心脏起搏器培训资料：SenseAbility 和附加功能 (2)

1、SenseAbility SenseAbility和附加功能和附加功能 SJM internal use ONLY SenseAbilityTM Formerly Automatic Sensitivity Control (ASC) is used in: Current RF (2007) II Family (2006) Atlas + DR and VR (2004) Epic + DR and VR (2003) Atlas DR and VR (2002) Epic DR and VR (2002) Photon DR and VR (2001) Photon DR (2000)

2、SJM internal use ONLY Ideal Sensing Circuit Ideal sensing circuit: Senses R-waves Senses varying amplitudes of arrhythmias from sinus rhythm to low amplitude ventricular fibrillation Does not over sense P-waves, T-waves, myopotentials or EMI Filters the signal to achieve a clean, noise-free waveform

3、 suitable for detection SJM internal use ONLY 理想的感知回路理想的感知回路 理想的感知回路理想的感知回路: 感知感知R波波 感知心律失常时从窦律至室颤之间变化的振幅感知心律失常时从窦律至室颤之间变化的振幅 无过感知无过感知P波、波、T波、肌电干扰或波、肌电干扰或EMI 过滤信号，以获得一个清晰且没有干扰的波，用于检测过滤信号，以获得一个清晰且没有干扰的波，用于检测 SJM internal use ONLY Sensing Challenges Sensing challenges Combine the functions of an ICD w

4、ith a dual chamber rate responsive pacemaker Add the ability to use atrial sensing as an SVT discriminator Accurate sensing in both the atrium and ventricle is critical for appropriate therapy delivery SJM internal use ONLY 感知的挑战感知的挑战 感知的挑战感知的挑战 结合结合ICD和双腔频率适应性起搏器的功能和双腔频率适应性起搏器的功能 加上心房感知，作为加上心房感知，作为

5、SVT鉴别标准鉴别标准 心房和心室的精确感知对发放正确的治疗至关重要心房和心室的精确感知对发放正确的治疗至关重要 SJM internal use ONLY Sensing Options Pacemakers Fixed sensitivity NSR VT/VF SJM internal use ONLY 起搏器的感知选项起搏器的感知选项 固定的感知灵敏度固定的感知灵敏度 NSR VT/VF SJM internal use ONLY Auto Sensitivity Control SJM internal use ONLY 自动感知灵敏度调整自动感知灵敏度调整(ASC) SJM int

6、ernal use ONLY Programmable Sensing Features Programmable sensing features Threshold start Decay delay Maximum sensitivity Refractory periods All parameters can be adjusted or “fine tuned” in the presence of sensing problems Boston Scientific and Medtronic have limited programmability for under/ ove

7、rsensing issues SJM internal use ONLY 可程控的感知功能可程控的感知功能 可程控的感知功能可程控的感知功能 阈值起始阈值起始(Threshold start) 衰减延迟衰减延迟(Decay delay) 最大感知灵敏度最大感知灵敏度(Maximum sensitivity) 不应期不应期(Refractory periods) 当存在感知问题时，调整这些参数中的一个或多个可有助当存在感知问题时，调整这些参数中的一个或多个可有助 于解决问题于解决问题 MDT和和BSX遇到感知不足遇到感知不足/过感知问题，可程控的参数有限过感知问题，可程控的参数有限 SJM i

8、nternal use ONLY Signal Processing The raw EGM signals are Filtered to minimize T-waves, noise and far-field signals Digitally rectified resulting in a signal that has only positive deflections WANDA reflects rectified BTK analyzer measures peak to peak and so do pacemakers SJM internal use ONLY 信号处

9、理信号处理 原始的原始的EGM信号信号 经过滤，使经过滤，使T波、噪音或远场信号最小化波、噪音或远场信号最小化 经数位校正，产生仅为正相的信号经数位校正，产生仅为正相的信号 WANDA反映校正过的信号反映校正过的信号 BTK分析仪测量从波峰至波谷的距离，起搏器也是分析仪测量从波峰至波谷的距离，起搏器也是 SJM internal use ONLY Sensed Refractory Sensed Refractory : Ventricular: 125 (nominal) or 157 ms Atrial: 93 (nominal), 125 or 157 ms Maximum Amplit

