimulus in the ventricle.
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VVI
Programmed
Base Rate
Noise
Programmed
Base Rate
Restarted
A
VVI
V

If a detected ventricular event occurs outside of the ventricular

refractory period, the pacemaker will:
Start the ventricular refractory and blanking

(after sense) periods.
If a detected ventricular event occurs within the ventricular

refractory period the pacemaker will:
Not restart the base RATE interval, but
Restart the ventricular refractory and blanking

(after sense) periods.
Note: This action forces asynchronous ventricular pacing in the

presence of continuous noise (reversion behavior).
If the ventricular event occurs within the ventricular blanking
period, it is not sensed, and no action is taken.

150
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Dual Chamber Modes
Dual Chamber Modes

The Model 5388 will pace in four dual-chamber modes: DOO,
DVI, DDD, and DDI.
Note: Modes that are punctuated by !? on the Menu screens
should be avoided or adjusted to a clinically useful mode.
DOO Mode
When pacing in the A-V sequential asynchronous mode (DOO),
the pacemaker will pace the atrium and the ventricle
asynchronously at the programmed base RATE and with the
programmed A-V INTERVAL. Both channels are
continuously blanked.
A-14
151
Part# 198618-001 Rev B
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Dual Chamber Modes
DOO
PVC
PAC
A
DOO
V
Programmed
Base Rate
When the V-A interval times out, the pacemaker will:
Start the A-V INTERVAL, and
When the A-V INTERVAL times out, the pacemaker will:
Start the V-A interval, and

152
Part# 198618-001 Rev B
A-15
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Dual Chamber Modes
DVI Mode
In the ventricular demand A-V sequential (DVI) mode there is no
atrial sensing function. If a ventricular event is sensed outside of
a refractory period during the V-A interval, the pacemaker
restarts the V-A interval. If a ventricular event is sensed during
the programmed A-V INTERVAL, the pacemaker inhibits the
ventricular stimulus and starts the V-A interval. The exception to
this is safety pacing, which is described later.
This mode is normally used when A-V synchrony is desired but
the atrium is prone to arrhythmias.
Notes:
A-16
and UPPER RATE do not apply in this mode.
PVARP
When pacing in the DVI mode, the pacemaker will pace the
atrium and the ventricle at the programmed base RATE and
with the programmed A-V INTERVAL in the absence of detected
ventricular electrical activity. The atrial sense amplifier is
continuously blanked.
153
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Dual Chamber Modes
DVI
A
DVI
V
Start
VSP
Timer
AV Interval = 170 ms
VA Interval = 580 ms
* End
VSP
Timer

If the V-A interval times out, the pacemaker will:
Start the ventricular safety pace timer (VSP),
Start the A-V INTERVAL,
Start the PAVB period, and
If no ventricular event is sensed and the A-V INTERVAL times out,

the pacemaker will:
Start the V-A interval,
Start the PVVR and PVVB (after pace) periods, and

154
Part# 198618-001 Rev B
A-17
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Dual Chamber Modes
DVI
PVC
A
DVI
V
*
VA Interval
Restarted

If the detected ventricular event occurs outside of the ventricular

refractory period and in the V-A interval, the pacemaker will:
A-18
Restart the V-A interval, and
Start the PVVR and PVVB (after sense) periods.
155
Part# 198618-001 Rev B
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Dual Chamber Modes
DVI
PVC
A
DVI
V
*
*
If the ventricular event is sensed inside the ventricular refractory

period, and in the V-A interval, the pacemaker will:
Not restart the V-A interval

156
Part# 198618-001 Rev B
A-19
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Dual Chamber Modes
DVI
A
DVI
V
Start
VSP
Timer
Stop
VSP
Timer
(110 ms)

If the ventricular event is sensed outside the ventricular safety

pace window, and in the A-V INTERVAL, the pacemaker will:
A-20
157
Part# 198618-001 Rev B
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Dual Chamber Modes
DVI
A
DVI
V
Sense Due
To Crosstalk
Start
VSP
Timer
*
Safety
Pace
110 ms

If the A-V INTERVAL is programmed to more than 110 ms, then when
a ventricular sensed event occurs inside the ventricular safety
pace window, the pacemaker will:
Start PVVR and PVVB (after sense), and
Schedule a safety pacing stimulus in the ventricle 110 ms after

the atrial event.
After the 110 ms period, the pacemaker will:
Start the V-A interval,
Restart PVVR and PVVB (after pace), and
Note: The response is similar if the ventricular-sensed event is a

refractory sense inside the ventricular safety pace window.

158
Part# 198618-001 Rev B
A-21
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Dual Chamber Modes
DVI
A
DVI
V
*
AV
Interval
Start
VSP
Timer
Sense Due
To Crosstalk
80
ms
AV
Interval
*
80
ms
Stop
VSP
Timer (110 ms)
VA Interval
670 ms
AV Interval = 80 ms
VA Interval
670 ms
If the A-V INTERVAL is programmed to less than 110 ms, then when
a ventricular sensed event occurs inside the ventricular safety
pace window, the pacemaker will:
At the end of A-V INTERVAL, the pacemaker will:
Deliver a pacing stimulus in the ventricle,
Restart PVVR and PVVB (after pace).

