起搏心电图与起搏器的故没障分析.pptVIP

患者，男，因I度AVB、间歇性III度AVB植入Vitatron公司的DDD起搏器，术后起搏、感知功能正常。一月后行CABG手术，术后心电图示I度AVB。 为什么PR间期 AV延迟? 例 2 1.是否程控为AAI的工作方式? 否 2.是否为心房电极脱位或断裂 ？否 3.是否为AV间期程控过长？否 4.是否心房不应期程控过长，使P波落在不应期内？否 5.是否心房感知灵敏度值程控过高造成心房感知不足？是 * * VOO mode paces in the ventricle but will not sense and, therefore, has no response to cardiac events. Pacemakers programmed to the VVI, VVIR, and VDD modes will revert to VOO mode upon magnet application. In this example, an intrinsic beat occurs, but it has no effect on the timing interval and another ventricular pace is delivered at the programmed rate. No sensing occurs, thus, the entire lower rate interval is unresponsive to intrinsic activity. * 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. * Single chamber rate-responsive pacing is identical to non-rate responsive pacing operation, with the exception that the pacing rate is driven by a sensor. The sensor determines whether or not a rate increase is indicated, and adjusts the rate accordingly. The highest rate that the pacemaker is allowed to pace is the upper rate limit or interval. In this example, the pacemaker is pacing at the maximum sensor indicated rate of 120 ppm. * Although this mode is seldom used (particularly in the USA) , AAI/R pacing is a mode which, unlike VVI/R, allows for normal AV conduction to occur. AAI/R is not often used because of the risk of development of AV block which can occur over time. In this example, the patient received a single chamber device programmed to the AAIR pacemaker mode due to sick sinus syndrome and chronotropic incompetence. Presently the patient is at rest, so the sensor is at the programmed lower rate. An atrial event (paced or sensed) will initiate a refractory period including a blanking period. As previously stated, in AAI/R, the refractory peri