心脏起搏器并发症和故障的处置.ppt

新旧电极在心腔内碰击产生信号被新电极感知 废弃的电极干扰 ICD/IPG干扰导致感知不良和会延误 VF识别 ICD/IPG相互干扰 4.心肌外刺激 心肌外刺激 常见类型 右心尖起搏膈肌刺激 左心室起搏膈神经刺激 肌肉刺激 治疗措施 术中高电压刺激 术后电极导线换位 导线替换 5.其它 电池提前耗竭 装置或元件损坏 4-Step Troubleshooting Strategy Step 1: 确定故障 患者叙述 从诊断信息获得 Step 2: 列出可能的原因 电极故障 Device 故障 其他故障 Step 3: 确定原因 诊断性测试与分析（Detection off） Step 4: 解决故障 无创或有创 谢谢 * * 起搏器介导心动过速 A lead is implanted in, what can be referred to as, a hostile environment. To function appropriately it must endure constant flexure with each heart beat. If a lead failure is suspected acutely, the failure is typically a connector issue or a placement issue (dislodgement, micro-dislodgement, perforation). Problem: The setscrew (lower left) was obstructing the connector bore. Possible Symptoms?: Erratic resistance, Intermittent capture, Over/Undersensing. Acute/Chronic? Acute Definitive Diagnostic: Fluoroscopy/X-ray (pin doesn’t go past the set screw), Manipulation, Invasive – pull lead before loosening the set screws. Problem: Leads were incorrectly plugged into the ports. AXB is actually ABX. 可能的表现: DFT过高. 阻抗可能增高. EGM 信号相反 (Can to HVB is actually Can to HVX). Acute/Chronic: Acute Solution: 有创方法– 重新正确连接电极. 线索：高压的阻抗回路 Another acute issue with the lead system occurs by way of lead instability that leads to dislodgements and/or perforations. Dislodgements and perforations generally occur at or shortly after implant. Common signs of lead dislodgement are a change of visual under fluoroscopy and/or x-ray, elevated or changed pacing threshold, and/or sensing threshold. Common signs of lead perforation are cardiac tamponade, change in pressure and dyspnea. Lead perforation can be definitively diagnosed by way of Echo. Problem: Atrial lead dislodgement. Possible Symptoms: Loss of capture and sensing. Inappropriate therapies during SVTs. Acute/Chronic: Mostly Acute Definitive Diagnostic: X-ray (compare to previous). Keep in mind that not all X-rays are taken in the exact same position. Solution: Invasive procedu，r