CRT 程控随访 Troubleshooting演示文稿.ppt

December 2002 Medtronic, Inc. * 2012-2-28：R感知降低——如果LV感知，则振幅降低；如RV感知，则LV EGM上的信号降低 LV lead dislodgements may have a sudden onset or may be progressive over time. The initial indications of a LV lead dislodgement are far-field P-wave sensing and elevated thresholds. An LV lead dislodgement may progress from a micro-dislodgement to a gross dislodgement of the lead. The indications of a gross lead dislodgement include failure to capture and loss of sensing of the LV on the VEGM. December 2002 Medtronic, Inc. * Note the first four beats in this threshold test. The VEGM shows a large sensing indication after the As event marker. The LV lead is sensing the atrial activity and the Vs is not associated with the QRS complex on the surface ECG. Also note that there is only one ventricular sense indication associated with the QRS. The RV is still sensing ventricular activity, but the LV lead has dislodged to a position where it is only sensing atrial activity. This scenario is different from the simple far-field P-wave sensing scenario because the LV lead is no longer sensing the ventricular depolarization and because the lead is no longer capturing (pacing at 7.5V yields an RV-only morphology on the ECG). 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