起搏器基本概念及起搏心电图阅图精编版.ppt

CorePace Module 4: Troubleshooting Interference falls under two categories: Electromagnetic interference (EMI) Skeletal myopotentials (noncardiac signals) Oversensing may occur when EMI signals are incorrectly interpreted as P- orR-waves. Sources of EMI are often found in hospitals and include surgical/therapeutic equipment, such as: Electrocautery Transthoracic defibrillation Lithotripsy RF ablation TENS units MRI is generally contraindicated for pacemaker patients. Exposure to a magnetic field may produce high-rate pacing that results in ventricular fibrillation and may damage the circuitry of the device. Concomitant devices, such as ICDs, should be tested to ensure that oversensing between the two devices does not occur. The most common type of myopotential interference is the inappropriate inhibition of pacing pulses as a result of the sensing of myopotentials. Myopotential oversensing is of greater concern with unipolar devices than bipolar devices. CorePace Module 4: Troubleshooting This ECG strip shows loss of atrial capture, followed by a scheduled ventricular pace. Following the ventricular pulse, the marker channel recorded an intrinsicP-wave. This ECG strip shows loss of ventricular capture. CorePace Module 4: Troubleshooting When the pacemaker problem is no output, the marker channel shows pacing markers桝P or VP梐lthough no artifact appears on the ECG. No output is defined as the failure to pace. Impulses are generated from the IPG, but is not transferred to the lead. CorePace Module 4: Troubleshooting A poor connection at the connector block can result in a lack of output, which can prevent the pacemaker from delivering a pacing pulse. In addition to lead dislodgment, lead perforation should be considered with acute implants as a potential cause of noncapture. Battery depletion can result in a lack of output, which can prevent the pacemaker from delivering a pacing pulse. At generator replacement procedures, (and sometimes at initial implants