St. Jude Medical Merlin PSA EX3100 Referenzhandbuch

Merlin™ PSA

Pacing System Analyzer, Model EX3100

Help Manual

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St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol

are trademarks and service marks of St. Jude Medical, LLC. and its related companies.

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Merlin™ PSA Help Manual i

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

System Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-1

Operator Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-1

Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Adverse Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

Tools Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

? Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

Audio Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Print Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Export Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Rhythm Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

Rhythm Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-1

ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-3

Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-3

Basic Event Markers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

Interval and Refractory Markers (Full Markers) . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Special Event Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Full-Display Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Waveform Channel Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

EGM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Current of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Waveform Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Rhythm Display Setup Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

Adjust Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

ECG Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

EGM Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Freeze Capture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-9

Merlin™ PSA Session Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

Connect the Leads to the Merlin™ PSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

Start a Merlin™ PSA session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

End a Merlin™ PSA Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

Suspend the Merlin™ PSA Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

Lead Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

Enable/Disable Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

Pacing, Mode, and V. Pacing Parameter Autoprogramming. . . . . . . . . . . . . . . 5-2

Intrinsic Signal Amplitude and Slew Rate Measurements . . . . . . . . . . . . . . . . . . . 5-3

Lead Impedance Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

Capture Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Perform a Capture Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Phrenic Nerve Stimulation Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Annotate Test Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Additional Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Ventricular Sensing Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Burst Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

Burst Pacing Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

AV Delay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Base Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Interventricular Delay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Low Frequency Attenuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Max Track Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Pulse Amplitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Pulse Width . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Refractory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

S1S1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

V. Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

V. Sensing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Ventricular Support Rate (VOO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Merlin™ PSA Help Manual iii

Mode Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

DDD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-1

DDI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2

DOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2

VDD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-3

VVI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-4

VOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-4

AAI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

AOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

ODO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-6

Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

Technical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

Main Programming Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

Patient Data: Lead Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

On-Screen Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

Device Parameters and Settings Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3

Print Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3

Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3

Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3

Safe Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-4

Emergency VVI Pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-4

Parameter Settings and Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

Technical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Merlin™ PSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Mechanical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Electrical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

LED States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Measurement Ranges and Tolerances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Essential Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Battery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-10

Merlin™ PSA Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11

Storage and Operating Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-12

Cleaning, Disinfecting, and Sterilization Methods . . . . . . . . . . . . . . . . . . . . . . . A-12

Special Instructions for the Patient Cable Model EX3150. . . . . . . . . . . . . . . . A-13

Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-17

Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-17

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-18

Loss of Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-18

System Failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-18

Low Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-18

EGM Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-18

Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1

Merlin™ PSA Help Manual 1-1

1. Introduction

Contents:

•System Description

•Operator Profile

•Indications for Use

•Warnings

•Precautions

System Description

The Merlin™ Pacing System Analyzer (PSA) Model EX3100 system provides you with the ability to

assess the electrical performance of a lead system during pulse generator implantation or invasive

lead-system troubleshooting. The Merlin PSA system uses the St. Jude Medical™ Merlin™ Patient Care

System (PCS).

In addition to the Merlin PCS, the Merlin PSA system consists of:

• a sterilizable patient cable

The Merlin PSA Patient Cable Model EX3150 connects the Merlin PSA with one to three implanted

leads.

• patient-cable adapters

The Merlin PSA Cable Adapter Model EX3170 and the Merlin PSA “M” Adapter Model EX3180

connect the Merlin PSA to commonly used PSA patient cables (see Connect the Leads to the

Merlin™ PSA). The PSA patient cables are then connected to the implanted leads.

For information on the Merlin PCS, refer to the Merlin PCS Model 3650 User’s Manual. For technical

data and other information on the Merlin PSA and accessories, refer to Technical Data.

Operator Profile

The intended operators of the Merlin™ PSA system include trained St. Jude Medical employees and

clinical personnel trained in pacing and electrophysiology, for example, nurses, technicians, or

physicians.

Note

Only persons properly trained to operate the Merlin PSA should do

so.

If the user connects both the Merlin PSA Model EX3100 and the PSA

Wand Model 3150 to the Merlin PCS, the programmer only enables

the Merlin PSA Model EX3100.

Refer to the Merlin PCS Model 3650 User’s Manual for Merlin PSA

installation instructions.

1-2 Introduction

Indications for Use

The Merlin™ Pacing System Analyzer (PSA) is indicated for use at the time of surgery in patients with

bradyarrhythmias, tachyarrhythmias, and/or heart failure undergoing implantation or lead revision of a

pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy system.

Intended Use

The Merlin™ PSA is intended to assess the pacing and sensing performance of the lead system prior to

pulse generator implantation, or during invasive lead system troubleshooting.

The Merlin PSA Patient Cable EX3150 is a three-channel resterilizable patient cable intended to

connect the Merlin PSA to as many as three IS-1, DF-1, or DF4 leads.

The Merlin PSA Patient Cable Adapter EX3170 is a three-channel adapter intended to connect the

Merlin PSA to as many as three disposable patient cables. The EX3170 Cable Adapter can connect to

the Model 4051L disposable patient cable for IS-1 leads or to the Model 4161 disposable patient cable

for DF4 leads. The opposite ends of the disposable patient cables connect to implantable pacing leads.

The Merlin PSA “M” Adapter Model EX3180 is intended to connect the Merlin PSA to the two-channel

Medtronic Model 2292 re-sterilizable patient cable. The opposite end of the Medtronic Model 2292

cable connects to implantable pacing leads.1

Following use, the patient cables must either be disposed or re-sterilized, depending on the

requirements of the cable.

Only use the Merlin PSA with the Merlin PCS.