A-22
159
Part# 198618-001 Rev B
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Dual Chamber Modes
DVI
Noise
A
DVI
V
Safety Pace

Ventricular Blanking After Pace = 175 ms
Ventricular Blanking After Sense = 125 ms
If the detected events occur within successive ventricular

refractory periods, the pacemaker will:
Restart the PVVR and PVVB (after sense) periods, and
Not restart the V-A interval.
Asynchronously pace in both chambers.
The rate is equal to the V-A interval plus 110 ms if the

is set longer than the ventricular safety
window (110 ms). The rate will be shorter than the
programmed base RATE.
A-V INTERVAL
The rate is equal to the programmed base RATE if the

A-V INTERVAL is set shorter than 110 ms.
The pacemaker is essentially in DOO mode.

160
Part# 198618-001 Rev B
A-23
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Dual Chamber Modes
DDD Mode
This mode provides a P-wave synchronous rate response with AV sequential pacing. Intrinsic activity in the atrium and ventricle
inhibits output stimuli and restarts certain timers.
Without atrial events within certain periods, the pacemaker
delivers a pacing stimulus to the atrium at the end of the
V-A interval which is equal to the programmed base RATE minus
the programmed A-V INTERVAL.
Without ventricular activity during certain periods, the
pacemaker delivers a pacing stimulus to the ventricle at the end of
the programmed A-V INTERVAL. An exception to this is safety
pacing, which is illustrated in the diagrams.
The pacing rate can be limited by the programmed UPPER RATE so
that the pacemaker does not pace the ventricle too fast in the
presence of atrial arrhythmias.
When pacing in the DDD mode, the pacemaker will pace the
atrium and the ventricle at the programmed base RATE and with
the programmed A-V INTERVAL in the absence of detected atrial or
ventricular intrinsic events.
A-24
161
Part# 198618-001 Rev B
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Dual Chamber Modes
DDD
PVARP
A
DDD
V
Programmed
Upper
Rate
Start
VSP
Timer
Upper Rate Interval = 545 ms
Stop
VSP
Timer
PVARP = 300 ms
If the V-A interval times out, the pacemaker will:
Start the ventricular safety pace timer,
Start the PAAB period, which is set to the same value as the
A-V INTERVAL,
Start the PAVB period,
Start the A-V INTERVAL, and

162
Part# 198618-001 Rev B
A-25
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Dual Chamber Modes
DDD
PVARP
A
DDD
V
Programmed
Upper
Rate
Start
VSP
Timer
Stop
VSP
Timer
PVARP = 300 ms
If no ventricular event is sensed, and the A-V INTERVAL times out,

and the UPPER RATE interval has timed out, the pacemaker will:
Start the PVAB (after pace) period and PVARP,
Start the PVVB (after pace) and PVVR periods,
Start the UPPER RATE interval,
Note: UPPER RATE is started by a ventricular pace, a ventricular

sense or a ventricular refractory sense. UPPER RATE is effective only
after an atrial sense (not an atrial refractory sense).
A-26
163
Part# 198618-001 Rev B
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Dual Chamber Modes
DDD
A
DDD
V
Start
VSP
Timer
Stop
VSP
Timer
SAV Interval = 170 ms 30 ms = 140 ms

*
PVARP = 300 ms
If the detected atrial event occurs outside of the PVARP, the

pacemaker will:
Start the PAAB period, which is set to the same value as the
SAV interval, and
Start the SAV interval.
Note: There is no PAVB period initiated upon an atrial sensed

event since a sensed event (as compared to a paced event) is
assumed to be small in amplitude and to not result in crosstalk. An
atrial sensed event also does not start the ventricular safety
pace timer.

164
Part# 198618-001 Rev B
A-27
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Dual Chamber Modes
DDD
Retrograde
Conduction
A
DDD
V

*
PVARP = 300 ms
If the atrial event occurs inside the PVARP (a PAC, a far-field

ventricular event, a retrograde conducted ventricular event) the
pacemaker will:
Restart PAAR and PAAB (after sense) periods, and
Not start SAV interval.
Note: This action prevents pacemaker-mediated

tachycardia (PMT).
A-28
165
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
PAC
A
DDD
V
Programmed
Upper Rate
Programmed
Upper Rate

PVARP = 300 ms
= End of Upper Rate Interval
If no ventricular event is sensed and the SAV interval times out

from a preceding atrial sensed event and the UPPER RATE interval
has not timed out, the pacemaker will:
Extend PAAB, and
Schedule a pacing stimulus in the ventricle when the

UPPER RATE interval times out.
Then, if no ventricular event is sensed and the UPPER RATE interval

times out, the pacemaker will:
Start the PVARP and PVAB (after pace) period,
Start the PVVR and PVVB (after pace) periods,
Restart the UPPER RATE interval,

