双腔时间间期功能.ppt

* VSS- note the ~120ms AV interval AP- VS/VP; coincidentally, a PVC occurs just after the AP. The PVC occurs during the crosstalk detection window. No real way to fix the intrinsic PVC’s- you could try increasing the rate. * No LOC; evaluate the ECG gain– THERE IS A T-WAVE! Again, the PVC occurs just after the AP and double counts the PVC * Loss of V-sensing; functional loss of capture. Mode is VVI although this is a DDD device. The PVC is of much higher amplitude in the V-bipolar configuration. May want to consider testing different polarities or just reprogram the bipolar sensitivity to see the intrinsic Sinus QRS * Device is programmed to AAI * * 51 Discuss the disadvantages of long PVARP * * * What does the device call a PVC???If it falls outside 280 ms. * * * * Just another example of A-Pace on PVC- notice the retrograde P-wave starts a new 330ms * 51 * * * * * Algorithm cannot determine ST from a true PMT * Trilogy, Affinity, Integrity, and ICDs: Wiggle is 31ms Identity and ADx devices: Wiggle is 50ms Integrity and Affinity = 31ms Everyone else = 50ms * * * * * * 120ms AV delay is a hallmark sign of Crosstalk occurring; * * Here is that hallmark 120ms AV delay!!! V-blanking can be programmed 12-52ms What other scenarios would cause the AV delay to shorten to 120 ms (i.e. Magnet, programmed, Rate Responsive AV Delay, Negative AV/PV Hysteresis) * This example shows VSS due to loss of A capture. The patient’s intrinsic R wave happens to fall in the CTDW and the device safety paces. * * * * * * * RRPVARP can help prevent competive atrial pacing. AP following AS in PVARP (that conducts) can be counted as cross talk even though this is not the case. Auto Ventricular blanking is not available if the stored EGM trigger high ventricular rate is selected- why- because after the software was set they discovered that every time the algorithm was activated it detected noise and a high v rate egm was stored- Will be fixed later!!! Auto Ventricular