K7 RDR频率骤降反应.pptVIP

Medtronic.Kappa 700 Series 频率骤降反应 频率骤降反应 临床问题: VVS or CSS病人因为频率突然下降而有晕厥 Kappa解决方法: 高频率起搏防止或减少晕厥的发生 优势: 减少因晕厥引起的摔倒或受伤 两种 RDR 治疗 1, 骤降检测: 检测心室率的骤降满足不 同的程控参数 频率骤降已定义 2,低频率检测: 检测与程控的低频率相比 心率的骤降 频率骤降未定义且难以确定 频率骤降反应-骤降检测治疗 1,检测窗口 (10 seconds to 2.5 minutes) 2,检测范围Drop Size (10 - 50 bpm) 3,骤降频率Drop Rate (30 - 100 bpm) 4,检测次数 (non-programmable 2) 5,干预频率 (60 - 180 ppm) 6,干预间期 (1 - 15 minutes) 频率骤降反应-骤降检测治疗 频率骤降反应- 低频率检测 1,检测次数 (1, 2, or 3) 2,干预频率 (60 - 180 ppm) 3,干预间期 (1 - 15 minutes) 频率骤降反应- 低频率检测 RDR 事件诊断 – 自动 RDR 详细诊断 RDR 详细诊断 RDR 程控建议 Medtronic Internal Use Only (当频率达到程控的较低频率及次数时干预发生 可与骤降反应同时发生) Rate Drop Response Rate Drop Response Clinician Selected diagnostics 3 3 Detection Beats (If Low Rate Detect or Both) 45 bpm 40-45 bpm Lower Rate 2 min 1 min Intervention Duration 100 ppm 100 ppm Intervention Rate 1 min 30 sec Detection Window 60 bpm 50 bpm Drop Rate 25 bpm 30 bpm Drop Size Drop Detect Drop Detect Detection Type VVS CSS Programming Guidelines Rate Drop Response Syncope, or fainting, very often has a cardiovascular origin. If the faint is due to a drop in heart rate that precedes or is the major factor, compared to vaso-dilation, the symptoms and sometimes the faint itself can be ameliorated with pacing. VVS has a variety of triggering mechanisms, though the actual cause is not well known or characterized. CSS, on the other hand, has a well known triggering mechanism and cause--hyper-carotid sinus sensitivity. When the carotids are massaged or have pressure applied to them, the person faints. VVS is more often found in younger individuals, whereas CSS is more prevalent in the older population. In the elderly, fainting often leads to falls, with fractures of the limbs as well as other injuries. The North American Vaso-Vagal Study definitively proved that, in carefully selected patients, pacing was a far better therapeutic option than drugs. The Newcastle experience in the UK has shown a reduction in overall medical costs (e.g., nursing