起搏器心电图全面解读.pptVIP

文氏现象与 2:1 阻滞 如果上限跟踪频率间期比心房总不应期长，起搏器首先表现文氏现象行为 PVARP 高限跟踪频率 AS AS AR 心房起搏 心室起搏 心室起搏 心室起搏 TARP SAV PAV PVARP SAV PVARP P 波阻滞（未感知的或未使用的） DDD 窦房结频率 = 109 bpm (550 ms) LR = 60 bpm (1000 ms) UTR = 100 ppm (600 ms) SAV = 200 ms PAV = 230 ms PVARP = 300 ms TARP TARP 文氏现象与 2:1 阻滞 如果上限跟踪频率间期比总心房不应期短，那么将发生 2:1 阻滞 高限跟踪极限 { P 波阻滞 AS AS 心室起搏 心室起搏 AR AR 窦房结频率 = 150 bpm (450 ms) PVARP = 300 ms SAV = 200 ms 跟踪的频率 = 66 bpm (900 ms) AV PVARP AV PVARP TARP TARP 如何保证文氏上限反应 上限频率间期(URI)长于总心房不应期(TARP) 自身心房间期SAI长于总心房不应期(TARP) 但短于上限频率间期(URI) 满足以上两个条件时发生文氏反应 如何保证文氏上限反应 上限频率间期(URI)长于总心房不应期(TARP) 自身心房间期SAI长于总心房不应期(TARP) 但短于上限频率间期(URI) 满足以上两个条件时发生文氏反应 * Remind audience that amplitude had been discussed when voltage was described. * The strength-duration curve illustrates the tradeoff of amplitude (intensity of stimulation, measured in volts) and duration (the length of time the stimulation is applied, measured in milliseconds). Capture occurs when the stimulus causes the tissue to react. On the graph, capture occurs on or above the curve. Anything below the curve will not capture. The lowest voltage on a stimulation curve which still results in capture at an infinitely long pulse duration is called rheobase. A voltage programmed below is inefficient and will lead to non-capture. The pulse duration at twice the rheobase value is defined as the chronaxie. Chronaxie time is typically considered most efficient in terms of battery consumption. * Safety margins have traditionally been selected as follows, when a threshold is determined by decrementing the pulse width at a fixed voltage: At a given voltage where the pulse width value is .30 ms: Tripling the pulse width will provide a two-time voltage safety margin. Pulse widths at a given voltage value which are .30 ms are not typically selected, because they are less efficient (expend more energy), while not providing further safety. In this case, the voltage should be doubled to provide a two-time safe