双腔起搏心电图分析和起搏器一般故障排除要点.pptVIP

* 起搏器文氏现象 * 1、2、5、6为起搏夺获波 3为融合波 4、5、6为自身心律 7为PVC * 真性融合波：波形接近起搏波 假性融合波：波形接近自身心律（起搏无效） * Slide 27 ? 2002 GUIDANT CORPORATION Continuing Education Program For Educational Use Only All Rights Reserved Pseudomalfunction Pseudofusion Beat Pseudofusion The pacemaker paces immediately after/simultaneously with an intrinsic depolarization. The resulting beat looks more intrinsic than paced. * Slide 29 ? 2002 GUIDANT CORPORATION Continuing Education Program For Educational Use Only All Rights Reserved Summary ? Pacing Problems ? Sensing Problems ? Pseudomalfunctions * 上图为过感知 * 1、5、7为起搏波 3为融合波 2、4、6为失夺获 * 房颤伴过感知 * 心室失夺获 第2、5个自身节律可能落在不应期 第3个自身节律未感知到 * 心室感知不足。 为什么那么大的心室信号不能被感知？可能导线脱位。 Normal AV pacing with capture; atrial and ventricular sensing cannot be determined Normal DDD function: capture cannot be determined Normal DDI pacing with capture. Atrial sensing good, ventricular sensing cannot be determined atrial undersensing is occurring. Appropriate V-sensing; Capture cannot be determined MTR setting too low Ventricular undersensing; atrial sensing cannot be determined; good atrial capture, functional LOC in ventricle Atrial undersensing; determine VA interval to assist evaluating a-sensing PVC之后的VA间期＝BRI－AV Delay (not PV Delay) Noise on V-lead causing V-oversensing Notice Sweep Speed! V-oversensing occurring; determine source Recording artifact- notice how T-wave is cut off and the line isn’t isoelectric but much higher! LOC in A and V; V-sensing good, cannot determine A-sensing V-oversensing EMI that leads to A-oversensing with inappropriate tracking Normal DDDR pacing 模式: DDD 频率: _____________ 起搏的/感知的AV间期: _____________ 心房夺获: _____________ 心室夺获: _____________ 心房感知: _____________ 心室感知: _____________ 双腔ECG分析#1 DDD 基本频率: 60 ppm 起搏的AV间期: 160 ms 感知的AV间期: 140 ms 心房夺获: _____________ 心室夺获: _____________ 心房感知: _____________ 心室感知: _____________ ECG #2a ECG #3 DDI 基本频率: 60 ppm 起搏的AV间期: 160 ms (为什么没有感知的AV间期?) 心房夺获: _____________ 心室夺获: _____________ 心房感知: