起搏器最大跟蹤頻率,頻率行為-上限頻率行為PPT參考幻燈片

上限頻率行為,1,上限頻率行為,上限頻率行為MTR2:1阻滯(TARP)頻率適應(yīng)性AV間期頻率適應(yīng)性PVARP/VREF,SJMinternaluseONLY,時(shí)間線,60,120,心房率,在基本頻率和最大跟蹤頻率之間為1:1跟蹤,基本頻率=60ppm最大跟蹤頻率(MTR)=120bpm,SJMinternaluseONLY,好處雙腔起搏跟蹤自身心房活動(dòng)(竇房結(jié)加速)房室傳導(dǎo)阻滯的患者能由于活動(dòng)或運(yùn)動(dòng)后心房率增加，心室將跟蹤直至達(dá)到最大跟蹤頻率缺點(diǎn)雙腔起搏跟蹤自身心房活動(dòng)(房性心動(dòng)過速),心房跟蹤,SJMinternaluseONLY,最大跟蹤頻率,設(shè)置基于:患者的活動(dòng)水平年齡LV功能患者對(duì)高起搏頻率的忍耐度,SJMinternaluseONLY,心房或P波跟蹤,SJMinternaluseONLY,起搏器文氏現(xiàn)象2:1阻滯,上限頻率行為,SJMinternaluseONLY,起搏器文氏現(xiàn)象,MTR限制了心室的起搏頻率MTR導(dǎo)致感知的AV間期延長(zhǎng)感知的AV間期延長(zhǎng)直至一個(gè)P波落入PVARP，并不能被跟蹤(很像III型AVB),SJMinternaluseONLY,感知的AV間期,PVARP,總心房不應(yīng)期(TARP),V,V,V,V,MTR,MTR,MTR,V,V,V,V,MTR,起搏器文氏現(xiàn)象,起搏器文氏現(xiàn)象,SJMinternaluseONLY,習(xí)慣上被稱為倒下頻率,2:1阻滯頻率,SJMinternaluseONLY,竇性心率上升至121ppmTARP設(shè)置為500ms(120ppm)2:1阻滯頻率=120ppm,2:1阻滯反應(yīng),每2個(gè)P波中的1個(gè)落入PVARP，不被跟蹤竇性心率是心室起搏頻率的2倍(很像IIII型AVB),SJMinternaluseONLY,感知的AV間期,PVARP,總心房不應(yīng)期(TARP),竇性心率-150ppm，心室頻率-75ppm,V,V,V,V,V,V,V,V,V,V,1:1跟蹤,2:1阻滯,竇性頻率:75ppm，心室頻率:75ppm,SJMinternaluseONLY,2:1阻滯頻率=60,000/TARPTARP=感知的AV間期+PVARPTARP=150ms+250ms=400ms2:1阻滯頻率=60000/400=150bpm,如何計(jì)算2:1阻滯頻率？,SJMinternaluseONLY,竇性心率,心室起搏頻率,將所有的都放在一起,SJMinternaluseONLY,起搏器嘗試模擬:當(dāng)竇性心率上升時(shí)，患者正常的PR間期縮短,頻率適應(yīng)性AV間期,SJMinternaluseONLY,頻率適應(yīng)性AV間期,當(dāng)心房頻率等于或大于90ppm時(shí)啟動(dòng)可程控低=1ms/bpm中=2ms/bpm高=3ms/bpm默認(rèn)值=IdentityADx關(guān)閉，Victory和Zephyr設(shè)置為低AV間期縮短直至達(dá)到MSR、MTR或最短AV間期,SJMinternaluseONLY,SJMinternaluseONLY,SJMinternaluseONLY,RRAVD設(shè)置為高心房頻率107bpm90bpm=17bpm17bpmX3ms(高)=縮短51ms160ms(感知的AV間期)縮短51ms=109ms109ms,頻率適應(yīng)性AV間期的計(jì)算,SJMinternaluseONLY,頻率適應(yīng)性AV間期,臨床應(yīng)用允許患者更高的2:1阻滯頻率允許程控更高的MTR,SJMinternaluseONLY,最短的AV間期,ADx/Identity/Integrity/Affinity最短的AV/PV間期2550ms，步幅5ms60120ms，步幅10ms默認(rèn)值:70msVictory和Zephyr默認(rèn)值100ms,為頻率適應(yīng)性AV間期設(shè)置的最低限制也與負(fù)向AV滯后伴搜索有關(guān),SJMinternaluseONLY,頻率適應(yīng)性PVARP/VREF,當(dāng)心房頻率等于或大于90ppm時(shí)啟動(dòng)可程控:僅在IdentityADx/IntegrityADx/Victory和Zephyr低=1ms/bpm中=2ms/bpm高=3ms/bpm默認(rèn)值=OFFPVARP/VREF縮短直至達(dá)到MSR、MTR或最短的PVARP/VREF當(dāng)打開時(shí)，默認(rèn)值為170ms,SJMinternaluseONLY,頻率適應(yīng)性PVARP/VREF,好處更長(zhǎng)的感知窗口更高的MTR和2:1阻滯頻率有利于AFSuppression運(yùn)算法則,SJMinternaluseONLY,SJMinternaluseONLY,60ppm,130ppm,143ppm,TARP=感知的AV間期+PVARP=170+250=420ms143PPM(2:1阻滯點(diǎn)),基本頻率,(MTR),TARP,起搏器反應(yīng),1:1跟蹤,文氏現(xiàn)象,2:1阻滯,隨心房率增加的起搏器反應(yīng),基本頻率60ppmMTR130ppm起搏的/感知的AV間期170msPVARP250ms,SJMinternaluseONLY,總結(jié),上限頻率行為MTR2:1阻滯(TARP)頻率適應(yīng)性AV/PV間期頻率適應(yīng)性PVARP/VREF,SJMinternaluseONLY,上限頻率行為(URB)計(jì)算的Workshop,27,程控的參數(shù):起搏的AV間期:200ms感知的AV間期:150msPVARP:250msMTR:110bpm2:1阻滯頻率=_,URB計(jì)算#1,SJMinternaluseONLY,程控的參數(shù):感知的AV間期:210msPVARP:350msMTR:120bpm2:1阻滯頻率=_這樣設(shè)置正確嗎?_如果不正確，為什么?_我們的考慮是什么?_,URB計(jì)算#2,SJMi