起搏器特殊功能教学课件.ppt

* * * * * 心肌的电冲动起源于窦房结，向下通过房室结和传导路径到达心室。 窦房结位于上腔静脉与右心房的交界处。它的细胞根据生理需要产生电脉冲引起心肌收缩，并将血液送到全身。电冲动从心房传出后，会引起心房收缩和除极波。 房室结位于右心房的下部，靠近室间隔。当除极波到达时会产生延迟，这可使心房完全收缩，给心室足够的充盈。这种延迟的机制又称房室顺序。 希氏束沿室间隔下降，分成两支，最后形成蒲氏纤维进入心室壁。经过房室结后电脉冲传导速度很快，引起心室强烈收缩，并使心脏泵血。 Student Notes Putting it together: An animated view of cardiac conduction and the associated ECG. Instructor Notes Auto-animated slide * 因此我们人工心脏起搏就是模拟我们正常心脏的冲动形成及传导顺序，帮助需要起搏支持的心脏重建。。。。。 愿望是非常美好的，现实是如何呢？ * Atrial fibrillation occurred in 24.2 percent of the study population, including 4.8 percent in whom it developed for the first time. The incidence of atrial fibrillation after randomization was significantly lower in the dual-chamber group (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008) (Figure 1 and Table 2). Of 487 patients in whom atrial fibrillation developed after randomization, 105 (21.6 percent) had chronic atrial fibrillation (15.2 percent of patients with dual-chamber pacing, as compared with 26.7 percent of patients with ventricular pacing; hazard ratio for chronic atrial fibrillation in the overall study population, 0.44; 95 percent confidence interval, 0.29 to 0.67; P0.001). Patients receiving dual-chamber pacing who had no history of atrial fibrillation had a 50 percent lower incidence of atrial fibrillation after randomization (hazard ratio as compared with ventricular pacing, 0.50; 95 percent confidence interval, 0.32 to 0.76; P=0.001), whereas patients receiving dual-chamber pacing who had a history of atrial fibrillation had a smaller, nonsignificant 14 percent reduction (hazard ratio, 0.86; 95 percent confidence interval, 0.70 to 1.04; P=0.12). Hospitalization for heart failure occurred in 10.3 percent of the patients receiving dual-chamber pacing and 12.3 percent of the patients receiving ventricular pacing (hazard ratio, 0.82; 95 percent confidence interval, 0.63 to 1.06; P=0.13). Adjusted Analyses Multivariable analyses were performed to control for slightly higher