10、ude R-Wave or P-Wave Sensed Sensed Refractory SJM internal use ONLY 感知不应期感知不应期 感知不应期感知不应期 : 心室心室: 125 (默认值默认值) 或或 157ms 心房心房: 93 (默认值默认值)、125 或或 157ms 最大振幅最大振幅 感知的感知的R波波 或或P波波 感知不应期感知不应期 SJM internal use ONLY Sensed Refractory For each sensed R-wave or P-wave the highest amplitude peak that falls wi

11、thin the sensed refractory is determined This peak amplitude is stored and used to determine the threshold start SJM internal use ONLY 感知不应期感知不应期 在感知不应期内在感知不应期内R波或波或P波的振幅峰值被确定波的振幅峰值被确定 该峰值振幅被存储，并用于决定阈值起始该峰值振幅被存储，并用于决定阈值起始 SJM internal use ONLY Threshold Start Definition: percentage of maximum peak a

12、mplitude sensed during the sensed refractory period used to begin the linear decay Ventricular threshold start 50%, 62.5% (nominal), 75% or 100% Atrial threshold start 50% (nominal) , 62.5%, 75% or 100% SJM internal use ONLY 阈值起始阈值起始 定义定义: 在感知不应期内感知到的最大峰值振幅的在感知不应期内感知到的最大峰值振幅的 百分比，用作于线性衰减的起始百分比，用作于线性

13、衰减的起始 心室阈值起始心室阈值起始 50%、62.5% (默认值默认值)、75% 或或 100% 心房阈值起始心房阈值起始 50% (默认值默认值)、62.5%、75% 或或 100% SJM internal use ONLY Threshold Start Nominally 62.5% of measured R (Max start value 3.75 mV if R waves are 6mV) Nominally 50% of measured P (Max start value 1.5 mV if P-waves are 3mV) Fixed rate of decay A

14、trium 0.5 mV per 312 ms Ventricle 1.0 mV per 312 ms 50% 62.5% R-WaveT-Wave SJM internal use ONLY 阈值起始阈值起始 默认值默认值: 测得测得R波的波的62.5% (如果如果R波波6mV，则最大起始值为，则最大起始值为3.75mV) 默认值默认值: 测得测得P波的波的50% (如果如果P波波3mV，则最大起始值为，则最大起始值为1.5mV) 固定的衰减率固定的衰减率 心房心房: 每每312ms衰减衰减0.5mV 心室心室: 每每312ms衰减衰减1.0mV 50% 62.5% R波波T波波 SJM i

15、nternal use ONLY Rules to SenseAbilityTM Threshold Start Ventricular: Threshold start will not start higher than 6.0 mV or lower than 1.0 mV Atrium: Threshold start will not start higher than 3.0 mV or lower than 0.3 mV I.E. If R-waves are 10 mV and threshold start is 62.5%, it will begin at 3.75 mV

16、 SJM internal use ONLY SenseAbilityTM阈值起始的原则阈值起始的原则 心室心室: 阈值起始参照的阈值起始参照的R波不会高于波不会高于6.0mV或低于或低于1.0mV 心房心房: 阈值起始参照的阈值起始参照的P波不会高于波不会高于3.0mV或低于或低于0.3mV 举例举例: 如果如果R波为波为10mV，阈值起始设置为，阈值起始设置为62.5%，则阈值，则阈值 起始将开始于起始将开始于3.75mV SJM internal use ONLY Decay Delay Holds threshold at starting value for a period of

17、time May be increased if oversensing T-wave oversensing on RV channel Far field R-waves on RA channel 0 ms 60 ms SJM internal use ONLY 衰减延迟衰减延迟 在一段时间内使阈值维持于起始值在一段时间内使阈值维持于起始值 如果发生过感知，则可增加衰减延迟如果发生过感知，则可增加衰减延迟 RV通道上的通道上的T波过感知波过感知 RA通道上的远场通道上的远场R波波 0 ms 60 ms SJM internal use ONLY Decay Delay Programmi