166
Part# 198618-001 Rev B
A-29
Medtronic
Confidential

Dual Chamber Modes
DDD
*
A
DDD
V
Programmed
Upper Rate
Programmed
Upper Rate
(Restarted)

PVARP = 300 ms
If a ventricular sensed event occurs outside of the ventricular

refractory and the SAV interval has timed out and the UPPER RATE
interval has not timed out and a ventricular pace has been
scheduled, the pacemaker will:
A-30
Start the PVARP and PVAB (after sense) period,
Start the PVVR and PVVB (after sense) periods,
Cancel the scheduled ventricular pace.
167
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
A
DDD
V
Programmed
Upper Rate
Programmed
Upper Rate
(Restarted)
PVARP = 300 ms
If a ventricular sensed event occurs outside of the ventricular

refractory and the SAV interval has not timed out and the
UPPER RATE interval has not timed out, the pacemaker will:

168
Part# 198618-001 Rev B
A-31
Medtronic
Confidential

Dual Chamber Modes
DDD
A
DDD
V
Start
VSP
Timer
Stop
VSP
Timer
PVARP = 300 ms

refractory period and the ventricular safety pace timer has timed
out and the A-V INTERVAL timer has not timed out, the
pacemaker will:
A-32
Start the PVVR and PVVB (after sense) period,
169
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
A
DDD
V
Sense Due
To Crosstalk
Start
VSP
Timer
Programmed
Upper Rate
Safety
Pace
PVARP = 300 ms
If the A-V INTERVAL is programmed to more than 110 ms and a

ventricular event is sensed before the VSP timer times out, the
pacemaker will:
Start the PVVB (after sense) period,
Continue the PVAB (after sense) period, and
Schedule a safety pacing stimulus in the ventricle 110 ms after

the atrial event.
(Explanation is continued on page A-34.)

170
Part# 198618-001 Rev B
A-33
Medtronic
Confidential

Dual Chamber Modes
Then when the ventricular safety pace period times out 110 ms
later, the pacemaker will:
Start the PVVR and PVVB (after pace) periods,

A-34
171
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
A
DDD
V
Sense Due
To Crosstalk
AV
Interval
*
80
ms
AV Interval = 80 ms
PVARP = 300 ms
When the A-V INTERVAL is programmed to less than 110 ms and

when a detected ventricular event occurs and the A-V INTERVAL has
not timed out, the pacemaker will:
Start the PVVB (after sense) period,
Continue the PVAB (after sense) period, and
Schedule a pacing stimulus in the ventricle at the end of

A-V INTERVAL.
(Explanation continued on page A-36.)

172
Part# 198618-001 Rev B
A-35
Medtronic
Confidential

Dual Chamber Modes
Then when the A-V INTERVAL does time out, the pacemaker will:
Start the PVVR and PVVB (after pace) period,
Deliver a pacing stimulus to the ventricle.

A-36
173
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
PVC
Start
PVARP
(Programmed value)
Restart
VA Interval
Restart
PVARP
(400 ms)
A
DDD
V
Upper
Rate
This sensed event

is treated as a PVC
Upper
Rate
(Restarted)
PVARP = 300 ms

refractory period, and the V-A interval has not timed out, and the
event is recognized as a PVC, the pacemaker will:
Start the PVARP at a value of 400 ms, or to the programmed

value if set longer than 400 ms, because the event is
recognized as a PVC,
Start the PVAB (after sense) period,
Restart the UPPER RATE interval, and
Restart the V-A interval.
Note: PVARP is extended only during the cycle in which the PVC
is recognized. Otherwise it goes back to the programmed value.

174
Part# 198618-001 Rev B
A-37
Medtronic
Confidential

Dual Chamber Modes
DDD
Noise
Cancelled A-Pace
A
DDD
V
Restart
Upper Rate
Interval
PVARP = 300 ms
If ventricular events are sensed in successive ventricular

refractory periods, the pacemaker will:
Inhibit atrial pacing and sensing, and
Asynchronously pace in the ventricle at the programmed

base RATE.
The pacemaker is essentially in VOO mode.
Notes:
A cancelled atrial pace will not start a ventricular safety

pace window.
UPPER RATE does not delay a ventricular pace after a cancelled
atrial pace.
PVARP,
as well as ventricular refractory, is continuously

restarted by ventricular refractory sensed events.
A-38
175
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDD
PVC
Restart
PVARP
(400 ms)
Start
PVARP
ogrammed value)
Start PVARP
(back at
programmed value)
A
DDD
V
Start
Upper
Rate
Restart Upper Rate
This
sensed
event is
treated as
a PVC

PVARP = 300 ms
If the detected ventricular event occurs within the ventricular

refractory period (outside of blanking) and the V-A interval has
not timed out, and the event is recognized as a PVC, the
pacemaker will:
Restart the PVARP, at a value of 400 ms, or to the programmed

PVARP if set longer than 400 ms, because the event is
recognized as a PVC,
Restart the PVAB (after sense) period,
Restart the PVVR and PVVB (after sense) periods,
Restart the UPPER RATE interval, but
Not restart the V-A interval.
Note: PVARP is extended only during the cycle in which the PVC
is recognized. Otherwise it goes back to the programmed value.

