除颤起搏器的临床应用ppt课件.pptx

1、History of ICDsPioneer of ICD Technology1985-First approved ICDVentak is a trademark of Cardiac Pacemakers,Inc.The next milestone for ICDsPectoral implants approved by the FDA in 1995More comfortable for patientsFaster implantsSmaller but just as powerful as older devices“Active Can”TechnologyTradit

2、ionalSystemRV-CanEvolution of ICD Technology19911995The First ICDs FeaturedEpicardial LeadsTransvenous Leadsand Advanced TherapyIncrease Effectivenessof ICD TherapyPectoral ICDsReduce Costs andIncrease Surgical Ease1985“Dual Chamber”ICDsBasic Functions of ICDHow it works Auto-Adjusting SensitivityPo

3、st-sensedsensitivity adjustmentPost-pacedsensitivity adjustmentProgrammed sensitivityPost-pace blankingMarker Channel TelemetryVPACEVPACEVSENSEVPACEVSENSERectifiedEGMChanging ThresholdPost-PacePost-Sense10 x4.5x0.3 mVThree Zone DetectionVT DetectionVFFVTVTDetection Status:ONOFFONInterval(ms):320400I

4、nitial NID:12/1612Sensitivity(mV):0.3VT Counter Value:123456789101112200 msVSVSVSVSVSTSTSTSTSTSTSTSTSTSTSTSTDVF DetectionFVT Detection via VF CounterTFTF121110987654321TFTFTFTFTFTFTFTFTFTFVSVSVSVSVSLOOKBACK WINDOW(8 INTERVALS BEFORE NID)FVT Detection via VT Counter121110987654321LOOKBACK WINDOW(8 IN

5、TERVALS BEFORE NID)VSVSVSTSTSTSTSTSTSTSTSTSTFTSTFVF Counter:Increased VT Detection SpecificitySinus TachycardiaAtrial TachycardiaAtrial FlutterAtrial FibrillationMorphologyXXXXOnset XStability XTherapiesBurst Ramp Ramp+ICD Indications,who gets one or notGregoratos G.J Am Coll Cardiol.1998;31:1175-12

6、09.1998 Class I Indications for ICD TherapyGregoratos G.J Am Coll Cardiol.1998;31:1175-1209.1998 Class II IndicationsGregoratos G.J Am Coll Cardiol.1998;31:1175-1209.1998 Class II Indications(cont.)Gregoratos G.J Am Coll Cardiol.1998;31:1175-1209.1998 Class III IndicationsGregoratos G.J Am Coll Card

7、iol.1998;31:1175-1209.1998 Class III Indications(cont.)Gregoratos G.J Am Coll Cardiol.1998;31:1175-1209.Implant ProcedureThe next milestone for ICDsPectoral implants approved by the FDA in 1995More comfortable for patientsFaster implantsSmaller but just as powerful as older devicesEvolution of ICD T

8、echnology19911995The First ICDs FeaturedEpicardial LeadsTransvenous Leadsand Advanced TherapyIncrease Effectivenessof ICD TherapyPectoral ICDsReduce Costs andIncrease Surgical Ease1985Three Zone DetectionFVT Detection via VT Counter121110987654321LOOKBACK WINDOW(8 INTERVALS BEFORE NID)VSVSVSTSTSTSTSTSTSTSTSTSTFTSTFVF Counter:Ramp+1998 Class III Indications(cont.)Gregoratos G.J Am Coll Cardiol.1998;31:1175-1209.