ICD的基本工作原理biotronik__培训课件.pptVIP

心律转复 用低能量同步除颤 除颤 用高能量非同步除颤 Time 40% 20% Biphasic (Voltage control) Biphasic 2 (Voltage/Time control) Voltage 100% 40% Shortening of second phase can reduce the DFT for critical patients* * Merkely B., Lubinski A., Kiss O., et al. Shortening the second phase duration of biphasic shocks: effects of class II antiarrhythmic drugs on defibrillation efficacy in humans. J Cardiovascular Electrophysiol 2001; 12:824-827 Shock Waveform 放电波形 Time 40% 2 ms Voltage 100% 40% Shock Polarity 放电极性 Normal t V Inversed t V 1st 30 J 2nd 40 J 3rd 40 J 4th 40 J 5th 40 J Normal Normal Inversed unsuccessful unsuccessful successful 从第一个最大除颤能量后开始交替 detection 1st shock normal polarity 2nd shock inverse polarity termination Patient Example charging ... redetection/charging ... Shock energy: No. of shocks: Shock impedance: up to 30/40 J 0-8 30 - 100 Ohms Example Shock Therapy 除颤治疗举例 小结 Sensing: ASC (Standard, Enhanced VF sensitivity, Enhanced T-wave suppression) Detection: VF：rate (VF zone), detection counter (X in Y) VT: rate (VT zone), detection counter (10-60), onset (%) stability (?ms), sustained VT (Safety timer: 30s-30min) Redetection: VF: rate (VF zone), detection counter (X in Y) VT: rate (VT zone), redetection counter (10-30), without onset and stability Termination detection: 12/16* sinus Shock confirmation: 3/4* sinus *不可程控 小结 Therapy: ATP: burst, ramp, burst+PES, … ATP optimization ATP timeout ATP One Shot Shock: waveform (biphasic, biphasic 2), polarity (normal, inversed, alternating) progressive course of therapy * * UT is set at 50% of R wave UT decays 0.125 mV every 250 ms through the Hold of Upper Threshold period (default 360 ms) Threshold drops to the Lower Threshold which is set to 25% of R wave LT then decreases 0.125 mV every 500 ms until Minimum Threshold is reache