176
Part# 198618-001 Rev B
A-39
Medtronic
Confidential

Dual Chamber Modes
DDD
Cancelled A-pace
*
A
DDD
V
Start
Upper Rate
Interval
Stop
Upper Rate
Interval
PVARP = 300 ms
If atrial events are sensed in successive atrial refractory periods

(atrial tachycardia with a cycle time of about 100 to 250 ms), the
pacemaker will:
Cancel the scheduled atrial pacing stimulus at the end of the

V-A interval to prevent pacing into an atrial tachycardia and
potentially converting it into atrial fibrillation, and
Pace in the ventricle in the demand mode at the programmed

base RATE.
Note: Since the atrial pacing stimulus is inhibited, the atrial pace
indicator will not be lit. The atrial sense indicator will light each
time there is an atrial event sensed inside or outside the
refractory period.
The pacemaker is essentially in VVI mode.
Note: A cancelled atrial pace will not start a ventricular safety
pace window.
A-40
177
Part# 198618-001 Rev B
Medtronic
Confidential

Dual Chamber Modes
DDI Mode
The device behaves in DDI mode as in DDD mode in all aspects
except the following: the pacing in the ventricle does not track
atrial sensed events. This mode is used when physiological pacing
is desired, but the patient is prone to atrial arrhythmia.
Note: In DDI mode, UPPER RATE is not applicable.

178
Part# 198618-001 Rev B
A-41
Medtronic
Confidential

Dual Chamber Modes
DDI
Cancelled A-Pace
*
A
DDI
V
*
Start
VSP
Timer
Stop
VSP
Timer

If the non-refractory atrial event is detected in the V-A interval,

the pacemaker will:
Start the PAAB (after sense) period, which starts with the
atrial sensed event and continues until the delivery of the
ventricular pace, and
Not start the SAV interval.
At the end of V-A interval, the pacemaker will:
A-42
Cancel the scheduled atrial pacing stimulus, and
Start the A-V INTERVAL.
179
Part# 198618-001 Rev B
Index
AAI mode
definition A-7
diagnostic diagrams A-10 to A-11
pacing setup table 5-43
Symbols
!? 3-20, 3-21
Numerics
2:1 safety margin
sensing threshold 5-28
stimulation threshold 5-32
3-letter code (NBG)
definition 5-44
A
A
Adverse effects 2-11 to 2-12

Amplitude, inappropriate variance 2-5
AOO mode
definition A-7
diagnostic diagram A-8
during RAP 3-28
ASYNC 3-20, 3-21
(atrial) OUTPUT 3-16

during RAP 3-29, 5-40
nominal value 7-4
A (atrial) SENSITIVITY
3-20
nominal value 7-4
range, increments 7-3
vs. A OUTPUT 3-20
(atrial tracking) 3-22, 5-36

DDI indicator 3-14
A TRACKING
Asynchronous pacing 3-6, 3-7, 5-15 to 5-16

adjusting A-V INTERVAL 3-7
caution 5-15
contraindication 1-6
diagnostic diagrams A-8, A-9, A-14
EMERGENCY/ASYNC. key 3-6, 5-15
to resume demand pacing 3-7
transition rules 3-40

180
Part# 198618-001 Rev B
I-1
Index
Atrial
arrhythmias 1-6
mapping 2-7
Basic operation 5-6 to 5-16

off 5-6 to 5-7
on 5-6 to 5-7
Atrial pacing
asynchronous 5-16
blanking specifications 7-4
contraindicated 1-6
demand (synchronous) 5-14
mode transition 3-40
output dial 3-10
refractory (ARF) 3-37
reversion response 3-38
Battery
drawer 3-31
drawer release button 3-31
indicator 3-13
life 3-31, 7-5
precaution 2-5
type 4-2, 7-5
Atrial sensing, contraindication 1-6

Attachment ring, bails 3-33, 4-6
fig. 3-33
AUTO/*MANUAL 3-19, 3-27
resetting rate-dependent parameters 5-26
(PAV) 3-26, 5-25, A-6
nominal value 7-4
ranges, automatic and manual 3-26, 7-3
safety pacing 3-39
timing symbol A-4
timing violations vs. RATE, PVARP 3-43
A-V INTERVAL
A-V Intervals
paced A-V interval see A-V INTERVAL (PAV)
sensed A-V interval see SAV (sensed A-V
interval)
B
Backlight
during lock 3-2, 3-34
during low battery 3-2
Battery replacement 5-42

