起搏器培训课件：植入式心电监测系统.pptVIP

* * Note: VT Onset” remained “OFF” for all tests. * * * * * * * * * * * * * * * * The minimum advised peak to peak signal amplitude when measured on the printed ECG strip remains 0.3 mV peak-to-peak. The minimum advised R wave amplitude as beat-to-beat displayed on the 2090 screen is 0.2 mV. The difference between the two methods is related to the fact that the R wave amplitude value as displayed on screen represents the rectified and filtered ECG signal available for R wave detection. It is advised to make use of the Vector Check tool for scanning of the indicated area of the left chest for a position and orientation with the highest and stable R wave amplitudes. Clinical experiences indicate that this best signal position may often be found over the ventricles, close to the V3 ECG electrode position. * * * The new 150 ms blanking period with dedicated noise search algorithm will avoid/reduce double counting on wide R wave complexes as sometimes seen with the old 70 ms blanking plus 60 ms refractory scheme. This will also reduce the risk of delayed- or missed FVT detections due to more consistent double counting resulting in false noise detection behavior. * * * * * * * * In this slide two examples are given. The upper graph shows in the stored ECG a wide variation in R-wave amplitude which is very typical for subcutaneous ECG monitoring. With a fixed threshold (as in the Reveal Plus) this may lead to undersensing of R-waves with smaller amplitudes and therefore false asystole detection (see Sense Marker and Filtered ECG). The lower graph shows a similar stored ECG with variations in R-wave amplitude but now each R-wave is sensed (see Sense Marker). This is due to the dynamic threshold (see Filtered ECG) with which the sensing threshold is adapted to the R-wave amplitude. For each sensed R-wave the sensing threshold is set to 65% of the R-wave amplitude and then slowly declines. With a dynamic threshold you will be able to track R-waves even when the R-wave