Download - 起搏器的诊断功能应用
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中国医学科学院 阜外心血管病医院 张 澍 陈 新
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九十年代后
起搏系统的自动化功能时间周 ( 间 ) 期自动化时间周 ( 间 ) 期自动化
起搏方式自动化起搏方式自动化
自动抗 PMT自动抗 PMT
起搏器能量输出自动化起搏器能量输出自动化
起搏器感知调整自动化起搏器感知调整自动化
心脏起博的现代进展
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九十年代后
起搏系统的自动化功能起搏器的诊断功能起搏器的诊断功能
心脏起博的现代进展
应用己经植入人体的起搏器及其导线将病人心脏活动信息记录、存贮和分折,了解病人心律、起搏器工作情况,帮助医生对制定治疗方案
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•这是什么心律 ?•是否正常 ?•可能的异常是… .
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•这是什么心律 ?•是否正常 ?•可能的异常是… .
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•这是什么心律 ?•是否正常 ?•可能的异常是… .
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起搏器的诊断功能
技术 : 记录、存贮、分折程序目的及作用 :
– 了解病人自身心律状况– 了解起搏器工作情况– 帮助诊断复杂心律失常 ( 起搏心律失常 )– 帮助修改起搏器程控参数 , 使起搏器工作更
生理性– 减少起搏器人工随访及程控次数
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常规自动诊断功能– 频率有关 : 心律、心率、 AV 、– 心脏事件 : 早搏、 AMS 次数– 起搏系统功能 :
• 程控状态、电极阻抗、电池状态医生选择诊断程序 :
– 上述有关的细节 -- 耗电多、占容量大
起搏器的诊断功能
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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Vita 2 DDDR Status ListingSerial number 09w0055667
AV synchrony 84% Pathological atrial rates 10%resynchronised by ASP 1%PVCs 3%Retrograde conduction 2%Others 0%
100%
Apaced 76%Vpaced 54%T-wave sensed 98%
VSP’s 2313/day
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At rest
During exercise
During recovery
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SAV SAVVA VA
V-APAV V-APAV V-AAV AV V-A
V-AAV
V-AAV
DDD 起搏方式
AR PV
AV PR
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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Marker Channels
识别起搏器是什么模式或做什么识别什么时候产生了输出脉冲识别什么时候产生了自身事件诊断过分感知、感知不良和无输出时间间期标记
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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高频事件 (High Rate Episode)
用来:– 确认心房或心室心动过速事件的存在– 与上一次随访事件频率、持续时间和频率事
件相比较– 评估药物治疗的功效– 评估在某些时间段内发生事件的趋势
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显 示 时 间 显 示 AMS 次 数 AMS 时 的 频 率 AMS 持 续 时 间
AMS 统 计 图
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模式转换 模式转换 -- Thera-- Thera
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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AIDA explorerAIDA explorerAIDA explorerAIDA explorer
Follow-upFollow-upTherapyTherapy SafetySafety
1st level : rapid diagnosis1st level : rapid diagnosis
2nd level : arrhythmia identification2nd level : arrhythmia identification
3rd level : in-depth arrhytmia analysis3rd level : in-depth arrhytmia analysis
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PM functioningPM functioningPM functioningPM functioning
Optimization of Optimization of PM ProgrammingPM Programming
AIDA provides AIDA provides clear messagesclear messages
Suggestion for Suggestion for reprogrammingreprogramming
Follow-upFollow-upTherapyTherapy SafetySafety
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14 14 A & V Tachy A & V Tachy episodes episodes
Follow-upFollow-upTherapyTherapy SafetySafety
EGM storage EGM storage
Arrhythmia identificationArrhythmia identificationArrhythmia identificationArrhythmia identification
Chrono arrhythmic Chrono arrhythmic event graph event graph
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常规随访病人
Marker Channel & EGM
房性心律失常认识
起搏器的诊断功能
专门诊断程序
起搏系统功能评价
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起搏系统状态夺获、感知管理资料电池状态
– 估计需多长时间更换(在较新的设备中)– 信息 -- 电池正常、更换起搏器、或已到择
期更换指针导线状态
– 导线阻抗读数是导线完整性的重要指数
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Capture Management DiagnosticCapture Management Diagnostic
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Sensitivity TrendSensitivity Trend
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P-wave Amplitude during Exercise
rest 1 2 3 4 5 60
1
2
3
4
5
Exercise stage
P-wave amplitude (mV)
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P-wave Amplitude during Exercise
P-wave amplitude relative to rest
(%)
Exercise stageRest 1 2 3 4 5 6
100
80
60
40
20
Average P-wave
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2,5
5
pote
ntia
l (m
V)
0 1 2 3 4 5
0
tim e (s)
-2,5
0
2,5
5,0
pote
ntia
l (m
V)
-2 ,5
0
2 ,5
5,0
pot
en
tial (
mV
)诊断功能今后的发展
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Deriving Blood Pressure from Z-Recordings
50 m
mH
g
4 s
blood pressure
im pedance
im
ped
ance
VT
W. Arthur, G. C. Kaye PBMR 5 (4): 245-249, 2000
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结 论起搏器诊断功能可用来处理各种起搏故
障、使治疗更为理想化起搏器诊断功能帮助医生诊断心律失常动态记录、随访功能使医生能了解长期 /
每一跳患者心律失常特征评价治疗的效果相关的研究工作
nn