电极完整性功能组合.ppt

* * Long-term lead impedance can be observed directly on the initial interrogation in some devices. In other devices, the data is accessible by selecting the QuickLink? [] icon from the initial interrogation screen or the appropriate option from under the Data icon. * Lead Impedances The device measures two different impedances which are automatically taken every day at 3:00 am: Pacing impedance is calculated for each implanted lead (atrial and ventricular). High-voltage impedance is measured for each coil in the programmed defibrillation pathway. In most systems, these coils are the RV and SVC coils. ? Impedance measurements are made using a subthreshold pulse. High-voltage shocks or pacing pulses that capture the heart are not delivered during these measurements. ? Impedance Values Because the measured impedances depend on device configuration and lead type, normal values for all systems are difficult to provide. However, the following impedance value ranges provide a general guideline: Normal Pacing impedances: 200 – 2000 ohms Normal High-voltage impedances: 20 – 200 ohms ? Abnormal Impedance Measurements When lead impedance values consistently fluctuate over 30 percent from the baseline value, either higher or lower, the lead impedance should be considered abnormal [1]. ? Abnormal impedance measurements and their corresponding trends may indicate the integrity of the lead is compromised: When the impedance values decrease significantly, the lead’s insulation may be the issue. When impedance values increase significantly, the lead may be fractured or there may be a faulty connection in the header. ? When presented with abnormal lead impedances, other lead integrity diagnostics should be analyzed. These include sensing trends, threshold trends, and evaluation of recorded episodes, which may reveal oversensing. ? [1] Hayes, David L., et. al. (2000). Cardiac pacing and defibrillation: a clinical approach. New York: Blackwell Publishing. (pg. 398). * * * In wh