杨延宗起搏器时间间期及特殊功能.ppt

This ECG depicts Wenckebach operation. Pacemaker 2:1 block is characterized by two sensed P waves per paced QRS complex. This pattern develops because every other P wave falls into PVARP. Starting on the left side of this ECG, the sequence begins with a sensed P wave. This P wave initiates a SAV, followed by a paced ventricular event. The next P wave falls into the PVARP, started by the ventricular pace, so no SAV is initiated. The following P wave is sensed outside of the PVARP, so a SAV is started. Again, no ventricular event occurs during the SAV, so the pacemaker paces in the ventricle. In this manner, a 2:1 block pattern is created. The rate at which the pacemaker will exhibit a 2:1 block pattern is determined by the SAV and the PVARP (or the TARP). Atrial rates with a P-P coupling interval shorter than the TARP will result in 2:1 block. To determine at what rate the pacemaker will go into 2:1 block, the TARP is simply converted from an interval to a rate. Therefore, the rate the pacemaker will go into 2:1 block is: 60,000/TARP. If the upper tracking rate interval is longer than the TARP, the pacemaker will exhibit Wenckebach behavior for some period of time before it goes into a 2:1 block pattern as the atrial rate increases. If the upper rate interval is shorter than the TARP, the pacemaker will exhibit 2:1 block behavior first and will never be able to achieve the upper tracking rate as the atrial rate increases. This situation is not as desirable as the situation in which there is a period of Wenckebach before 2:1 block because patients can tolerate the gradual ventricular rate drop of Wenckebach better than the precipitous ventricular rate drop caused by 2:1 block. 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 be recharged every few days! Compare the P-P interval at w