continued operation during 3-31, 7-5
fig. 5-41
reversible polarity 3-31
Bipolar lead system 1-2
connecting directly to device 4-10
connecting to patient cable 4-8
precautions 2-6
Blanking 7-4
definitions 3-37, A-5
timing symbol A-4
timing symbols A-5
C
Cable to device connections 5-17
Cable to lead system connections 4-8
Cables
description, patient 4-4
precautions 2-6
sockets for 3-32
surgical 1-2
Capture, definition 5-31
Bails, attachment 3-33
Cardioversion 2-2
Base rate see RATE 7-2
Cautery 2-2
I-2
181
Part# 198618-001 Rev B
Index
Cellular phones 2-3
Chart
mode vs parameter settings 5-43
DDD mode 3-4

definition A-24
menu M (Dial-a-mode) 3-30, 5-37
Checks, safety and technical 6-4

Cleaning
patient cables 6-3
temporary pacemaker 6-2
see also Sterilization
Communication transmitters 2-3
Conduction, retrograde 2-8
Connector block, temporary pacemaker 3-32
Connector pin receptacles 3-32
caution 4-10
seal, fig 4-10
DDI mode 5-36

definition A-41
indicator 3-14, 5-5
pacing setup tableAOO mode
Defibrillation 2-2
Connector setup 4-6 to 4-11

lead system to patient cables 4-8
leads directly to device 4-10
overview 5-17 to 5-18
patient cable to device 4-6
precaution 2-4
warning 4-10
Demand (synchronous) pacing

definition 5-13
dual chamber 5-13
single chamber 5-14
to resume from asynchronous 5-8
Contents, package 1-4
Dial-a-mode (menu M) 3-30, 5-37
Contraindications 1-6
Dials 3-10
Controls 3-2 to 3-10

fig. 3-3
lower screen 3-18
upper screen 3-2
Diathermy equipment 2-3
Description, general 1-2, 5-2

Device maintenance 6-2 to 6-4
Dimensions 7-5
Disposable pouch 2-9, 4-3
Conversion chart, rate and interval 5-45
DOO mode
definition A-14
Dual chamber modes
definitions A-14, A-16, A-24, A-41

182
Part# 198618-001 Rev B
I-3
Index
Dual chamber pacing

asynchronous 5-15
definition 5-3
demand 5-13
DVI mode
definition A-16
Features
functional 3-34 to 3-43
physical 3-31 to 3-33
safety 1-3
Failures
random 2-5
self-test 3-36
Fluid incursion, precautions 2-9
E
Electromagnetic interference (EMI) 2-3
Electrostatic discharge (ESD) 2-8, 2-9
General description 1-2, 5-2
Electrosurgical equipment 2-3

EMC standards 7-5
Emergency connections 5-18
Haversine waveform 7-5
Emergency pacing 5-8

nominal values 5-8
Heartwires
connection to cables 4-8
connections directly to device 4-10
device receptacles 3-32
EMERGENCY/ASYNC. key
adjusting RATE, OUTPUT 3-7

emergency pacing values 3-7
function 3-6
if upper screen is locked 3-35, 3-7
HIGH OUTPUT
adverse effect 2-12

indicator 3-17, 5-12
precaution 2-7
Environmental precautions 2-9 to 2-10

Equipment
diathermy 2-3
electrosurgical 2-2, 2-3
line-powered 2-2
magnetic resonance imaging (MRI) 2-3
medical telemetry 2-3
High-rate indicator 3-15

High-rate pacing therapy
contraindicated in ventricle 1-6
no ventricular back-up 2-4
precaution 2-4, 2-6
Humidity 2-10
Erratic output, sensing 2-5
I
Indications 1-5
I-4
183
Part# 198618-001 Rev B
Index
Indicators 3-3, 5-4 to 5-5

DDI 3-14
false signals 2-5
fig. 3-3
high output 3-17, 5-12
high rates 3-15
lock 3-14, 3-34, 5-9
low battery 3-13
pace and sense LEDs 3-11
pacemaker setup 3-13
Indifferent electrode 4-9
Intended use 1-5
Interference, reversion response 3-38
L
Lead systems
adverse effects 2-12
bipolar 1-2, 2-6, 4-8
connecting directly to device 4-10
fig. 4-11
connecting to patient cables 4-8
fig. 4-9
inappropriate connections 2-12
precautions 2-6
reposition 2-12
unipolar 2-6, 4-8
warnings 2-4
Intrinsic rhythm
effect on pacing therapy 5-3
view using PAUSE 3-8, 5-9
LEDs (light-emitting diodes)

during self-test 3-35
green (pace) 3-11
orange (sense) 3-11
Line-powered equipment 2-2
Jumper cable 4-9
Lock
indicators 3-14, 5-5
Lock feature 3-34, 5-9

during RAP 3-29
EMERGENCY/ASYNC.key 3-7
lock/unlock key 3-2
MENU key 3-9
OFF key 3-6
ON key 3-5
PAUSE key 3-8
Keys 3-2 to 3-9

