围手术时代心脏植进装配的治理 专家共叫.ppt

围手术期间心脏植入装置的管理 专家共识解读 南昌大学第二附属医院 鲍慧慧 ; Committee Staff 8AHA/ACC/4ASA/1STS; 概 要;Abbreviations; More than 3,000,000 devices were implanted in the globe 全球约有三百万以上患者心脏植入装置 700,000 devices was implanted in 2009 2009年有700,000患者心脏植入装置 Increasing at the rate of 15% every year 每年以15% 速度递增 ;Ensure patients with devices safe in perioperative period Need for a consistent statement 1、Rapid changes in CIED technology 2、Expanding use of EMI 3、 Confusing recommendations ;Problems that can occur during medical procedures; EMI and CIEDs Electrosurgical energy ;EMI and CIEDs;Extent of abnormal behavior depends on ： Strength Duration Particular type of interference Clinical impact depends on ： Patient’s intrinsic rate and rhythm Pacing mode Functioning of protective circuitry engineered to filter out extraneous electrical currents ; Electrosurgical energy;Interactions with CIEDs including ： Inhibition Triggering unneeded tachyarrhythmia therapy Electrical reset Oversensing ;Directly to the pulse generator or system electrode Permanent damage of the CIED pulse generator Damage to the lead-myocardial interface causing an increase of pacing thresholds No damage if the distance is 6 inches ;Determine consequences of oversensing： Duration of exposure Path of the current Patient’s underlying rhythm Oversensing in ICDs results in ： inhibition of pacing ATP therapy ICD shocks ;ICD require a certain duration of continuous high-rate sensing to fulfill arrhythmia detection criteria An approach that limits electrosurgery usage to short bursts may be a safer approach to patient-CIED management than either reprogramming the CIED or placement of a magnet over the pulse generator;CIED uses a minute-ventilation sensor for rate response Rate responsive algorithms occurs because the impedance measurement is miscalculated due to the current from the electrosurgery. Also in some CIEDs, the magnetic