ICD-随访技术-lj

DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyICD患者管理--Followup新疆医科大学第一附属医院心脏中心周贤惠DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyICD随访与普通起搏器随访的不同•随访频率每次放电后都要来随访•随访内容起搏系统情况事件分析诊断、治疗参数调整DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly随访的目标•以患者临床利益为本,为医生提供治疗建议–安全（系统参数测试与调整，优化使用寿命）–有效（分析事件与ICD诊断治疗）–满足个性化要求（调整参数，开启特殊功能）DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly完整的随访步骤DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyQuickLook•询问•电池电压•充电时间•电极阻抗•心律失常事件计数•起搏百分比•观察窗DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyInitialInterrogation有无磁铁频率？•程控头内的磁铁会使识别暂停！–遥测通讯建立后，识别会立即恢复DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly扫黄-EGMNOTE:有无线遥测的ICD，如用程控头询问进入后需即刻把程控头拿开，否则会一直SUSPENDEDDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyQuickLook界面-DataGoodCapacitor(Fasterisbetter)GoodLeads&ConnectionsGoodBatteryDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly观看电池与电极测试详细信息的另外一种方法通过DataIcon对评估上次患者接受电击治疗的时间间隔尤其有价值!短间期计数器用于评估电极潜在的问题.DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyAutoCapFormationInterval(ViaParamsIcon/VFTherapies/AutoCapFormation)TheAutosettingformsthecapacitorat6monthintervals.Ifthereisachargeexceeding16seconds,theICDautomaticallychangesthecapformationintervalto1month.Onasecondchargeexceeding16seconds,thedevicesetsanERIindicatorontheQuickLookscreen.DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly参数回顾•感知与识别参数•治疗参数•起搏参数DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly测试•起搏阈值•P/R波•电极阻抗DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyLeadless™ECG无导线心电图•与体表的LeadI导联心电图相似–CanHVX(SVC)•可以用于询问时,测试和记录时，不需再连接体表ECGLeadlessECG(CanHVX)LeadI(Surface)MarkerChannel™LeadlessECG(CanHVX)LeadI(Surface)MarkerChannel™节省时间!!!DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly起搏阈值(TESTS/PACINGTHRESHOLD)进行阈值测试前,为了使用LeadlessEKG,你需要预先程控EGM通道为“CanHVX”..DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly测试值:可接受范围测试值植入时可接受范围随访时可接受范围A.pacingthreshold1.5V3VV.pacingthreshold1V3VDFT最大输出减去阈值10Joules常规不测试DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly自动感知测试Marquis系列-EGM振幅EnTrust-Sensing(TESTS/EGMAMPLITUDEORTESTS/SENSING)1.设置测试的起搏参数2.选择开始测试3.观察自身心律DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly测试值:可接受的范围测试值植入时可接受范围随访时可接受范围P-wave1.5mV1mVR-wave8.0mV5mVDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly手动感知测试JEWEL/GEM系列ICD或者检查自动测试(DATA/COLLECTIONSETUP)如果你想走纸来手动评估感知,EGM来源必须与ICD看到的一致才能满足诊断的决定.程控近场的EGM进行手动感知测试(Atip/AringandVtip/Vring).DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly电极阻抗在:QuickLook,viaData/BatteryLeadMeasurements,viaTests/LeadImpedanceDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly电极阻抗趋势(DATA/QUICKLOOK/图标-»)电极阻抗趋势可以显示：RVPacing,APacing,RVDefibrillation,SVCDefibrillation,DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly注意:GEM以前的MedtronicICDs,高压阻抗(HVB)测试只能是有痛的放电下进行.需要具备如同在导管室里进行DFT测试一样的条件：麻醉师镇静、体外除颤器备用、有经验的医生护士。无痛电极阻抗测试(TESTS/LEADIMPEDANCE)DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly事件回顾DefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnly从事件列表开始TheEpisodeLogisalistofarrhythmicepisodesdetectedcontaining:•Typeofepisode•Therapydelivered•Successoflasttherapydelivered•Dateandtimeofepisodes•Durationofepisode•AverageAandVcyclelength•MaximumVcyclelength•EGMavailabilityUsetheViewfiltertodisplayonlyepisodeswithspecificcharacteristicsthatyouortheclinicianareinterestedinDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AF,IrregularConductedVrhythmwithSuddenregularizedVTonset,unsuccessfulBursttherapyacceleratingrhythmintoVFzone.34JshocksuccessfullyterminatedVarrhythmiaandAFDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AandVdisassociateuponsuddenonset,irregularintervalVF;firstVFtherapyof20Jwassuccessful;shortepisodedurationDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AtrialarrhythmiaconductedfastandirregularintheV–therapywithheldappropriatelyDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AVdissociated,suddenonset,regularintervalVTsuccessfullyterminatedwithATPDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyFlashback®提供信息分析心律失常的突发性FlashbackMemorydata•ProvidedformostrecentVT,VF,AT/AFepisodesandmostrecentinterrogation•Upto2000V-VandA-Aintervalsandstoredmarkerdata•AgoodwayofdeterminingarrhythmiaonsettrendsAFconductedfastandirregulartotheventricleDefibrillationSystemsTrainingManualMedtronicConfidential--ForInternalUseOnlyFlashback练习A