心臟病及保健heart disease and health http://心臟病.tw www

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心臟病及保健 heart disease and health http://心臟病.tw www.heartdisease.idv.tw 永久性心臟節律器 李應紹博士 植入永久性心臟節律器適應性: 第一類適應性 (確實需要,適當)心臟傳導完全阻塞,永久性或陣發性,併心臟 或神經症狀,如: - 有症狀之慢心跳 - 心臟衰竭 - 心跳停頓大於3秒或慢心跳每分鍾少於40 - 神智不清 - 手術後不太會恢復的心臟傳導完全阻塞 - 房室結灼燒術後

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()
(Pacing mode)
= V= A= D=
O= = V= A= D=
O= = T= I=
D= O= = P= M=
C= R= O= = P=
S= D= O=
DDDR = (1)(2)
(3)(4)
(single chamber mode)
() (double chamber mode)


DDR() VDD() VVIR ()
“pacing system analyzer”
V= voltage () I= current (), amperes
Impedance =ohms, =250-2000 Ohm’s law of electricitycurrent = voltage/resistance (capture threshold)=

(sensing threshold)=
=
refractory period =
Fusion = QRS T

(dual chamber pacing) AV interval (AVI, AV delay) =

AVI
Adaptive AV interval =
AVI
Postventricular atrial refractory period (PVARP) = retrograde P endless-loop tachycardia
(total atrial refractory period, TARP) = AVI + PVARP
Adaptive PVARP = PVARP
(upper rate limit, URL) = TARP
(ventricular refractory period, VRP, blanking period) =
= “crosstalk”

pacing threshold < 1 V pulse duration 0.5 ms impedance: 350-800
500-1200
threshold
pacing output 2.5 V pulse duration 0.3-0.6 ms sensitivity: 1.5-2 mV
4-5 mV



(1) (noncapture)-

“pseudo-noncapture” =
(2) (undersensing)
Rp

(oversensing) -
crosstalk
(pacemaker syndrome)
sinus rhythm (retrograde AV conduction)
VVI
hysteresis
(endless loop tachycardia)-
HIS bundle retrograde p PVARP ( )
PVARP
Crosstalk -