CRT心电图异常识别和处理.ppt

术前心电图 窦性心律 心房扑动 CRT-D术后心电图 CRT-D术后房性快速性心律失常 双室起搏比例明显降低—调整抗心律失常药物 药物治疗 胺碘酮0.2tid7天 0.2bid7天 0.2qd 术后一个月复查 总 结 CRT疗效受到各种复杂因素的影响，而心电图图形变化多样，其中有些是起搏的问题，而有些则是起搏器特殊功能的运作。因此正确认识和识别这些复杂的情况对于提高CRT起搏的疗效具有重要意义。 * * * This slide should be used to show the earliest and latest Ts before pacing. In the LV, the earliest activation was the basal anteroseptal segment and the latest activation was basal lateral segment. December 2002 Medtronic, Inc. * * * December 2002 Medtronic, Inc. * Another LV Only Threshold Test. In this test, they started high and worked down. At 3 V there is one morphology. At 2.5V there is another morphology and at 2V that morphology is consistent. What else would we need to verify that this was anodal stim? We need to see the rest of the strip to see loss of capture. Pace Polarity: Lvtip/Rvring 3V-Anodal Stim 2.5V Intermittent LV only/BiV anodal Stim pacing 2.0V-LV only pacing morphology December 2002 Medtronic, Inc. * A dislodged LV lead or a basally implanted lead can sense the left atrial (LA) depolarization. The key to identifying this issue is noting that the first Vs occurs before the onset of the QRS complex on the surface ECG. P-wave oversensing may be eliminated by changing ventricular sensitivity. P-wave oversensing can be differentiated from a full LV lead dislodgement by noting whether the LV lead can still produce a sense indication on the VEGM and whether it can still capture the ventricle. December 2002 Medtronic, Inc. * Note the sense indication on the VEGM after the Ap event in this strip. This indication is seen before the onset of the QRS. The LV lead is picking up far-field atrial activity. Also note that the two subsequent sense indications fall within the QRS, so the LV lead has not fully dislodged into the CS. Note the wide VEGM which gives one the main clue that the LV lead has not fully dislodged and is still sensing. The RV lead sense indication generally falls at the beginning of the QRS (usu