心脏起搏器培训资料频率适应性起搏

RateResponsivePacing频率适应性起搏RateResponsivePacingSensorTechnologyOptimizingRateAdaptation频率适应性起搏传感器技术最优化的频率反应RateResponsivePacingAlsoknownas...SensorDrivenPacingRateAdaptivePacingRateModulatedPacing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RateResponsivePacingUseofasensorbesidesthesinusnodetoadjustthepacingratetomeetthepatient’smetabolicneedsIndicatedforchronotropicincompetence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WhatisChronotropicIncompetence?DefinitionAninadequateheartrateforagivenlevelofmetabolicneedMaximumHR<90%x(220-age)MaximumHR<120bpm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

<120bpm60708090100110120130140150TimeIncreaseinMetabolicDemandDecreaseinMetabolicDemandPPMNormalChronotropicResponse60708090100110120130140150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PPMTime60708090100110120130140150ChronotropicIncompetencePPM时间60708090100110120130140150变时性功能不全TimePPM60708090100110120130140150ChronotropicIncompetence时间PPM60708090100110120130140150变时性功能不全PPMTime60708090100110120130140150ChronotropicIncompetencePPM时间60708090100110120130140150变时性功能不全CausesofChronotropicIncompetenceAgingDrugsHeartDisease变时性功能不全的原因老年药物心脏疾病DiagnosisofChronotropicIncompetenceHistoryHolterorTelemetryMonitoringExerciseTesting变时性功能不全的诊断病史Holter或遥测监护运动试验NormalSinusNodeThegoldstandardforPacemakersensors正常的窦房结起搏器传感器的金标准CharacteristicsofTheIdealSensorPhysiologicSensitiveRapidonsetandoffsetLinearresponsetoworkloadRespondstometabolicdemandemotionsfeverUnaffectedbycardiacmedications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CharacteristicsofTheIdealSensorTechnicalReliableandstableUtilizesstandardleadsMinimalbatterydrainStandardconnectorStandardimplanttechniqueSimpletoprogramandfollow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Today’sSensorsNon-physiologicsensorsVibrationAccelerationPhysiologicMinuteVentilationTemperatureQ-TIntervalClosedLoopSystem(CLS)Combinationsensors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温度QT间期闭环系统(CLS)混合传感器PiezoelectriccrystalCircuitboardPiezoelectricCrystalSensormountedtocanEasytomanufactureRapidresponsetoonsetofactivityCompatiblewithstandardpacingleads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LowcurrentdrainEasytomanufactureRapidresponsetoonsetofactivityCompatiblewithstandardpacingleadsNotresponsivetopressureappliedtocanUsedinallcurrentSt.JudeMedicalpacemakersAccelerometerCircuitBoardAccelerometer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StandardBipolarLeadSignalGeneratedBetweentheRingandtheCanr=0.97withNSRMinuteVentilationNospecialsensorSendslow-levelelectricalsignalstomeasuretransthorasicimpedanceRequiresbipolarpacingleadsTempo®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ThermistorTemperatureThermistorinLeadSensormountedinleadRequiresspecialpacinglead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QTIntervalStandardUnipolarorBipolarLead

Theintervalbetweenthe

Spikeandtheevoked

Twaveshortenswithexercise(200-300ms).Limitation:

RequiresstimulationQT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）RestExerciseEvokedResponseStandardBipolarLead

TheQRSdepolarizationareadecreaseswithexerciseLimitation:RequiresstimulationChangeswithbodypositions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ClosedLoopSystem(CLS)StandardBipolarLead

Translateschangesincardiaccontractility(inotropy)intoheartrateLimitations:RequiresstimulationChangeswithbodypositions/content/detail.php?id=24751.00.80.60.40.20VentricularFillingEjectionIsovolumetricContraction50100150200250300RestLoad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=24751.00.80.60.40.20心室充盈射血等容收缩50100150200250300休息负荷状态下ProgrammingofRate-ModulatedPacemakersBaseRateMaxTrackingRate(DDDR)MaxSensorRateThresholdSlopeReactionTimeRecoveryTime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

ZHeartRateMaximumHeartRateWorkload(220-Age)x0.9NormalSinusNodeZ

Z

Z

Z心率最大心率工作量(220–年龄)x0.9正常的窦房结PacingRateWorkloadSensorSignalMaximumSensorRate(MSR)(220-Age)x0.9MaximumSensorRateZ

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)x0.9最大传感器频率Z

Z

Z

ZThresholdTheamountofactivityrequiredtoinitiatesensoractivityProgrammablefrom1-7LowernumberrequireslessactivityAutomaticThresholdavailableonalldevices(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THRESHOLD1234567PacingRateWorkloadSensorSignalZ

Z

Z

ZThreshold阈值

1234567起搏频率工作量传感器信号Z

Z

Z

Z阈值AutoThresholdMeasuresvarianceinlast18hoursofactivityAdjustsautomaticallyMeasuredAverageSensorvaluedisplayedoninterrogationOffsetvaluesforAutoThresholdAuto-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,+2.0SlopeThesensor-drivenheartrateforagivenlevelofactivityProgrammablefrom1-16Highervalues=higherheartrateAutomaticSlope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SensorSignal

MSR(220-Age)x0.91618PacingRateWorkloadZ

Z

Z

ZSlope传感器信号

MSR(220–年龄)x0.91618起搏频率工作量Z

Z

Z

Z斜率

AutoSlopeAutomaticslopeadjustmentaccordingtochangesinpatient-specificactivityCreatesanewactivityvariancehistogramevery7daystocalculateanewslopeResearchshowsnormalheartratestayswithin23%ofheartratereservefor99%ofthetime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PacingRateTimeVeryslowVeryfastBasicRateSensorIndicatedRate(SIR)FastSlowReactionTimeTimetoincreasefrombaseratetoMaximumSensorRate(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TimeBasicRateSensorIndicatedRate(SIR)veryslowveryfastRecoveryTimeTimetodecreaseratefromMaximumSensorRate(MSR)tobaseratePacingRate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示频率下降至基本频率所需的时间起搏频率SensorIndicatedRateHistogramHistogramdisplayofthedistributionofpacedratesthatwouldhaveoccurredhadthesensorbeentotallycontrollingthesystemRecordsifSensorprogrammedtoOnorPassive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SensorIndicatedRateHistogramDisplaysTotalnumberofsamplecountswithineachraterangeThepercentageofsamplecountsateachsensorindicatedraterangeDatereadTotaltimesampledDatelastclearedRe-programmingSensorfromOfftoanothersettingwillclearthehistogram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SensorIndicatedRateHistogram传感器指示频率直方图SensorIndicatedRateHistogramCapacity:Eachbincancollectupto16,777,215eventsWhenonebinisfullcounterstopscollectingSamplingRateEvery1.6seconds-310daysEvery26seconds-14years传感器指示频率直方图容量:每个计数仓能够收集多达16,777,215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SensorIndicatedRateHistogramBenefitsAssessbehaviorofthesensorindependentofotheralgorithmsorbehaviorsFacilitatesprogrammingthesensorwhenthepacemakerisinhibitedbynativerhythmEliminatestheneedforformalexercisetestingtoassesssensorfunctionProvidesanoverviewofthesensorfunction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PredictionModelAllowsanalysisofdifferentsensorsettingsbasedonthepatient’se