除颤起搏器的临床应用

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1、除颤起搏器的临床应用山东省千佛山医院心内科闫素华ContentsICDHistoryBasicfunctionsofdefibSensing,detectionandtherapiesICDindications—whogetsoneornotImplantprocedure—howdowetestthedevice.HistoryofICDsInternaldefibrillatorLate1940’sto1950’sUnitshownisfromtheearly1960’sPioneerofICDTechnologyMichelMirowski,MDDe

2、dicatedhislifetodevelopingtheICDafterhisresearchpartnerdiedinhisarmsfromaventriculararrhythmiaCreatedthefirstimplantableICD,whichstartedclinicaltrialsin19801985-FirstapprovedICDBulky,heavyShort-lived(18m)AbdominalimplantThoracotomyrequiredNon-programmableLimitedtherapyoptionsVentak

3、isatrademarkofCardiacPacemakers,Inc.ThenextmilestoneforICDsPectoralimplantsapprovedbytheFDAin1995MorecomfortableforpatientsFasterimplantsSmallerbutjustaspowerfulasolderdevices“ActiveCan”TechnologyTraditionalSystemRV-CanEvolutionofICDTechnology19911995TheFirstICDsFeaturedEpicardial

4、LeadsTransvenousLeadsandAdvancedTherapyIncreaseEffectivenessofICDTherapyPectoralICDsReduceCostsandIncreaseSurgicalEase1985“DualChamber”ICDsIntroducedin1997CombinedualchamberpacingwithventriculararrhythmiadetectionandtherapyAbilitytosenseatrialactivityduringarrhythmiasSVTDiscrim

5、ination:Theabilitytowithholdtherapyfornon-lethalarrhythmiasBasicFunctionsofICDAutomaticallydetectandtreatVentricularTachycardia(VT)Antitachycardiapacing(ATP)CardioversionAutomaticallydetectandtreatVentricularFibrillation(VF)DefibrillationBradypacingVVI,VVIR,DDDRHowitworksSensingDet

6、ectionTherapyAuto-AdjustingSensitivityDesignedtosensefineVFPost-sensedsensitivityadjustmentPost-pacedsensitivityadjustmentProgrammedsensitivityPost-paceblankingMarkerChannel™TelemetryVPACEVPACEVSENSEVPACEVSENSERectifiedEGMChangingThresholdPost-PacePost-Sense10x4.5x0.3mVThreeZone

7、DetectionVTFVTVFVTDetectionVentricularsensitivityTachydetectioninterval(TDI)VTinitialNIDVTredetectNIDVFFVTVTDetectionStatus:ONOFFONInterval(ms):320400InitialNID:12/1612Sensitivity(mV):0.3VTCounterValue:123456789101112200msVSVSVSVSVSTSTSTSTSTSTSTSTSTSTSTSTDVFDetectionVentricularsens

8、itivityFibrillationdetecti