双腔起搏器技术及临床心电图表现.pptVIP

In this example, the TARP is shorter than the upper tracking rate interval. Therefore, the pacemaker will exhibit Wenckebach operation as the P-P interval exceeds the upper tracking rate interval. In this graphic, we can see the difference between A-A timing and V-V timing schemes. In V-V timing, if a conducted ventricular event occurs during the AV interval, the ventricular pace is inhibited and a ventricular escape Interval (V-A interval) is immediately started. This effective shortening of the AV interval causes the entire V-V Interval to be shortened. Therefore, it is possible to be pacing in the atrium in DDD mode and be at a rate slightly faster than the programmed lower rate. In A-A timing, if a conducted ventricular event occurs during the AV interval, the ventricular pace is inhibited but the A-A interval remains consistent and does not exhibit the same shortening in the presence of AV conduction that V-V timing does. The goal of A-A timing is to provide for consistent A-A intervals, regardless of ventricular conduction. A-A timing is most important at higher rates. Imagine a pacemaker programmed to an upper rate of 130 ppm (interval of approximately 460 msec). Now lets say that there is ventricular conduction and the difference between the programmed PAV and the ventricular conduction time is 30 msec. That means that if the pacemaker were operating under V-V timing rules, the entire V-V interval at the upper rate would be shortened by 30 msec杄quating to a rate of 140 ppm! This is quite a difference from the intended programmed upper rate of 130 ppm. If the pacemaker were operating under A-A timing rules, the entire AV interval would time out regardless of ventricular conduction, maintaining the intended upper rate of 130 ppm. This picture is meant to provide some cheap laughs. Actually, the physician is real as is the device. The physician is Dr. Ake Senning from Sweden. The device is the first implantable pacemaker (circa 1958). The battery needed to