最佳起搏模式和部位讲解说明.pptVIP

Definition of Sites Giudici and Karpawich (1999) RV Inlet Septum: “Above, on, or beneath the annulus of the septal/anterior tricuspid valve leaflets. Relatively normal QRS morphology and axis.” RV Infundibular Septum: “Proximal to the pulmonic valve distal to, or near, the crista supraventricularis. Left bundle branch, vertical axis.” RV Outflow Septum: “Near the septal/moderator band insertion at the mid-position on the right ventricular septum. Left bundle branch, vertical axis.” RV Apical Septum: “Proximal to the septal/moderator band continuity that does not typically produce a vertical QRS axis.” Karpawich PP, et al. Am Heart J 1991;121:827-33 RV Apical Pacing RV Septal Pacing Are These Leads in the Same Location? Conclusion: No major differences but some systolic improvement relative to RV apex after 6 months Conclusion: No hemodynamic benefit of RVOT pacing relative to RV apex after 3 months Conclusion: RVOT pacing preserves LV systolic and diastolic performance relative to RV apex after 6-18 months Tse HF, et al.JACC 2002;40:1451-8 Bourke JP, et al. Europace 2002;4:219-28 Victor F, et al. JACC 1999;33:311-6 四.起搏部位 4.右心室多部位（RVMS）起搏 RVS－His是一个部位 RVA作为另一个部位 可缩短右心室的电激动时间 价值有待评价 Pachon-Mateos 五.频率反应 Chronotropic Incompetence 50% of pacemaker recipients have an inappropriate sinus mechanism to exertion and emotional stimuli Sick-Sinus Syndrome patients frequently have sinus function deterioration over time The problem can be precipitated or exacerbated by the need for antianginal or antiarrhythmic medication 115 55 Resting Rate Onset Activity Plateau Slow Return To Baseline End Activity Rapid Rise Time HR (min-1) Benditt, David G., Rate Adaptive Pacing; Blackwell Publishing 1993. p.57, fig 4.10 Heart-Rate Response in the Healthy Heart Myths and Reality Age: Myth: Old patients don’’t need rate adaptive pacing Reality: Older pacemaker patients require the same heart rate support as younger patients Myths and Reality Women: Myth: Wo