心脏起搏器培训资料：频率适应性起搏-(2)课件

1、Rate Responsive Pacing频率适应性起搏 Rate Responsive PacingSensor TechnologyOptimizing Rate Adaptation频率适应性起搏传感器技术最优化的频率反应Rate Responsive PacingAlso known as.Sensor Driven PacingRate Adaptive PacingRate Modulated Pacing频率适应性起搏也被称为.传感器驱动的起搏频率反应性起搏频率调节的起搏Rate Responsive PacingUse of a sensor besides the sinu

2、s node to adjust the pacing rate to meet the patients metabolic needsIndicated for chronotropic incompetence频率适应性起搏使用除窦房结以外的一个传感器，调整起搏频率，以满足患者新陈代谢的需要适用于变时性功能不全的患者What is Chronotropic Incompetence?DefinitionAn inadequate heart rate for a given level of metabolic needMaximum HR 90% x (220 - age)Maximu

3、m HR 120 bpm 什么是变时性功能不全?定义心率不足以满足一特定水平的新陈代谢需要最大心率 90% x (220 年龄)最大心率 120 bpm 60 70 80 90100110120130140150TimeIncrease in Metabolic DemandDecrease inMetabolic DemandPPMNormal Chronotropic Response 60 70 80 90100110120130140150时间新陈代谢需要增加新陈代谢需要减少PPM正常的变时反应PPMTime 60 70 80 90100110120130140150Chronotro

4、pic IncompetencePPM时间 60 70 80 90100110120130140150变时性功能不全TimePPM 60 70 80 90100110120130140150Chronotropic Incompetence时间PPM 60 70 80 90100110120130140150变时性功能不全PPMTime 60 70 80 90100110120130140150Chronotropic IncompetencePPM时间 60 70 80 90100110120130140150变时性功能不全Causes of Chronotropic Incompetenc

5、eAgingDrugsHeart Disease变时性功能不全的原因老年药物心脏疾病Diagnosis of Chronotropic IncompetenceHistoryHolter or Telemetry MonitoringExercise Testing变时性功能不全的诊断病史Holter或遥测监护运动试验Normal Sinus NodeThe gold standard for Pacemaker sensors正常的窦房结起搏器传感器的金标准Characteristics of The Ideal SensorPhysiologic Sensitive Rapid onset

6、 and offset Linear response to workload Responds to metabolic demandemotionsfever Unaffected by cardiac medications理想的传感器特点生理学方面 灵敏 快速启动和频率补偿 对工作量的线性反应 对新陈代谢需要的反应情绪发热 不受心脏药物的影响Characteristics of The Ideal SensorTechnical Reliable and stable Utilizes standard leads Minimal battery drain Standard conn

7、ector Standard implant technique Simple to program and follow理想的传感器特点技术方面 可靠和稳定 使用标准导线 最小的电池消耗 标准接头 标准植入技术 程控和随访简单Todays SensorsNon-physiologic sensorsVibrationAccelerationPhysiologicMinute VentilationTemperatureQ-T IntervalClosed Loop System (CLS)Combination sensors今天的传感器非生理传感器震动(压力)加速度计生理传感器每分钟通气量

8、温度QT间期闭环系统 (CLS)混合传感器Piezoelectric crystalCircuit boardPiezoelectric CrystalSensor mounted to canEasy to manufactureRapid response to onset of activityCompatible with standard pacing leads压电晶体电路板压电晶体传感器固定在机壳上容易生产对活动的反应快速与标准的起搏导线兼容Low current drainEasy to manufactureRapid response to onset of activit

9、yCompatible with standard pacing leadsNot responsive to pressure applied to canUsed in all current St. Jude Medical pacemakersAccelerometerCircuit BoardAccelerometer电流消耗低容易生产对活动的反应快速与标准的起搏导线兼容对施加在机壳上的压力没有反应使用于目前所有SJM公司的起搏器上加速度计电路板加速度计Standard Bipolar LeadSignal Generated Betweenthe Ring and the Canr

10、 = 0.97 with NSRMinute VentilationNo special sensorSends low-level electrical signals to measure transthorasic impedanceRequires bipolar pacing leadsTempo标准双极导线在环和机壳之间产生信号每分钟通气量没有特殊的传感器发送低水平的电信号以供测量经胸阻抗需要双极起搏导线ThermistorTemperature Thermistor in LeadSensor mounted in leadRequires special pacing lead

11、热敏电阻导线中的热敏电阻传感器固定在导线上需要特殊的起搏导线QT IntervalStandard Unipolar or Bipolar Lead The interval between theSpike and the evoked T wave shortens with exercise (200-300 ms).Limitation:Requires stimulationQT 间期标准的单极或双极导线 起搏钉和T波之间的间期因运动而缩短(200-300ms)局限性:需要刺激 （运动时交感神经兴奋，心肌收缩力增强，心肌细胞除极和复极的时间缩短）RestExerciseEvoked

12、Response Standard Bipolar Lead The QRS depolarization area decreases with exercise Limitation:Requires stimulationChanges with body positions休息运动ER波 标准的双极导线 QRS除极面积随运动而减少 局限性:需要刺激随体位变化Closed Loop System (CLS)Standard Bipolar Lead Translates changes in cardiac contractility (inotropy) into heart rate