18、ng Ventricular Post sensed: 0, 30, 60 ms (nominal), 95, 125, 160, 195 and 220 ms Post paced: Auto, and the options above Atrium Post sensed: 0 (nominal), 30, 60, 95, 125, 160, 195 & 220 ms Post paced: Same as post sensed SJM internal use ONLY 衰减延迟的程控衰减延迟的程控 心室心室 感知后感知后: 0、30、60ms (默认值默认值)、95、125、160

19、、195 和和 220ms 起搏后起搏后: 自动和以上选项自动和以上选项 心房心房 感知后感知后: 0 (默认值默认值)、30、60、95、125、160、195 和和 220ms 起搏后起搏后: 同感知后同感知后 SJM internal use ONLY Maximum Sensitivity (The “Floor”) Definition: The most sensitive level to which the device can decay Anything below the maximum sensitivity is not seen by the device Sepa

20、rately programmable (ICD and pacemaker) Nominals: Ventricular 0.3 mV (max is 0.2mV) Atrial 0.2 mV (max is 0.1mV) SJM internal use ONLY 最大感知灵敏度最大感知灵敏度 定义定义: ICD能衰减到的最敏感水平能衰减到的最敏感水平 任何低于最大感知灵敏度的信号都不能被任何低于最大感知灵敏度的信号都不能被ICD看见看见 ICD和起搏器的最大感知灵敏度可分开程控和起搏器的最大感知灵敏度可分开程控 默认值默认值: 心室心室0.3mV (最大为最大为0.2mV) 心房心房0.

21、2mV (最大为最大为0.1mV) SJM internal use ONLY Maximum Sensitivity Decays until reaches max sensitivity or another signal is sensed V- Max Sensitivity = 0.3 mV A- Max Sensitivity= 0.2 mV 0.3 mV SJM internal use ONLY 最大感知灵敏度最大感知灵敏度 衰减直至达到最大感知灵敏度或感知到另一个信号衰减直至达到最大感知灵敏度或感知到另一个信号 V- 最大感知灵敏度最大感知灵敏度 = 0.3mV A- 最大

22、感知灵敏度最大感知灵敏度 = 0.2mV 0.3 mV SJM internal use ONLY R wave Sensed Sensed Refractory R-wave = 7 mV R-wave = 4 mV Threshold Start 62.5% = 2.5 mV Threshold Start: 62.5% = 3.75 mV 3.75 mV 2.5 mV R-wave Sensed Sensed Refractory Max Sensitivity Decay Delay 60 ms Decay Delay 60 ms SenseAbilityTM SJM internal

23、 use ONLY 被感知的被感知的R波波 感知不应期感知不应期 R波波= 7mV R波波 = 4 mV 阈值起始阈值起始 62.5% = 2.5 mV 阈值起始阈值起始 62.5% = 3.75 mV 3.75 mV 2.5 mV 被感知的被感知的R波波 感知不应期感知不应期 最大感知灵敏度最大感知灵敏度 衰减延迟衰减延迟 60 ms 衰减延迟衰减延迟 60 ms SenseAbilityTM SJM internal use ONLY Competitive Comparison Boston Scientific Max sensitivity Medtronic Max sensiti

24、vity Programmable Refractory periods SJM internal use ONLY 竞争产生比较竞争产生比较 BSX 最大感知灵敏度最大感知灵敏度 MDT 最大感知灵敏度最大感知灵敏度 SJM internal use ONLY Post Paced There is a separate algorithm used when the device is pacing There is no P- or R-wave to measure The threshold start and decay delay are based upon the pacin

25、g rate SJM internal use ONLY 起搏后起搏后 起搏时的运算法则不同起搏时的运算法则不同 没有测得的没有测得的P波或波或R波波 阈值起始和衰减延迟基于起搏频率阈值起始和衰减延迟基于起搏频率 SJM internal use ONLY Post Paced As the rate increases, the threshold start will decrease This allows the device to become more sensitive at fast rates VRP VRPVRPVRP Automatic Post Pace Thresho