during lock 3-35
Locked-up, self-test failure 3-36

Low battery indicator 3-13, 5-4
at power on 3-5

184
Part# 198618-001 Rev B
I-5
Index
Lower screen 3-18 to 3-30

controls 3-18, 5-19
menu 1 3-19 to 3-22
menu 2 3-23 to 3-27
menu 3 (RAP) 3-28 to 3-29
menu M 3-30
messages 3-7, 3-8, 3-42, 3-43, 5-7
M
Magnetic resonance imaging (MRI) 2-3
MANUAL/AUTO 3-27
Mapping, atrial 2-7
Medical telemetry equipment 2-3
Menu 1 3-19 to 3-22
A (atrial) SENSITIVITY 3-20
A TRACKING 3-22, 5-36
A-V INTERVAL 3-22
V (ventricular) SENSITIVITY 3-21
Menu 2 3-23 to 3-27
A-V INTERVAL 3-26, 5-25
PVARP 3-25, 5-24
SETTING 3-27, 5-26
UPPER RATE 3-24, 5-23
Menu 3 (RAP) 3-28 to 3-29, 5-39 to 5-40
see also Rapid atrial pacing
key 3-9
timing violations 3-41
MENU
Menu M (Dial-a-mode) 3-30, 5-37

Menu parameter dial 3-10
Menus 5-19
fig. 5-20
status line 3-19
wont advance 3-36
I-6
Messages
2:1 block point 3-42
asynchronous pacing 3-7
OFF 5-7
PAUSE 3-8
UPPER RATE violation 3-43
upper screen is locked 3-34
Mode selection 5-35 to 5-38
DDI 5-36
menu M (DDD, DVI, DOO, VVI) 3-30, 5-37
transition rules 3-30, 3-40
Modes 7-2
definition, diagrams
AAI A-7, A-10 to A-11
AOO A-7, A-8
DDD A-24, A-25 to A-40
DDI A-41, A-42
DOO A-14, A-15
DVI A-16, A-17 to A-23
VOO A-7, A-9
VVI A-7, A-12 to A-13
nominal 7-4
N
NBG code
!? 3-20, 3-21
lower screen 3-19
parameter settings, chart 5-43
tables 5-44
Noise, reversion operation 3-38
Nominal values 7-4
emergency pacing 5-8
power-on 5-6
RAP rate 3-28
185
Part# 198618-001 Rev B
Index
O
OFF key
function 3-6, 5-7

ON
key 3-4
function 3-4, 5-7
to pace synchronously (demand) 3-5
Operation after battery removal 7-5

3-16, 3-17
high output indicator 3-17
high, adverse effect 2-12
inappropriate variance 2-5
loss of control 2-5
nominal values 7-4
ranges and increments 7-2
symbol A-3
vs. SENSITIVITY 3-20, 3-21
OUTPUT
Pacing
asynchronous, contraindication 1-6
atrial 1-6
atrial, contraindication 1-6
dual chamber, asynchronous 5-15
dual chamber, demand 5-13
high-output, asynchronous 3-7
high-rate therapy 1-6, 2-4
setup table 5-43
single chamber, asynchronous 5-16
single chamber, demand 5-14
termination of 2-8
Pacing mode 7-2
nominal 7-4
selection 5-35 to 5-38
menu M 5-37
transitions 3-40
Pacing system analyzer (PSA) 1-5
Package contents 1-4
Parameters
PACE
3-22
A-V INTERVAL 3-26
OUTPUT 5-12
PVARP 3-25
RATE 5-12
SENSITIVITY 3-20, 3-21, 5-21
SETTING 3-27
UPPER RATE 3-24, 5-23
A TRACKING
LEDs 3-11, 5-4

PACE
setup indicators 3-13, 5-4
Paced A-V interval see A-V INTERVAL (PAV)

Pacemaker diagnostic diagrams
definition of symbols A-3 to A-6
dual chamber modes A-14 to A-42
single chamber modes A-7 to A-13
Pacemaker setup indicators 5-4
Patient cable 1-2

connecting to device 4-6
fig. 4-7
connecting to lead system 4-8
description 4-4
sockets for 3-32

186
Part# 198618-001 Rev B
I-7
Index
Rapid atrial pacing (RAP) 3-28 to 3-29, 5-39

to 5-40
A OUTPUT 3-29, 5-40
caution 5-39, 5-40
rate, nominal 7-4
rate, range, increments 7-2
to resume upper screen pacing 5-40
PAUSE key
3-8
how to 5-9
if upper screen is locked 3-35
precaution 2-8, 3-8
time limit 5-10
PAVB period, definition A-5