Contraindications

There are no contraindications to the use of a lead-analysis device. The patient’s age and medical

condition, however, may dictate the pacing modes and lead assessment activities appropriate for the

patient.

The Merlin™ PSA is not intended for use as a temporary pacemaker or for life sustaining pacing

support.

The Merlin PSA is not intended for diagnostic purposes.

Warnings

Line-powered Equipment. An implanted lead or a lead with an 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 only use line-powered equipment

according to its intended use as properly grounded line-powered Class I equipment used on or in the

vicinity of the patient.

Electrosurgical Cautery. Electrosurgical cautery could induce ventricular arrhythmias and/or

fibrillation, or may cause device malfunction or damage. If electrocautery is necessary, keep the current

path and groundplate as far away from the leads as possible.

1. The Medtronic Model 2292 re-sterilizable patient cable has an embedded resistor connected via connector pins P3

and P5 that enables Medtronic equipment to distinguish between different supported PSA cables. However, pins

P3 and P5 are not connected to the Merlin PSA which does not support this functionality.

Merlin™ PSA Help Manual 1-3

Burst Pacing. Use of atrial or ventricular burst pacing may result in ventricular tachycardia or

fibrillation. Defibrillation equipment should be readily available during the PSA session.

Handling Inserted Leads. Do not touch the terminal pins or exposed metal when handling inserted

leads. Do not allow the terminal pins or exposed metal to unintentionally contact electrically

conductive or wet surfaces.

Unconnected Atrial Leads. Do not operate the Merlin™ PSA in the DDD or VDD pacing mode with

only the ventricular pacing lead connected. Interference detected at the unconnected atrial input of

the Merlin PSA can result in false sensing and can drive the ventricular pacing rate to the Max Track

Rate setting.

Asystole. During threshold tests, asystole may result due to loss of capture.

Electromagnetic Interference (EMI). At high sensitivity (low numerical settings) and in the presence

of excessive levels of interference, the Merlin PSA may inhibit completely or revert to asynchronous

operation, pacing at the Base Rate. Additional sources of strong EMI that can temporarily affect the

operation of the Merlin PSA include the following:

• Electrosurgical equipment

• Diathermy equipment

• Some medical telemetry equipment, when operated within one meter of the Merlin PSA

• Communication transmitters such as cellular phones and “walkie talkies”.

Move the source of EMI as far from the Merlin PSA as possible.

Asynchronous Pacing. During asynchronous pacing operation, pacing stimuli may be inadvertently

delivered within the vulnerable period of the T-wave. This may be hazardous to patients with acute

myocardial infarction or who are otherwise predisposed to arrhythmias.

Precautions

Temporary Pacing. Do not use the Merlin™ PSA as a temporary pacemaker. It should not be used to

provide extended external pacing in situations where the patient is left unattended. Testing has not

been performed to support this function.

Power Loss. In the event of a power loss to the programmer, the Merlin PSA continues to pace in the

safe pacing mode for the length of backup battery life. Do not use the Merlin PSA as an external

temporary pacemaker. Connect the patient to an external temporary pacemaker as soon as possible.

For more information, see Safe Pacing.

High Output and Maximum Sensitivity. In the presence of large depolarization potentials or large

output pulses, use of high sensitivity settings (low numerical settings) may allow potentials to

inappropriately inhibit (or trigger) the output.

Connecting the Lead System. Install the Merlin PSA in the Merlin PCS storage compartment and

launch the PSA application. (For installation instructions, see the Merlin PCS Model 3650 User’s

Manual.) Then connect the sterile patient cables (and accessories, as necessary) to the Merlin PSA

before connecting the lead to the sterile patient cable.

Electrostatic Discharge (ESD). Pacing leads provide a low-impedance pathway to the heart.

Therefore, discharge any static electricity prior to touching the patient, the cables, or the leads.

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 pacing mode to a demand

mode and then gradually reduce the pacing rate below the patient’s intrinsic rate. Once a spontaneous

rhythm is established, you can turn off pacing.

1-4 Introduction

Defibrillation/Cardioversion. The Merlin PSA may be damaged by defibrillation shocks when it is

connected to an implanted lead system. Test the Merlin PSA after it has been exposed to such charges

by launching the PSA application and verifying that the Merlin PSA is functional. Whenever possible,

for the safety of the patient, disconnect the Merlin PSA from the lead system before defibrillation or

cardioversion. After a typical defibrillation shock, the Merlin PSA will recover is less than five seconds.

Environmental Precautions. The Merlin PSA has been carefully designed and tested to ensure

reliability during normal use. However, electronic devices are susceptible to many environmental

stresses. Take precautions to avoid damaging the device, including (but not limited to) the following

examples:

• do not expose the Merlin PSA to extreme temperatures and/or humidity as that may result in

inaccurate measurements

• do not expose the Merlin PSA to mechanical shock as it may damage the Merlin PSA and result in

unreliable measurements

• do not store the Merlin PSA near magnets or magnetic-field-inducing coils as it may shorten its

lifetime.

Other environmental factors may affect proper performance of the device in the hospital setting. Use

of appropriate environmental health and safety practices helps prevent environmental damage to the

device.

Heart-Rate Monitoring. Monitor the patient’s heart rate with an ECG monitor while using the Merlin

PSA.

Liquid Immersion. Do not immerse the Merlin PSA in liquid or damage will result.

Adverse Events

Potential adverse events include:

• Prolonged surgery

• Arrhythmia

•Discomfort

• Additional surgical procedure

• Infection

Inhaltsverzeichnis

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