26、ld Start SJM internal use ONLY 起搏后起搏后 随着频率的增加，阈值起始将下降随着频率的增加，阈值起始将下降 使使ICD在较快频率时有更高的敏感度在较快频率时有更高的敏感度 VRP VRPVRPVRP 自动的起搏后阈值起始自动的起搏后阈值起始 SJM internal use ONLY 附加功能附加功能 Far R Suppression SJM internal use ONLY SenseAbility 远场远场R波抑制波抑制 SJM internal use ONLY Special: Additional Problem: Far Field R waves

27、 are being sensed on the Atrial Channel Atrial sensitivity needs to be sensitive enough to reliably sense atrial fibrillation SJM internal use ONLY 附加功能附加功能 问题问题: 心房通道上感知到远场心房通道上感知到远场R波波 心房感知灵敏度需足够敏感，从而能可靠感知到房颤心房感知灵敏度需足够敏感，从而能可靠感知到房颤 SJM internal use ONLY Special: Additional Ventricle Atrium SJM int

28、ernal use ONLY 附加功能附加功能 心室心室 心房心房 SJM internal use ONLY Additional Parameters Solution: Turn on Far R Suppression Far Field R-waves are evaluated by looking on the Atrial EGM for sensed events following paced and sensed Ventricular events Also the VS-AS Interval Counter could be checked. This counte

29、r measured how many times the VS to next AS wave is 80 ms. A high count may indicate Far R sensing on the atrial channel. SJM internal use ONLY 附加参数附加参数 解决方案解决方案: 打开远场打开远场R波抑制波抑制 通过观察心室起搏和感知事件后的心房通过观察心室起搏和感知事件后的心房EGM上的上的 感知事件，来评估远场感知事件，来评估远场R波波 同时检查同时检查VS-AS间期计数器。该计数器测量间期计数器。该计数器测量VS至至 下一个下一个AS的距离的距

30、离 80ms的次数。高的计数提示心的次数。高的计数提示心 房通道上的远场房通道上的远场R波感知波感知 SJM internal use ONLY Additional Parameters Far R Suppression is a blanking period that is used to cover up Far-Field R-waves on the Atrial Sensing Channel Settings: (Atlas DR, Atlas+ DR, Epic DR, Epic+ DR, Photon DR, Photon DR) Off, 20, 30, 200 ms

31、(Nominal: Off) Settings: (Atlas+ HF, Epic HF, Epic+ HF) Off, 20, 30, 250 ms (Nominal: Off) Following a ventricular paced or sensed event, the atrial channel becomes blanking for the programmed period of time. SJM internal use ONLY 附加参数附加参数 远场远场R波抑制是一个空白期，用于掩盖心房感知通道波抑制是一个空白期，用于掩盖心房感知通道 上的远场上的远场R波波 设置

32、设置: (Atlas DR, Atlas+ DR, Epic DR, Epic+ DR, Photon DR, Photon DR) 关闭关闭, 20, 30, 200ms (默认值默认值: 关闭关闭) 设置设置: (Atlas+ HF, Epic HF, Epic+ HF) 关闭关闭, 20, 30, 250ms (默认值默认值: 关闭关闭) 。在程控的间期内，紧。在程控的间期内，紧 跟一个心室起搏或感知事件，心房通道成为空白期跟一个心室起搏或感知事件，心房通道成为空白期 SJM internal use ONLY Far R Suppression PVAB FRSFRS Sensing

33、Far R suppression Surface RV Electrogram RA Electrogram Pacing SJM internal use ONLY 远场远场R波抑制波抑制 PVAB FRSFRS 感知感知 远场远场R波抑制波抑制 体表心电图体表心电图 RV EGM RA EGM 起搏起搏 SJM internal use ONLY Far R Suppression SJM internal use ONLY 远场远场R波抑制波抑制 SJM internal use ONLY Far R Suppression SJM internal use ONLY 远场远场R波抑制

34、波抑制 SJM internal use ONLY Solution: Far R Suppression turned On SJM internal use ONLY 解决方案解决方案: 打开远场打开远场R波抑制波抑制 SJM internal use ONLY SenseAbility Arrhythmia Unhiding SJM internal use ONLY 附加功能附加功能 心律失常揭示心律失常揭示 SJM internal use ONLY Special: Additional Problem: Inability to detect tachycardias at fa

