起搏器植术后故障分析.pptVIP

临床医生和厂家技术代表之间的“鸿沟”－结束语 对于起搏心电图的分析 临床医生：更习惯于基于体表心电图的判断 技术代表：更擅长基于程控仪上的标记通道和EGM（腔内电图）来做进一步的判断 两种不同的切入习惯，但服务的对象是一致的，因此在解决术后起搏故障时互相借鉴是必要的。 后备幻灯片－单腔的时间间期 起搏间期 起搏间期 起搏间期 起搏间期 起搏间期 起搏间期 起搏间期 = 绝对不应期 = 相对不应期或噪音采样期 = 警觉期 后备幻灯片－心房和心室的时间间期 PVARP 警觉期 起搏的AV间期 感知的AV间期 心室警觉期 心室不应期 心室空白期 基于心室的时间间期 VA (AEI) = 800 ms AV 频率 = 63 ppm (AV+VA) 基于心房的时间间期 AA间期 = 1000 ms 频率 = 60ppm AV间期 更短 AV 后备幻灯片－基于心房的时间间期与基于心室的时间间期伴自身R波 程控: BR: 60ppm, 起搏的AV间期: 200ms * CorePace Module 4: Troubleshooting An intrinsic depolarization occurs in the atrium, but this depolarization is not sensed by the pacemaker. Therefore, the pacemaker sends an inappropriate pacing pulse to that chamber. Undersensing can be thought of as 搊verpacing. In this example, an AAI pacemaker is programmed to inhibit the atrial pacing pulse when a P-wave is sensed. Because the P-wave was not sensed, the pacemaker delivered an atrial pulse. If a pacemaker is undersensing, you will not see appropriate atrial sense markers on the marker channel. * CorePace Module 4: Troubleshooting If a pacemaker is oversensing, you will see signals on the marker channel that do not correspond to the ECG pattern. In this example, the pacemaker recorded a ventricular pulse on the marker channel. However, no activity was demonstrated on the ECG strip. Pauses or intervals longer than the programmed lower rate will occur in single chamber systems. Dual chamber systems may show tracking at the upper rate with atrial oversensing. This ECG exhibits oversensing that may be attributed to: Lead insulation failure (a decrease in lead impedance will be seen) Make-and-break fracture A lead connection problem (Note: The information below transitions into the next slide.) Insulation failure梐 common cause of oversensing梠ccurs when myopotentials are detected at the site of the insulation break. Lead fracture is another common cause of oversensing. As the frayed ends of conductor wires 搈ake and break？contact, the pacemaker senses these 搈ake and break？signals, w