单腔起搏器的相关技术与临床电图表现.pptVIP

北美和英国起搏及心电生理学会代码 识别起搏节律 识别起搏节律 单腔常用术语 低限频率 相对不应期与空白期 滞后 阈值 感知灵敏度 单极和双极 融合波 空白期和相对不应期 (空白期)起搏器“看不见”任何活动； (相对不应期)起搏器“看得见”任何后动； VVI 模式 起搏器受自身活动的抑制 滞后 可在感知自身搏动后使频率降到设定的低限频率以下 滞后 允许感知事件之间发生低限频率，起搏频率较高 强度 - 时间曲线图 强度 - 时间曲线图画出了振幅和脉宽的关系 曲线或曲线以上的值将导致夺获 感知灵敏度的概念 感知不良 有内在的去极化存在，但起搏器未能看见或感知 过分感知 感知到不适当的信号 可以是生理的或非生理的 起搏器各组成部分与人体组织结合形成一个完整的电路 脉冲发生器：电源或电池 电极或电线 阴极（负电极） 阳极（正电极） 人体组织 个案一： 个案二： 个案三： 噪声转换 连续的不应期感知将引起以低限频率或传感器驱动的频率起搏 个案五：Patient with a VVIR for Sick Sinus Syndrome. Single chamber timing has three components: Lower rate interval Refractory period Blanking period Single chamber devices that are programmed to a rate responsive mode add a fourth component, the upper rate interval. A paced or sensed event will initiate a blanking period. Blanking is a method to prevent multiple detection of a single paced or sensed event by the sense amplifier (e.g., the pacemaker detecting its own pacing stimuli or depolarization, either intrinsic or as a result of capture). During this period, the pacemaker is blind to any electrical activity. A typical blanking period duration in a single-chamber mode is 100 msec*. Note: In Thera and Kappa devices, nonprogrammable blanking parameters are dynamic (ranging from 50-100 ms) depending on the strength/duration of the paced or sensed signal. In inhibited modes (VVI/AAI), intrinsic events that occur before the lower rate interval expires will reset the lower rate interval, as shown in the example above. As with paced events, sensed events will also initiate blanking and refractory periods. Hysteresis allows the sensed intrinsic rate to decrease to a value below the programmed lower rate before pacing resumes. Hysteresis provides the capability to maintain the patients own heart rhythm as long as possible, while pacing at a faster rate if the intrinsic rhythm falls below the hysteresis rate. The hysteresis rate is always the lower rate limit. The lower rate limit is initiated by a paced event, while the hysteresis rate is init