心臟起搏器培訓資料：頻率適應性起搏-(2)課件

1、Rate Responsive Pacing頻率適應性起搏 Rate Responsive PacingSensor TechnologyOptimizing Rate Adaptation頻率適應性起搏傳感器技術最優(yōu)化的頻率反應Rate Responsive PacingAlso known as.Sensor Driven PacingRate Adaptive PacingRate Modulated Pacing頻率適應性起搏也被稱為.傳感器驅動的起搏頻率反應性起搏頻率調節(jié)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頻率適應性起搏使用除竇房結以外的一個傳感器，調整起搏頻率，以滿足患者新陳代謝的需要適用于變時性功能不全的患者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 什么是變時性功能不全?定義心率不足以滿足一特定水平的新陳代謝需要最大心率 90% x (220 年齡)最大心率 120 bpm 60 70 80 90100110120130140150TimeIncrease in Metabolic DemandDecrease inMetabolic DemandPPMNormal Chronotropic Response 60 70 80 90100110120130140150時間新陳代謝需要增加新陳代謝需要減少PPM正常的變時反應PPMTime 60 70 80 90100110120130140150Chronotro

4、pic IncompetencePPM時間 60 70 80 90100110120130140150變時性功能不全TimePPM 60 70 80 90100110120130140150Chronotropic Incompetence時間PPM 60 70 80 90100110120130140150變時性功能不全PPMTime 60 70 80 90100110120130140150Chronotropic IncompetencePPM時間 60 70 80 90100110120130140150變時性功能不全Causes of Chronotropic Incompetenc

5、eAgingDrugsHeart Disease變時性功能不全的原因老年藥物心臟疾病Diagnosis of Chronotropic IncompetenceHistoryHolter or Telemetry MonitoringExercise Testing變時性功能不全的診斷病史Holter或遙測監(jiān)護運動試驗Normal Sinus NodeThe gold standard for Pacemaker sensors正常的竇房結起搏器傳感器的金標準Characteristics of The Ideal SensorPhysiologic Sensitive Rapid onset

6、 and offset Linear response to workload Responds to metabolic demandemotionsfever Unaffected by cardiac medications理想的傳感器特點生理學方面 靈敏 快速啟動和頻率補償 對工作量的線性反應 對新陳代謝需要的反應情緒發(fā)熱 不受心臟藥物的影響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理想的傳感器特點技術方面 可靠和穩(wěn)定 使用標準導線 最小的電池消耗 標準接頭 標準植入技術 程控和隨訪簡單Todays SensorsNon-physiologic sensorsVibrationAccelerationPhysiologicMinute VentilationTemperatureQ-T IntervalClosed Loop System (CLS)Combination sensors今天的傳感器非生理傳感器震動(壓力)加速度計生理傳感器每分鐘通氣量

8、溫度QT間期閉環(huán)系統(tǒng) (CLS)混合傳感器Piezoelectric crystalCircuit boardPiezoelectric CrystalSensor mounted to canEasy to manufactureRapid response to onset of activityCompatible with standard pacing leads壓電晶體電路板壓電晶體傳感器固定在機殼上容易生產對活動的反應快速與標準的起搏導線兼容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電流消耗低容易生產對活動的反應快速與標準的起搏導線兼容對施加在機殼上的壓力沒有反應使用于目前所有SJM公司的起搏器上加速度計電路板加速度計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標準雙極導線在環(huán)和機殼之間產生信號每分鐘通氣量沒有特殊的傳感器發(fā)送低水平的電信號以供測量經胸阻抗需要雙極起搏導線ThermistorTemperature Thermistor in LeadSensor mounted in leadRequires special pacing lead

11、熱敏電阻導線中的熱敏電阻傳感器固定在導線上需要特殊的起搏導線QT IntervalStandard Unipolar or Bipolar Lead The interval between theSpike and the evoked T wave shortens with exercise (200-300 ms).Limitation:Requires stimulationQT 間期標準的單極或雙極導線 起搏釘和T波之間的間期因運動而縮短(200-300ms)局限性:需要刺激 （運動時交感神經興奮，心肌收縮力增強，心肌細胞除極和復極的時間縮短）RestExerciseEvoked

