起搏器程控PPT.pptVIP

For smooth-walled hearts or those that lack trabeculation, or in patients that have had a previous CABG procedure, active fixation leads may be a better choice to prevent lead dislodgment. The lead pictured on top is a fixed screw design. Those pictured at the bottom have an extendable/retractable helix. Epicardial or myocardial leads are implanted to the outside of the heart. These implants represent less than 5% of leads implanted, and are used primarily in pediatric cases or for patients in whom transvenous lead implant is contraindicated. Built-in Redundancy (multiple helical wires) Lead technology is advancing such that unipolar and bipolar leads will have smaller French sizes than those currently available. Depending on the monitoring equipment, unipolar pacing usually exhibits a larger pacing spike on some surface ECGs. In the unipolar system, the impulse: Travels down the lead wire to stimulate the heart at the tip electrode also referred to as the cathode (? Returns to the metal casing of the impulse generator or the anode (+) by way of body fluids The flow of the impulse makes a complete circuit. While unipolar and bipolar leads look similar (both have the appearance of one wire), most bipolar leads have a coaxial design, meaning an inner wire is insulated and wrapped with an outer wire, giving the lead the appearance of having only one wire. Bipolar leads are less susceptible to oversensing noncardiac signals as the spacing of the two electrodes (located in close proximity to one another) accounts for a much lower incidence of sensing extra-cardiac signals. The impulse: Travels down the lead wire to stimulate the heart at the tip electrode, which is the cathode (? Travels to the ring electrode, which is the anode (+), located several inches above the lead tip Returns to the pulse generator by way of the lead wire Dual-chamber pacing requires attention to these parameters: Lower rate AV and V-A intervals Upper rates Refractory periods Blanking perio