起搏器心电图 课件.pptVIP

* 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, which results in oversensing. Oversensing may also occur if the lead is loose in the connector block. * This ECG strip shows loss of ventricular capture. * CorePace Module 4: Troubleshooting When the pacemaker problem is no output, the marker channel shows pacing markers桝P or VP梐lthough no artifact appears on the ECG. No output is defined as the failure to pace. Impulses are generated from the IPG, but is not transferred to the lead. * 这类患者心电图变化有以下特点:1发病时心房率变快,突然出现新的心律失常。2原有宽大畸形的QRS波群振幅变浅、出现与原主波方向相反的波形,相当于坏死性Q波形成。3ST-T波从原来与主波方向相反的继发性改变, 演变为与主波方向相同的伪性改善,并有动态变化。 * 起搏器心电图 * ?? 三腔起搏是近年来发展的一项新技术，是起搏器适应证的扩展。左、右心房同步十右室起搏。用于治疗阵发性房颤，心房为左房和右房同步起搏形成的融合搏动，心室仍为平常的起搏表现。三脏起搏的另一类型是左、右心室同步十右房起搏，用于治疗充血性心力衰竭，心室为左室和右室同步起搏产生的搏动，心房仍为平常的起搏表现。 三腔起搏心电图 * 起搏器心电图 * ?? 对有阵发性房颤、房内阻滞和充血性心力衰竭、室内阻滞的人可采用四腔起搏治疗、即左、右心房同步，左、右心室同步。 四腔起搏心电图 * 起搏器心电图 * 问题分类 感知不良 过感知 无夺获 无输出 通过心电图诊断 * 起搏器心电图 * 一、感知不良 有自身的除极活动存在，但起搏器未能察觉或感知 未感知 P 波 心房感知不良 * 起搏器心电图 * 二、过感知 心室过感知 标记道显示自身活动 …尽管没有活动 定义：感知到不适当的信号 可以是