12、Response Standard Bipolar Lead The QRS depolarization area decreases with exercise Limitation:Requires stimulationChanges with body positions休息運動ER波 標準的雙極導線 QRS除極面積隨運動而減少 局限性:需要刺激隨體位變化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閉環(huán)系統(tǒng) (CLS)標準的雙極導線 將心肌收縮性變化轉換成心率局限性:需要刺激隨體位變化/content/detail.php?id=2475 1.00.80.60.40.20心室充盈射血等容收縮50100150200250300休息負荷狀

14、態(tài)下Programming of Rate-Modulated PacemakersBase RateMax Tracking Rate (DDDR)Max Sensor RateThresholdSlopeReaction TimeRecovery Time頻率適應性起搏器的程控基本頻率最大跟蹤頻率 (DDDR)最大傳感器頻率閾值斜率反應時間恢復時間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 年齡) x 0.9正常的竇房結Pacing Rat

15、eWorkloadSensor SignalMaximum Sensor Rate (MSR) (220 - Age) x 0.9Maximum Sensor RateZ Z Z Z起搏頻率工作量傳感器信號最大傳感器頻率 (MSR) (220 年齡) x 0.9最大傳感器頻率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)閾值啟動傳感器所需的活動量可以程控為 1-7 較低的數值需要較少的活動度SJM所有的起搏器上都有自動閾值 (AUTO)功能THRESHOLD 1 2 3 4 5 6 7Pacing RateWorkloadSensor SignalZ Z Z ZThreshold閾值 1 2 3 4 5 6 7起搏頻率工作量傳感器信號Z Z Z Z閾值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自動閾值測量最近18個小時內活動度的變化自動調整詢問時將顯示測得的平均傳感器值自動閾值調整的偏移值 自動 -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斜率一特定活動度水平的傳感器驅動心率可程控為1-16較高的數值 = 較高的心率自動斜率Sensor Signal MSR(220 - Age) x 0.91618Pacing RateWorkloadZ Z Z ZSlope傳感器信號 MSR(220 年齡) x 0.91618起搏頻率工作量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 自動斜率根據患者的活動度變化，而自動調整斜率每7天產生一個新的活動度變化直方圖，從而計算出一個新的斜率研究表明，在99%的時間內，正常心率保持有23%心率儲備Pacing RateTimeVery slowVery fastBasic RateSensor Indicated Rate (SIR)FastSlowReaction T

20、imeTime to increase from base rate to Maximum Sensor Rate (MSR)起搏頻率時間非常慢非?？旎绢l率傳感器指示頻率 (SIR)快慢反應時間從基本頻率上升至傳感器指示頻率所需的時間TimeBasic RateSensor Indicated Rate (SIR)very slowvery fastRecovery TimeTime to decrease rate from Maximum Sensor Rate (MSR) to base ratePacing Rate時間基本頻率傳感器指示頻率 (SIR)非常慢非?？旎謴蜁r間從傳感器指

21、示頻率下降至基本頻率所需的時間起搏頻率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傳感器指示頻率直方圖直方圖顯示了傳感器完全控制起搏系統(tǒng)情況下的起搏頻率分布僅在傳感器程控為“打開”或“觀察”時記錄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傳感器指示頻率直方圖顯示每個頻率范圍的采樣總數每個傳感器指示頻率范圍的采樣百分比讀取數據

23、的日期全部采樣時間上次清空日期將傳感器從關閉程控至其他設置將清除直方圖Sensor Indicated Rate Histogram傳感器指示頻率直方圖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傳感器指示頻率直方圖容量:每個計數倉能夠收集多達16,

24、777,215個事件當一個計數倉已滿時，則停止收集采樣頻率每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傳感器指示頻率直方圖益處評價獨立于其他運算法則的傳感器行為當起搏器被自身節(jié)律抑制時，仍便于程控傳感器不再需要正式的運動試驗來評價傳感器功能提供一個傳感器功能的匯總Prediction ModelAllows analysis of different sensor settings based on the patients everyday activitiesDisplays intrinsic heart r