35、st tracking or sensor driven rates due to a shortened detection window SJM internal use ONLY 附加功能附加功能 问题问题: 由于快速跟踪或传感器频率引起检测窗口缩短，从而不能由于快速跟踪或传感器频率引起检测窗口缩短，从而不能 检测心动过速检测心动过速 SJM internal use ONLY Pace Refractory Sensing Window at 120 bpm pacing 150 ms Special: Additional Pace Refractory Sensing Window

36、 at 80 bpm pacing 400 ms Pace Refractory 350 SJM internal use ONLY 起搏不应期起搏不应期 在在120bpm时的感知窗口为时的感知窗口为150ms 附加功能附加功能 起搏不应期起搏不应期 在在80bpm时的感知窗口为时的感知窗口为400ms 起搏不应期起搏不应期 350ms SJM internal use ONLY Special: Additional Solution: Arrhythmia Unhiding looks for possible hidden rhythms and if detected will exp

37、and the detection window SJM internal use ONLY 附加功能附加功能 解决方案解决方案: 心律失常揭示可以寻找可能被掩盖的节律。如检测到，则心律失常揭示可以寻找可能被掩盖的节律。如检测到，则 扩大检测窗口扩大检测窗口 SJM internal use ONLY Arrhythmia Unhiding Three parts to the Arrhythmia Unhiding Algorithm The Pacing Rate must be fast enough Detection of possible hidden tachyarrhythmi

38、a Extension of detection window SJM internal use ONLY 心律失常揭示心律失常揭示 心律失常揭示运算法则的心律失常揭示运算法则的3个部分个部分 起搏频率必须足够快起搏频率必须足够快 检测到可能被掩盖的快速心律失常检测到可能被掩盖的快速心律失常 扩大检测窗口扩大检测窗口 SJM internal use ONLY Arrhythmia Unhiding Three Part Process Fast Pacing Rate 1 Pacing Interval Extension 3 Look for Hidden Events 2 SJM int

39、ernal use ONLY 心律失常揭示心律失常揭示 3个步骤个步骤 快速起搏频率快速起搏频率 1 起搏间期延长起搏间期延长 3 寻找被掩盖事件寻找被掩盖事件 2 SJM internal use ONLY Arrhythmia Unhiding Detection of possible hidden rhythm First, the rate must be fast. This creates a condition that allows a tachycardia to remain “hidden” for an extended period of time. The rat

40、e is considered fast enough whenever the ventricular escape interval is less than or equal to the shorter of either twice the lowest programmed rate cut off or twice the ventricular refractory period. SJM internal use ONLY 心律失常揭示心律失常揭示 检测可能被掩盖的节律检测可能被掩盖的节律 首先，频率必须快。这样就产生了一个条件，即心首先，频率必须快。这样就产生了一个条件，即

41、心 动过速在一个较长的时间间期内持续动过速在一个较长的时间间期内持续“被掩盖被掩盖” 只要心室逸搏间期短于或等于以下值中的较小值只要心室逸搏间期短于或等于以下值中的较小值 程控的最低频率起始点的程控的最低频率起始点的2倍或心室不应期的倍或心室不应期的2倍倍 SJM internal use ONLY Arrhythmia Unhiding - Example Pace 400VT-1 Detection 400 ms 275Ventricular Refractory Period 275 ms 500Ventricular Escape Interval 500 ms SJM interna

42、l use ONLY 心律失常揭示举例心律失常揭示举例 起搏起搏 400VT-1检测检测400ms 275心室不应期心室不应期275ms 500心室逸搏间期心室逸搏间期500ms SJM internal use ONLY Special: Additional Ventricular Refractory Period 275 ms Ventricular Escape Interval 500 PacePace VT-1 Detection 400 ms Twice Ventricular Refractory Period 275 = 550 ms Twice VT-1 Detectio

43、n 400 = 800 ms Shorter of these two = 550 ms Vent. Escape Interval = 500 ms 500 ms 550 ms so the potential for a hidden rhythm now exists 1 SJM internal use ONLY 附加功能附加功能 心室不应期心室不应期275ms 心室逸搏间期心室逸搏间期500ms 起搏起搏起搏起搏 VT-1检测检测400ms 心室不应期的心室不应期的2倍倍 = 550 ms VT-1检测的检测的2倍倍 = 800 ms 较小值较小值 = 550 ms 心室逸搏间期心室

