心脏起搏治疗【心内科】.ppt

心脏起搏治疗【心内科】 Once the lead(s) are positioned correctly and tested, they are anchored to the tissue at the pocket site. Enough slack is left in the lead to accommodate body movement. Then the lead is checked for stability. This slide shows atrial lead placement. The atrial lead is typically positioned in the atrial appendage. This slide shows a fluoro image of proper ventricular lead placement. Typically the lead is advanced as far as possible in the ventricular apex, being careful to avoid perforating the myocardium. Fluoroscopy is used to view lead placement. In general, the leads pass through the venous system with ease. Some manipulation is typically required to move the tip (1) across the bicuspid valve and/or (2) position the tip in the atrium. A stylet is often used to facilitate lead maneuvering. Once the lead is placed, electrical testing is essential. Sensing and pacing measurements are taken to verify proper positioning. The pulse generator pocket is made deep in the fascia above the pectoral muscle. The pocket should be carefully sized so it is large enough to prevent erosion and small enough to prevent migration. Routine techniques are used to suture and dress the incision. No special post-operative orders are required. The follow-up schedule is determined by the physician. More aggressive follow-up is reserved for patients who are pacemaker dependent or have devices with known potential problems, so that these problems can be avoided. The first follow-up visit normally occurs between 2 weeks and 90 days after implant. Patient complaints may necessitate a visit any time. In all follow-up situations, routine data is collected about cardiac and pacemaker performance. The most useful tools are the ECG and pacing system programmer. For routine follow-up: Verify the pacing system programmed parameters by interrogating the implanted device. Obtain an ECG strip with Marker Channel. Evaluate the patient’s underlying rhythm, disease progressi