13、Limitations:Requires stimulationChanges with body positions/content/detail.php?id=2475 1.00.80.60.40.20Ventricular FillingEjectionIsovolumetric Contraction50100150200250300RestLoad闭环系统 (CLS)标准的双极导线 将心肌收缩性变化转换成心率局限性:需要刺激随体位变化/content/detail.php?id=2475 1.00.80.60.40.20心室充盈射血等容收缩50100150200250300休息负荷状

14、态下Programming of Rate-Modulated PacemakersBase RateMax Tracking Rate (DDDR)Max Sensor RateThresholdSlopeReaction TimeRecovery Time频率适应性起搏器的程控基本频率最大跟踪频率 (DDDR)最大传感器频率阈值斜率反应时间恢复时间Z Z Z ZHeart RateMaximum Heart RateWorkload(220 - Age) x 0.9Normal Sinus NodeZ Z Z Z心率最大心率工作量(220 年龄) x 0.9正常的窦房结Pacing Rat

15、eWorkloadSensor SignalMaximum Sensor Rate (MSR) (220 - Age) x 0.9Maximum Sensor RateZ Z Z Z起搏频率工作量传感器信号最大传感器频率 (MSR) (220 年龄) x 0.9最大传感器频率Z Z Z ZThresholdThe amount of activity required to initiate sensor activityProgrammable from 1-7 Lower number requires less activityAutomatic Threshold available

16、on all devices (AUTO)阈值启动传感器所需的活动量可以程控为 1-7 较低的数值需要较少的活动度SJM所有的起搏器上都有自动阈值 (AUTO)功能THRESHOLD 1 2 3 4 5 6 7Pacing RateWorkloadSensor SignalZ Z Z ZThreshold阈值 1 2 3 4 5 6 7起搏频率工作量传感器信号Z Z Z Z阈值Auto ThresholdMeasures variance in last 18 hours of activityAdjusts automaticallyMeasured Average Sensor value

17、 displayed on interrogation Offset values for Auto Threshold Auto -0.5, +0.0, +0.5, +1.0, +1.5, +2.0自动阈值测量最近18个小时内活动度的变化自动调整询问时将显示测得的平均传感器值自动阈值调整的偏移值 自动 -0.5, +0.0, +0.5, +1.0, +1.5, +2.0SlopeThe sensor-driven heart rate for a given level of activityProgrammable from 1-16Higher values = higher heart

18、 rateAutomatic Slope斜率一特定活动度水平的传感器驱动心率可程控为1-16较高的数值 = 较高的心率自动斜率Sensor Signal MSR(220 - Age) x 0.91618Pacing RateWorkloadZ Z Z ZSlope传感器信号 MSR(220 年龄) x 0.91618起搏频率工作量Z Z Z Z斜率 Auto SlopeAutomatic slope adjustment according to changes in patient-specific activityCreates a new activity variance histog

19、ram every 7 days to calculate a new slopeResearch shows normal heart rate stays within 23% of heart rate reserve for 99% of the time 自动斜率根据患者的活动度变化，而自动调整斜率每7天产生一个新的活动度变化直方图，从而计算出一个新的斜率研究表明，在99%的时间内，正常心率保持有23%心率储备Pacing RateTimeVery slowVery fastBasic RateSensor Indicated Rate (SIR)FastSlowReaction T

20、imeTime to increase from base rate to Maximum Sensor Rate (MSR)起搏频率时间非常慢非常快基本频率传感器指示频率 (SIR)快慢反应时间从基本频率上升至传感器指示频率所需的时间TimeBasic RateSensor Indicated Rate (SIR)very slowvery fastRecovery TimeTime to decrease rate from Maximum Sensor Rate (MSR) to base ratePacing Rate时间基本频率传感器指示频率 (SIR)非常慢非常快恢复时间从传感器指

21、示频率下降至基本频率所需的时间起搏频率Sensor Indicated Rate HistogramHistogram display of the distribution of paced rates that would have occurred had the sensor been totally controlling the systemRecords if Sensor programmed to On or Passive传感器指示频率直方图直方图显示了传感器完全控制起搏系统情况下的起搏频率分布仅在传感器程控为“打开”或“观察”时记录Sensor Indicated Rat

22、e HistogramDisplaysTotal number of sample counts within each rate rangeThe percentage of sample counts at each sensor indicated rate rangeDate readTotal time sampledDate last clearedRe-programming Sensor from Off to another setting will clear the histogram传感器指示频率直方图显示每个频率范围的采样总数每个传感器指示频率范围的采样百分比读取数据

23、的日期全部采样时间上次清空日期将传感器从关闭程控至其他设置将清除直方图Sensor Indicated Rate Histogram传感器指示频率直方图Sensor Indicated Rate HistogramCapacity:Each bin can collect up to 16,777,215 eventsWhen one bin is full counter stops collectingSampling RateEvery 1.6 seconds - 310 daysEvery 26 seconds - 14 years传感器指示频率直方图容量:每个计数仓能够收集多达16,

24、777,215个事件当一个计数仓已满时，则停止收集采样频率每1.6秒310天每26秒14年Sensor Indicated Rate HistogramBenefitsAssess behavior of the sensor independent of other algorithms or behaviorsFacilitates programming the sensor when the pacemaker is inhibited by native rhythmEliminates the need for formal exercise testing to assess sensor functionProvides an overview of the sensor function传感器指示频率直方图益处评价独立于其他运算法则的传感器行为当起搏器被自身节律抑制时，仍便于程控传感器不再需要正式的运动试验来评价传感器功能提供一个传感器功能的汇总Prediction ModelAllows analysis of different sensor settings based on the patients everyday activitiesDisplays intrinsic heart r