44、逸搏间期 = 500 ms 500 ms 550 ms 提示现在可能存在被掩盖节律提示现在可能存在被掩盖节律 1 SJM internal use ONLY Special: Additional Once the rate criteria is met, we now look for hidden events. The last part of the ventricular refractory period is checked for hidden events. The area of the refractory period that is checked for even

45、ts is called the Adaptive Relative Refractory Period ARRP = Ventricular Pacing Refractory Period - (Ventricular Escape Interval/2)-30 ms SJM internal use ONLY 附加功能附加功能 一旦频率标准满足，即开始寻找被掩盖的事件一旦频率标准满足，即开始寻找被掩盖的事件 心室不应期的最后部分用于检查被掩盖事件心室不应期的最后部分用于检查被掩盖事件 用于检查事件的不应期部分被称作自适应相对不应期用于检查事件的不应期部分被称作自适应相对不应期 (ARRP

46、) ARRP = 心室起搏不应期心室起搏不应期 - (心室逸搏间期心室逸搏间期/2)-30 ms SJM internal use ONLY Special: Additional Ventricular Escape Interval 500 Pace Pace Ventricular Refractory Period 275 ms 500 ms -30 ms = 220 ms 2 ARRP 2 SJM internal use ONLY 附加功能附加功能 心室逸搏间期心室逸搏间期500ms 起搏起搏 起搏起搏 心室不应期心室不应期275ms 500 ms -30 ms = 220 ms

47、2 ARRP 2 SJM internal use ONLY Special: Additional If an event is sensed during the ARRP the ARRP Event counter is incremented by one The ARRP counter is programmable to OFF or ON from 2 to 15 (Nominal Setting is 3) SJM internal use ONLY 附加功能附加功能 如果在如果在ARRP间期内感知到一个事件，那么间期内感知到一个事件，那么ARRP事件计数事件计数 器增加器

48、增加1 ARRP计数器可程控为关闭或打开计数器可程控为关闭或打开(2-15，默认值为，默认值为3) SJM internal use ONLY Special: Additional If the ARRP Counter is programmed to OFF, Arrhythmia Unhiding is OFF The ARRP counter is reset when the pacing rate falls below the Arrhythmia Unhiding Rate Criteria SJM internal use ONLY 附加功能附加功能 如果如果ARRP计数器

49、程控为关闭，那么心律失常揭示关闭计数器程控为关闭，那么心律失常揭示关闭 当起搏频率低于心律失常揭示频率标准时，当起搏频率低于心律失常揭示频率标准时，ARRP计数计数 器重设器重设 SJM internal use ONLY Special: Additional Criteria have now been met and we believe we have a “hidden” tachycardia. Now we must ensure that we will detect this tachycardia. SJM internal use ONLY 附加功能附加功能 现在标准已经

50、满足，我们相信有一个现在标准已经满足，我们相信有一个“被掩盖的被掩盖的”心动过心动过 速速 现在我们必须确保检测到该心动过速现在我们必须确保检测到该心动过速 SJM internal use ONLY Special: Additional In order to unhide the tachycardia, the pacing interval is extended by the ARRP for the next 6 intervals If the 6 extended pacer intervals occur without detecting an arrhythmia, t

51、he Arrhythmia Unhiding Algorithm will be locked out for the next 10 intervals SJM internal use ONLY 附加功能附加功能 为了揭示心动过速，接下去为了揭示心动过速，接下去6个间期的起搏间期被延长个间期的起搏间期被延长 ARRP 如果如果6个被延长的起搏间期内未检测到心律失常，那么接个被延长的起搏间期内未检测到心律失常，那么接 下去下去10个间期，心律失常揭示运算法则将被关闭个间期，心律失常揭示运算法则将被关闭 SJM internal use ONLY Special: Additional Ven

