起搏器心图及分析.ppt

If the upper tracking rate interval is longer than the TARP, the pacemaker will exhibit Wenckebach behavior for some period of time before it goes into a 2:1 block pattern as the atrial rate increases. If the upper rate interval is shorter than the TARP, the pacemaker will exhibit 2:1 block behavior first and will never be able to achieve the upper tracking rate as the atrial rate increases. This situation is not as desirable as the situation in which there is a period of Wenckebach before 2:1 block because patients can tolerate the gradual ventricular rate drop of Wenckebach better than the precipitous ventricular rate drop caused by 2:1 block. Rate-Adaptive AV (RA-AV) is a shortening of the A-V interval in the presence of an increased atrial rate梑e it intrinsic or sensor driven. With higher intrinsic atrial rates, the SAV interval will shorten, which shortens the TARP, and allows for 1:1 tracking to occur at higher rates. With high rate sensor-driven pacing, the sensor-indicated rate determines the PAV interval, and allows for a longer VA interval which increases the atrial escape interval, allowing greater opportunity for intrinsic atrial events to be sensed. Both the PAV and the SAV shorten with increasing rates. For the PAV, the adaptation is based on the sensor-indicated rate. For the SAV, the adaptation is based on the intrinsic atrial rate. RA-AV has three programming requirements, in addition to the SAV and the PAV (at lower rates): A start rate, which determines when RA-AV operation begins A minimum AV interval, which is the shortest allowable SAV or PAV value A stop rate, which determines the rate where the minimum SAV and PAV is reached. Note: Device operation mentioned above is available in Thera and Kappa devices. Older generation pacemakers (such as Elite II) used a simpler algorithm: When the atrial rate reached 120 bpm, the SAV would shorten to 65 ms if RA-AV was programmed ON. Crosstalk is a phenomenon that occurs when one chamber sens