心脏起搏器培训资料：频率适应性起搏-(2)课件.ppt

1、Rate Responsive Pacing频率适应性起搏 Rate Responsive Pacing Sensor Technology Optimizing Rate Adaptation频率适应性起搏 传感器技术 最优化的频率反应Rate Responsive Pacing Also known as.Sensor Driven PacingRate Adaptive PacingRate Modulated Pacing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Rate Responsive Pacing Use of a sensor besides t

2、he sinus node to adjust the pacing rate to meet the patients metabolic needs Indicated for chronotropic incompetence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What is Chronotropic Incompetence? DefinitionAn inadequate heart rate for a given level of metabolic need Maximum HR 90% x (220

3、- age) Maximum HR 120 bpm 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 120 bpm 60 70 80 90100110120130140150TimePPMNormal Chronotropic Response 60 70 80 90100110120130140150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PPMTime 60 70 80 90100110120130140150Chronotropic IncompetencePPM时间 60 70 80 90100110

4、120130140150变时性功能不全TimePPM 60 70 80 90100110120130140150Chronotropic Incompetence时间PPM 60 70 80 90100110120130140150变时性功能不全PPMTime 60 70 80 90100110120130140150Chronotropic IncompetencePPM时间 60 70 80 90100110120130140150变时性功能不全Causes of Chronotropic Incompetence Aging Drugs Heart Disease变时性功能不全的原因 老

5、年 药物 心脏疾病Diagnosis of Chronotropic Incompetence History Holter or Telemetry Monitoring Exercise Testing变时性功能不全的诊断 病史 Holter或遥测监护 运动试验Normal Sinus Node The gold standard for Pacemaker sensors正常的窦房结 起搏器传感器的金标准Characteristics of The Ideal Sensor Physiologic Sensitive Rapid onset and offset Linear respo

6、nse to workload Responds to metabolic demand emotions fever Unaffected by cardiac medications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Characteristics of The Ideal Sensor Technical Reliable and stable Utilizes standard leads Minimal battery drain Standard connector Standard imp

7、lant technique Simple to program and follow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Todays Sensors Non-physiologic sensorsVibrationAcceleration PhysiologicMinute VentilationTemperatureQ-T IntervalClosed Loop System (CLS) Combination sensors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 (

8、CLS) 混合传感器Piezoelectric crystalCircuit boardPiezoelectric Crystal Sensor mounted to can Easy to manufacture Rapid response to onset of activity Compatible with standard pacing leads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 Low current drain Easy to manufacture Rapid response to onset of activit

9、y Compatible with standard pacing leads Not responsive to pressure applied to can Used in all current St. Jude Medical pacemakersAccelerometerCircuit BoardAccelerometer 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Standard Bipolar LeadSignal Generated Betweenthe Ring and

10、 the Canr = 0.97 with NSRMinute Ventilation No special sensor Sends low-level electrical signals to measure transthorasic impedance Requires bipolar pacing leads Tempo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ThermistorTemperature Thermistor in Lead Sensor mounted in lead Requires s

11、pecial pacing lead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QT Interval Standard Unipolar or Bipolar Lead The interval between theSpike and the evoked T wave shortens with exercise (200-300 ms). Limitation:Requires stimulationQT 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

12、时间缩短）Evoked Response Standard Bipolar Lead The QRS depolarization area decreases with exercise Limitation:Requires stimulationChanges with body positionsER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Closed Loop System (CLS) Standard Bipolar Lead Translates changes in cardiac contractility (inotropy) into h

13、eart rate Limitations:Requires stimulationChanges with body positionshttp:/ 1.00.80.60.40.20Ventricular FillingEjectionIsovolumetric Contraction50100150200250300RestLoad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http:/ 1.00.80.60.40.20心室充盈射血等容收缩50100150200250300休息负荷状态下Programming of Rate-Modulate

14、d Pacemakers Base Rate Max Tracking Rate (DDDR) Max Sensor Rate Threshold Slope Reaction Time Recovery Time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 ZHeart RateMaximum Heart RateWorkload(220 - Age) x 0.9Normal Sinus NodeZ Z Z Z心率最大心率工作量(220 年龄) x 0.9正常的窦房结Pacing RateWorkloadSensor

