非竞争性心房起搏.ppt

非竞争性心房起搏 防止房性心律失常 临床问题： 由竞争性心房起搏引起的房性心律失常 心房起搏落在心房生理相对不应期内会导致房性心律失常 解决方案：非竞争性心房起搏 (NCAP) 不应期感知心房事件启动 一个 300 ms 的 NCAP 间期，无心房起搏在这个窗口内发生 PAV 间期缩短以维持平稳的心室频率 心室安全起搏 防止交叉感知 临床问题：交叉感知 交叉感知是感知到了对应的心腔传递出的起搏刺激，这会导致不希望有的起搏器反应，例如假抑制 交叉感知的原因 心房感知不足 夺获丢失 AV 延迟延长 感知其他导线的极化后效应 解决方案：心室安全起搏 在一个心房起搏事件后，一个心室安全起搏被启动 如果在安全起搏窗口发生心室感知，一个起搏脉冲会在缩短的间期内 (110 ms) 被发送 心室安全起搏 心室安全起搏 降低心室安全起搏发生率 程控合适的感知值 如果过感知起搏刺激引起 心室安全起搏，可使用降低输出的方法 * DDDR / 60 / 120 NCAP 揙N DDD / 70 / 120 心房后心室空白期 PAV 间期 房室安全起搏窗口 PVARP AV PVARP PVARP AV 110 ms VS VP VP VP AP AP AP DDD 60 / 120 If an atrial pace falls within the atriums relative refractory period, an atrial tachycardia may be induced. This can happen if a P wave falls during the PVARP (which will not inhibit the scheduled atrial pace) and then the scheduled atrial pace occurs shortly after the refractory sensed P wave and induces an atrial arrhythmia. Non-Competitive Atrial Pacing (NCAP) can be used in an effort to prevent atrial pacing from occurring too close to a refractory sensed event. If NCAP is programmed ON, the scheduled atrial pace will be delayed until at least 300 msec has elapsed since the refractory sensed P wave occurred. The ensuing PAV may then be shortened to keep the ventricular rate from experiencing the same delay. Note: The PAV may never be shorter than 80 ms. Crosstalk is a phenomenon that occurs when one chamber senses the output pulse of the other chamber. Crosstalk can become a problem when one chamber senses the output of the other chamber and is inhibited. If the ventricular chamber is inhibited by the atrial pacing pulse, as seen in the third complex above, the ventricular output is withheld. In this particular example, crosstalk inhibition is intermittent but the outcome could be disastrous if it occurred with every paced atrial beat. If the ventricular lead is blanked for an adequate period of time after the atrial pacing pulse to avoid seeing the atrial pacing pulse, crosstalk inhibition will not occur. Programmable