52、tricular Escape Interval 500 Pace Ventricular Refractory Period 275 ms Pace = ARRP Pace 3 SJM internal use ONLY 附加功能附加功能 心室逸搏间期心室逸搏间期500ms 起搏起搏 心室不应期心室不应期275ms 起搏起搏 = ARRP 起搏起搏 3 SJM internal use ONLY Arrhythmia Un-hiding Pacing 80ppm 1 Pacing 120ppm Potential for Hidden Arrhythmia SJM internal use

53、ONLY 心律失常揭示心律失常揭示 起搏起搏 80ppm 1 起搏起搏 120ppm 可能存在被掩盖的心律失常可能存在被掩盖的心律失常 SJM internal use ONLY Pacing with Hidden Tachycardia 2 High rate pacing Arrhythmia Initiated Hidden within pacing refractory period SJM internal use ONLY 起搏伴被掩盖的心动过速起搏伴被掩盖的心动过速 2 高频率起搏高频率起搏 心律失常启动心律失常启动 起搏不应期内被掩盖起搏不应期内被掩盖 SJM intern

54、al use ONLY Pacing with Hidden Tachycardia 12 3 ARRP Pacing Interval Extended by ARRP to Detect Tachyarrhythmia SJM internal use ONLY 起搏伴被掩盖的心动过速起搏伴被掩盖的心动过速 12 3 ARRP 起搏间期延长起搏间期延长ARRP，以检测快速心律失常，以检测快速心律失常 SJM internal use ONLY Additional Parameters: Arrhytmia Unhiding SJM internal use ONLY 附加功能附加功能:

55、心律失常揭示心律失常揭示 SJM internal use ONLY Arrhythmia Unhiding SJM internal use ONLY 心律失常揭示心律失常揭示 SJM internal use ONLY Arrhythmia in Hiding SJM internal use ONLY Arrhythmia in Hiding SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY To find this on Merlin: Parameters/ Special/ Additional Se

56、nseAbility Programmability SenseAbility 可程控性可程控性 SJM internal use ONLY Atrial Sensing Automatic or Fixed SJM internal use ONLY 心房感知心房感知 自动或固定自动或固定 SJM internal use ONLY Max Atrial Sensitivity is 0.2 mv SJM internal use ONLY 最大心房感知灵敏度为最大心房感知灵敏度为0.2mV SJM internal use ONLY At Fixed It Is What You Set

57、It To SJM internal use ONLY 固定的心房感知灵敏度固定的心房感知灵敏度 SJM internal use ONLY Pacemaker and defib max sensitivity can be different SJM internal use ONLY 起搏器和除颤器的最大起搏器和除颤器的最大 感知灵敏度可以不同感知灵敏度可以不同 SJM internal use ONLY Can Change for Double Counting Due to Wide QRS SJM internal use ONLY 如果存在宽如果存在宽QRS波引起波引起 的双重

58、计数，则可调整的双重计数，则可调整 感知不应期感知不应期 SJM internal use ONLY To Change Threshold Start and Decay Delay SJM internal use ONLY 改变阈值起始和衰减延迟改变阈值起始和衰减延迟 SJM internal use ONLY Nominal is 0 SJM internal use ONLY 默认值默认值 0 SJM internal use ONLY Nominal is 0 SJM internal use ONLY 默认值默认值 0 SJM internal use ONLY Nominal

59、is 50% SJM internal use ONLY 默认值默认值 50% SJM internal use ONLY Nominal is 0.8 mV SJM internal use ONLY 默认值默认值 0.8mV SJM internal use ONLY Nominal is 60 ms SJM internal use ONLY 默认值默认值 60ms SJM internal use ONLY Nominal is Auto SJM internal use ONLY 默认值默认值 自动自动 SJM internal use ONLY Nominal is 62.5% S

60、JM internal use ONLY 默认值默认值 62.5% SJM internal use ONLY Nominal is Auto SJM internal use ONLY 默认值默认值 自动自动 SJM internal use ONLY May Change if T-wave Over Sensing During Pacing SJM internal use ONLY 如果在起搏期间发生如果在起搏期间发生T波过感知，波过感知， 则可以改变起搏后不应期则可以改变起搏后不应期 Case Studies Hows my sensing? 病例讨论病例讨论 ICD的感知如何的感