15、SignalMaximum Sensor Rate (MSR) (220 - Age) x 0.9Maximum Sensor RateZ 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) x 0.9最大传感器频率Z Z Z ZThreshold The amount of activity required to initiate sensor activity Programmable from 1-7 Lower number requires less activity Automatic Threshold available on all device

16、s (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THRESHOLD 1 2 3 4 5 6 7Pacing RateWorkloadSensor SignalZ Z Z ZThreshold阈值 1 2 3 4 5 6 7起搏频率工作量传感器信号Z Z Z Z阈值Auto Threshold Measures variance in last 18 hours of activity Adjusts automatically Measured Average Sensor value displa

17、yed on interrogation Offset values for Auto Threshold Auto -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, +2.0Slope The sensor-driven heart rate for a given level of activity Programmable from 1-16Higher values = higher heart

18、rate Automatic Slope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Sensor Signal MSR(220 - Age) x 0.91618Pacing RateWorkloadZ Z Z ZSlope传感器信号 MSR(220 年龄) x 0.91618起搏频率工作量Z Z Z Z斜率 Auto Slope Automatic slope adjustment according to changes in patient-specific activity Creates a new activity variance h

19、istogram every 7 days to calculate a new slope Research shows normal heart rate stays within 23% of heart rate reserve for 99% of the time 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Pacing RateTimeVery slowVery fastBasic RateSensor Indicated Rate (SIR)FastSlowR

20、eaction Time Time to increase from base rate to Maximum Sensor Rate (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TimeBasic RateSensor Indicated Rate (SIR)very slowvery fastRecovery Time Time to decrease rate from Maximum Sensor Rate (MSR) to base ratePacing Rate时间基本频率传感器指示频率 (SIR)非常慢

21、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Sensor Indicated Rate Histogram Histogram display of the distribution of paced rates that would have occurred had the sensor been totally controlling the system Records if Sensor programmed to On or Passive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Sen

22、sor Indicated Rate Histogram DisplaysTotal number of sample counts within each rate rangeThe percentage of sample counts at each sensor indicated rate rangeDate readTotal time sampledDate last cleared Re-programming Sensor from Off to another setting will clear the histogram传感器指示频率直方图 显示每个频率范围的采样总数每

23、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Sensor Indicated Rate Histogram传感器指示频率直方图Sensor Indicated Rate Histogram Capacity:Each bin can collect up to 16,777,215 eventsWhen one bin is full counter stops collecting Sampling RateEvery 1.6 seconds - 310 daysEvery 26 seconds - 14 years传感器指

24、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Sensor Indicated Rate Histogram BenefitsAssess 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 ex

25、ercise testing to assess sensor function Provides an overview of the sensor function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Prediction Model Allows analysis of different sensor settings based on the patients everyday activities Displays intrinsic heart rate

26、s, sensor predicated rates, and programmed sensor behavior Enables assessment of Chronotropic competency预测模型 允许分析基于患者每天活动度的不同传感器设置 显示自身心率、传感器预测频率和程控的传感器行为 可以评价变时功能Prediction Model FunctionAllows analysis of different sensor settings without repeated exercisesModels all sensor parameters with: Re-gra

27、phing Printing预测模型 功能允许分析不同的传感器设置，而无需重复运动对所有的传感器参数建立模板: 重新制图 打印Prediction Model预测模型Prediction Model预测模型Prediction Model BenefitsExercise the programmer, not the patientLess patient anxiety Allows fine-tuning of the sensor in a patient who is unable to exercise over and overDecreases follow up timeDisplays and provides print out Current sensor behavior Expected sensor behavior预测模型 益处训练程控仪，而非患者减少患者的不安 可以无需患者重复运动而准确设置传感器减少随访时间显示和提供打印输出 当前的传感器行为 期望的传感器行为 Rate Responsive Pacing Sensor Technology Optimizing Rate Adaptation频率适应性起搏 传感器技术 最优化的频率反应