双腔起搏器技术及临床心电图表现.PPT

相关心电图表现 下图中设备工作是否正常？ DDI 60; PAV 150 * This is a challenging and very unusual strip. Pacemaker operation is normal. A complete work-up was performed on the pacing system. No programming was able to resolve the atrial refractory sensing. Knowing the patient’s history is imperative to interpret the situation correctly. This patient has had ASD repair, a Finestein procedure, and some type of myoplasty. It appears that there may be far-field oversensing of the QRS, but... The result of the surgery left the patient with two sinus or atrial mechanisms that are reflected by the two atrial EGMs. (This slide demonstrated the beauty of simultaneous ECG and EGMs. Both P-waves are the same amplitude. The ‘2’ P - waves are not evident in this ECG, but are in the EGM.) His underlying rhythm is CHB. Occasionally you may see something similar to this in heart transplant patients, receiving dual chamber pacemakers. Their presentation can be even more confusing as often times the native and donor sinus nodes have different atrial amplitudes and rates. Since sensing the “second” P-wave did not affect pacemaker function, the device was left at the same parameters. (Like the previous case, mode switch operation and RAAV were ‘OFF’.) Remember to ‘exclude’ refractory sensed events, if using the histogram. Mode: DDD Model: Thera DR 7942 LR: 60 ppm Atrial Sensitivity: .5 mV UR: 140 ppm Atrial Output: 5.0 V Mode Switch: OFF Ventricular Sensitivity: 2.8 mV PAV: 210 ms Ventricular Output: 5.0 V SAV: 180 ms RAAV: OFF Atrial Lead Impedance: 612 ohms Ventricular Lead Impedance: 877 ohms * Interpretation: The pacing rate is 70 ppm. (Measure VA from VS to AP, and add AV interval.) Atrial pacing - appears normal. Atrial sensing - There are atrial refractory senses after each QRS. This is most likely reflecting retrograde conduction, after each intrinsic QRS. We are unable to assess the pacemaker’s ability to se