Periods
blanking 3-37
refractory 3-37
Physical features 3-31 to 3-33
Pouch, disposable 2-9, 4-3
Power, loss of control 2-5
Power-on 3-4, 5-6
Precautions
environmental 2-9 to 2-10
pressed 3-36
PSA (pacing system analyzer) 1-5
Pulse width 7-2
atrial 3-16
ventricular 3-17
Rate to interval conversion chart 5-45
PVAB period
definition A-5
3-25, A-6
manual adjustments 5-24
nominal value 7-4
timing violations
vs. RATE, A-V INTERVAL 3-43
vs. SAV, UPPER RATE 3-42
wenckebach response 3-39
PVARP
Rate-dependent parameters 5-23 to 5-26

manual settings 3-23
menu 2 3-23 to 3-27
reset using AUTO 5-26
specifications 7-3
Receptacles
caution 3-32
heartwires 3-32
safety cable 2-9
seal 4-10
Refractory periods 3-37
definitions A-6
timing symbols A-4
R
Random failures 2-5
I-8
3-15
dial 3-10
during RA 3-29
high-rate indicators 3-15, 5-12
limit 7-4
loss of control 2-5
nominal value 3-15, 7-4
range, increments 5-12, 7-2
timing violations 3-41, 3-42
versus A-V INTERVAL, PVARP 3-43
versus UPPER RATE 3-43
RATE
187
Part# 198618-001 Rev B
Index
Sensing 5-27
atrial, contraindication 1-6
Refractory sense 3-37

symbol A-3
Sensing threshold 5-28

precaution 2-6
procedure 5-29 to 5-30
safety margin 5-28
Registration card 1-4

Repair 6-4
Retrograde conduction 2-8
5-21
loss of control 2-5
nominal values 7-4
precaution 2-7
ranges, increments 7-3
vs. corresponding output 5-22
SENSITIVITY
Reversion
operation 3-38
random failure 2-5
window A-4
Ring, bails 3-33, 4-6
Service 6-4
Safety
checks 6-4
features 1-3
margin, sensing threshold 5-28
margin, stimulation threshold 5-32
pacing 3-39, 7-3
standards 7-5
SETTING,
SAV (sensed A-V interval) 3-26, A-6

nominal value 7-4
range 7-3
vs.UPPER RATE, PVARP 3-42
Seal, connector pin receptacle 4-10
key 3-9
Menu 3 (rapid atrial pacing) 3-28
Menu M (Dial-a-mode) 3-30
SELECT
Setup indicators 3-13

OUTPUT 5-13, 5-14, 5-15, 5-16
SENSITIVITY 3-20, 3-21, 5-13, 5-14
Shut-down message 5-7
Single chamber pacing
asynchronous 5-16
demand 5-14
unipolar lead system 4-8
Sockets
heartwires 3-32
patient cables 3-32
Specifications 7-2 to 7-6
Standards, IEC, CSA 7-5
Self-test 3-35
LEDs 3-11
SENSE
SENSE
menu 2 3-27
resetting manual adjustments 5-26
setup indicators 3-13, 5-4
Status line
lower screen 3-19
upper screen 3-13 to 3-14
Sensed A-V interval see SAV

Sensed event symbol A-3

188
Part# 198618-001 Rev B
I-9
Index
Sterilization
environmental precaution 2-9
patient cables 6-3
temporary pacemaker 6-2
Timing symbols A-3 to A-6
Stimulation threshold
capture definition 5-31
precaution 2-6
procedure 5-33
safety margin 5-32
Surgical cables 1-2

sockets for 3-32
Unlocking device 3-34
Timing violations 3-41 to 3-43

Transition rules 3-40
Unipolar lead systems

connecting to patient cables 4-8
dual chamber 4-8
precaution 2-6
3-24
2:1 block point 3-39
manual adjustments 5-23
nominal value 7-4
timing violations
vs. RATE 3-43
vs. SAV, PVARP 3-42
wenckebach response 3-39
UPPER RATE
Synchronous (demand) pacing

transition rules 3-40
to resume 5-8
T
Table
pacing setup 5-43
Tables
NBG code definition 5-44
rate and interval conversion 5-45
Tachyarrhythmia 2-11
Technical checks 6-4
Technical service 6-4
Temperature
operating 7-5
stabilization 2-10
storage 7-5
Upper screen 3-12 to 3-17

A OUTPUT 3-16
locked parameters 3-34
RATE 3-15
status line 3-13 to 3-14
V OUTPUT 3-17
Use, intended 1-5
Terminating pacing 2-8

Threshold evaluations 5-27 to 5-34
precaution 2-6
sensing threshold 5-27 to 5-30
stimulation threshold 5-32 to 5-34
Timing diagrams see Modes
I-10
189
Part# 198618-001 Rev B
Index
V
V (ventricular) OUTPUT
5-12
WARNING messages 3-23 to 3-24
dial 3-10
during RAP 3-29
high output indicator 3-17, 5-12
V (ventricular) SENSITIVITY
Warnings 2-2 to 2-4

Wenckebach response 3-39
Wire attachment ring, bails 3-33, 4-6
3-21

vs. V OUTPUT 3-21
V-A interval
timing symbol A-4
Ventricular pacing
asynchronous 5-16
blanking specifications 7-4
demand 5-14
refractory 3-37
safety pacing 3-39
Viewing intrinsic rhythm (PAUSE) 5-9
VOO mode
definition A-7
VSP (ventricular safety pace)
definition A-3
specification 7-3
VVI mode
definition A-7
menu M 3-30, 5-37

