起搏故障1.ppt

CorePace Module 4: Troubleshooting Even patients who have complete antegrade block may have the ability to conduct retrograde. But having the ability to conduct retrograde is not enough. There must be a situation in which the conduction pathways have had a chance to recover when a ventricular contraction occurs. This diagram shows the initiation of a PMT by a PVC. A retrograde P-wave occurs as a result of the PVC. This retrograde P-wave is sensed outside of the PVARP and starts an SAV interval. When the SAV interval times out, the upper tracking rate has not yet expired so the SAV interval is extended. A ventricular pace is initiated at the end of the upper tracking rate. Because the SAV interval was extended, the AV conduction pathways have recovered and the ventricular pace causes another retrograde P-wave. The sequence continues, which results in a sustained PMT. CorePace Module 4: Troubleshooting CorePace Module 4: Troubleshooting Atrial fibrillation, atrial flutter, etc. can quickly drive the paced ventricular rate to the upper rate limit. Similarly, oversensing caused by myopotentials or extraneous noise will be tracked, as seen on the ECG above. CorePace Module 4: Troubleshooting CorePace Module 4: Troubleshooting History and diagnosis should include: Date of implant Implant values (thresholds, lead impedance, P- and/or R-wave amplitudes, etc.) Indication for pacing Lead and generator information Patient exposure to EMI, such as electrocautery, radiation, defibrillation, cardioversion, or such external sources as heavy-duty electrical equipment, should be reported. Changes in medications that may increase thresholds include: Encainide Flecainaide Moricizine Propafenone Some Beta blockers Bretylium Procainamide Quinidine Some corticosteroids may reduce thresholds (prednisone). Lifestyle changes may occur daily (exercise, eating, and sleeping, for example) that can contribute to threshold changes. CorePace Module 4: Troubleshooting Having the patient pe