起搏器植入技术精选.ppt

* * * * * * * * * * * * * * * * * * PA and Lateral Chest X-ray: This is the same figure as in an earlier slide for atrial lead location however, now focusing on the ventricular lead. This is a dual chamber dual-unipolar pacing system with both leads inserted via the left cephalic vein. The ventricular tip does not reach the lateral edge of the heart. It also appears to go below the level of the diaphragm. The reason for this is that the diaphragm is a domed structure. The peak of the dome is behind the heart. Hence, it appears that the heart and hence the lead, extends below the level of the diaphragm. One must remember that the chest x-ray is a two-dimensional representation of a three dimensional structure. On the lateral view, the lead is directed anteriorly towards the sternum. * * * * * 可能会导致患者起搏器的房颤 * * * PA and Lateral Chest X-ray - Lead placement This patient has a dual unipolar DDD pacing system. Both leads were inserted via the left cephalic vein. The atrial lead is directed anteriorly on the lateral and angled medially high within the cardiac silhouette. The ventricular lead is located in the RV apex. This is not quite to the outer wall of the heart as this would be LV and indicate perforation. The apex of the RV is often below the level of the diaphragm. On the anterior view, a lead located n the RV apex is directed anteriorly. * * 主动导线可以先不旋出直接测试，测试合格后再固定 心室上旋出8-10圈，心房上旋出10-12圈 * * * * * * * * * SJM internal use ONLY 最后ECG分析 确认起搏器功能是否正确 SJM internal use ONLY 潜在的围手术期并发症 出血 气胸 解剖困难 导线放置困难 心律失常 SJM internal use ONLY 最后植入步骤 最后ECG分析，确认起搏器功能 术后第一天做胸部X线检查，以确认导线位置 出院前起搏器随访 术后6周至12个月，安排常规随访 SJM internal use ONLY 小结 外科医生 / 心脏科医生 / 电生理医生 手术室 / 心导管室 / 电生理实验室 设备 导线放置 阈值测量 囊袋缝合 最后步骤 * * * * * * * * Trend screen provides a graphical record of real-time measurements over time Battery voltage; HV lead impedance; pacing lead imped; capture thresholds and signal amplitude * * 中国国内大部分手术都是术后程控，如果术中因为某些原因，手术中途中止，起搏器未开封，那么所有信息还要清除，会比较麻烦，另外很多医院