K Sensing Assurance感知保障培训讲义.pptVIP

Medtronic.Kappa 700 Series 感知保障 感知保障  临床问题: 感知灵敏度设置为固定值,会发生不感知或EMI/肌电干扰引起的过感知 Kappa 的解决方法: 起搏系统对策得的P/R波可自动调节设定的感知灵敏度 优势: 通过自动监测和调节感知灵敏度确保感知,提高病人的安全性, Sensing AssuranceTarget Sensing Margin Sensing Assurance -- Atrial Bipolar Example Auto Adjustment of Sensitivities Sensing Assurance -- Basic Rules of Operation Sensing Assurance will adjust if... Sense to Pace ratio 1:5 60% of sensed events are High/Low It will not adjust based on... PVC events “invalid” events (noise detector) Sensing Assurance -- Basic Rules of Operation Ventricular Sensitivity Trend Atrial Sensitivity Detail Medtronic Internal Use Only Chamber, Sense Polarity Target Margin (Low - High) Atrial Bipolar 4x - 5.6x Atrial Unipolar, Vent Bipolar and Unipolar 2.8x - 4x “Adequate” “High” 2.8 mV “Low” 2.0 mV 5.6xSensitivity 4xSensitivity CurrentSensitivity 0.5 mV 17 个连续低感知事件“LOW”, 感知灵敏度数值下调一档 36个连续高感知事件“HIGH”,感知灵敏度数值上调一档 Sensing Assurance Sensing Assurance is an operation whereby the Kappa 700 Series pacemakers automatically adapt the sensitivity settings for both the atrial and ventricular channel. This adaptation occurs over time whenever the amplitude of the intrinsic waveform changes up or down compared to the previously established measurements. Sensing Assurance Since the development of inhibited pacemakers, the challenge has always been to prevent undersensing of intrinsic cardiac signals and, at the same time, prevent oversensing of myopotentials and EMI. P- and R-waves not only differ in size, but also in morphology. Unpredictable changes in either aspect can lead to undersensing. There is no assurance that, when programming a fixed sensitivity value, the waveform will remain stable from follow-up to follow-up. The answer is to have a pacemaker designed to detect such changes and respond to them by automatically adapting the sensitivity value. Frohlig (1988) detected an overall average decrease in atrial signal amplitude due to exercise. Atri