190
Part# 198618-001 Rev B
I-11
Index
I-12
191
Part# 198618-001 Rev B
Index

180
Part# 198618-001 Rev B
I-13
Index
I-14
180
Part# 198618-001 Rev B
REF_R00
Printing instructions: doc#163256; refer to Reference manuals

row in the applicable table.
198618001
Blank For Position Only. Do Not Print!
Rev
Size inches (mm)/CTC

UC200102260 EN xxx release
Define as desired
REF_R00
Printing instructions: doc#163256; refer to Reference manuals

row in the applicable table.
Europe
Americas
Europe/Africa/Middle East Headquarters

Medtronic Europe S.A.
Route du Molliau
1131 Tolochenaz
Switzerland
Internet: www.medtronic.co.uk
Tel. 41-21-802-7000
Fax 41-21-802-7900
Latin America Headquarters

Medtronic, Inc.
7000 Central Avenue NE
Minneapolis, MN 55432-3576
USA
Tel. 763-514-4000
Fax 763-514-5544
Medtronic E.C. Authorized Representative

Medtronic B.V.
Wenckebachstraat 10
6466 NC Kerkrade
The Netherlands
Tel. 31-45-566-8000
Fax 31-45-566-8668
Canada
Medtronic of Canada Ltd.
6733 Kitimat Road
Mississauga, Ontario L5N 1W3
Canada
Tel. 905-826-6020
Fax 905-826-6620
Toll-free in Canada: 1-800-268-5346
United States
World Headquarters
Medtronic, Inc.
710 Medtronic Parkway NE
Minneapolis, MN 55432-5604
USA
Internet: www.medtronic.com
Tel. 763-514-4000
Fax 763-514-4879
Asia-Pacific
Japan
Medtronic Japan
Solid Square West Tower 6F
580 Horikawa-cho, Saiwai-ku
Kawasaki, Kanagawa 210-0913
Japan
Tel. 81-44-540-6112
Fax 81-44-540-6200
Medtronic USA, Inc.

Toll-free in the USA: 1-800-505-4636
(24-hour consultation for physicians
and medical professionals)
Australia
Medtronic Australasia Pty. Ltd.
Unit 4/446 Victoria Road
Gladesville NSW 2111
Australia
Tel. 61-2-9879-5999
Fax 61-2-9879-5100
Asia
Medtronic International Ltd.
Suite 1602 16/F, Manulife Plaza
The Lee Gardens, 33 Hysan Avenue
Causeway Bay
Hong Kong
Tel. 852-2891-4068
Fax 852-2591-0313
*198618001*
198618001
Rev
Medtronic, Inc. 2001

All Rights Reserved
UCX198618001 198618001
January 2001
Size inches (mm)/CTC

UC200102260 EN xxx release
Define as desired

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5388FC-198618-001.

Part # 198618001 Rev B

Inside Front coverFor Position OnlyDo Not Print!

Part # 198618001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.tpg Page i Monday, January 29, 2001 12:53 PM

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.tpg Page ii Monday, January 29, 2001 12:53 PM

Read instruction manual prior to use

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page iii Monday, January 29, 2001 1:02 PM

5388 Technical Manual

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page iv Monday, January 29, 2001 1:02 PM

5388 Technical Manual

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page v Monday, January 29, 2001 1:02 PM

Controls and Indicators of the Model 5388. 3-3

The Model 5388 Connector Block. 3-32

Press battery drawer release button. 4-2

The Model 5409 Disposable Pouch. 4-3

Removing the connector pin receptacle seals. 4-10

Connecting connector pins directly to the Model 5388. 4-11

Device Shut-Down Message. 5-7

Rate and Output. 5-11

Cable to Device Connections. 5-18

Emergency Connections. 5-18

5388 Technical Manual

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page vi Monday, January 29, 2001 1:02 PM

Lower Screen Menus. 5-20

Upper Rate. 5-23

A-V Interval. 5-25

Resetting to Automatic Values. 5-26

Atrial Undersensing. 5-27

Decrease Rate and Output. 5-29

Decrease Sensitivity. 5-30

Increase Sensitivity. 5-30

Loss of Ventricular Capture. 5-31

Increase Rate, Decrease Output. 5-33

Increase Output. 5-34

Atrial Tracking. 5-36

RAP (Rapid Atrial Pacing). 5-39

Battery Replacement. 5-41

Typical Blanking and Refractory Periods. A-5

5388 Technical Manual

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page 1 Monday, January 29, 2001 1:02 PM

5388 Technical Manual

Part# 198618-001 Rev B

5388 US ENGLISH UC200102260 EN/CTC

5388enm1.bk Page 2 Monday, January 29, 2001 1:02 PM