内容讲义教案segms

1、Interactive Stored IEGMSJM internal use ONLY ECG and Stored IEGM WorkshopCross ChannelDual ChannelSJM internal use ONLY Dual ChannelCross ChannelSJM internal use ONLY EGM 1How would you analyze EGM? mendations?SJM internal use ONLY EGM 2How would you analyze EGM? mendations?SJM internal use ONLY EGM

2、 3 How would you analyze EGM? mendations?SJM internal use ONLY EGM 4How would you analyze EGM? mendations?SJM internal use ONLY EGM 5How would you analyze EGM? mendations?SJM internal use ONLY EGM 6How would you analyze EGM? mendations?SJM internal use ONLY EGM 7How would you analyze EGM? mendations

3、?SJM internal use ONLY EGM 8How would you analyze EGM? mendations?SJM internal use ONLY EGM 9How would you analyze EGM? mendations?SJM internal use ONLY EGM 10How would you analyze EGM? mendations?SJM internal use ONLY EGM 11How would you analyze EGM? mendations?SJM internal use ONLY EGM 12How would

4、 you analyze EGM? mendations?SJM internal use ONLY EGM 13How would you analyze EGM? mendations?SJM internal use ONLY EGM 14How would you analyze EGM? mendations?SJM internal use ONLY EGM 15How would you analyze EGM? mendations?Case StudySJM internal use ONLY Post-op Check- Initial InterrogationSJM i

5、nternal use ONLY Freeze Capture 2SJM internal use ONLY Freeze Capture 3SJM internal use ONLY Patient DataSJM internal use ONLY Auto P Wave MeasurementSJM internal use ONLY Auto R Wave MeasurementSJM internal use ONLY A Sense Test Real TimeSJM internal use ONLY A Capture TestSJM internal use ONLY A C

6、apture Scroll BackSJM internal use ONLY V Capture TestSJM internal use ONLY Final SettingsSJM internal use ONLY What Is Your Analysis?A lead dislodgement in to the VentricleNo Auto P/R Wave Measurement EGM recording due to NOT utilizing the Automatic Implant Date featurePatient scheduled for A-lead

7、repositioningSJM internal use ONLY Initial InterrogationSJM internal use ONLY A Sense TestSJM internal use ONLY V Sense TestSJM internal use ONLY A Capture TestSJM internal use ONLY V Capture TestSJM internal use ONLY Stored EGM 1SJM internal use ONLY Stored EGM 2SJM internal use ONLY SJM internal u

8、se ONLY Final Analysis of Case StudyAutomatic features are only as good as the reps that utilize the proper proceduresAuto Implant DateInput lead informationAlways perform a post-op checkBe thorough in troubleshooting techniquesSJM internal use ONLY NO MORE EGMSSJM internal use ONLY EGM AnswersPVC;

9、Junctional or Idioventricular rhythm (cannot tell without surface ECG) that begins on the second event. How often does this happen, any patient symptoms? Treat arrhythmia. Notice on the 3rd event, the PVC occurs during the crosstalk detection window and the device safety paces.AMS entry trigger: App

10、ropriate AMS entry. Patients intrinsic ventricular response is appropriate. Not all atrial events prior to the AMS trigger are sensed likely due to falling in PVAB.High V-rate: This is a single chamber device. The patient is probably in AF w/ RVR and not VT-notice V-V cycle lengthSJM internal use ON

11、LY EGM AnswersFreeze during follow up; Lots of stuff going on but the bottom line is, Loss of A-capture! The patients intrinsic ventricular event happens to fall after a non-capture AP event except for events 3 and 7. Underlying rhythm is junctional in origin. Assess A-capture thresholds and over pr

12、ogram safety margins.PVC; on second event, device A-paces but a PVC occurs prior to the AVD timing out. There is about a 6 beat run of a ventricular rhythm. Must compare morphology of QRS to determine if junctional or ventricular in origin but most likely to be ventricular.High V Rate; Patient goes

13、in to a PAT. The patient seems to have varying degrees of 1st AVB.SJM internal use ONLY EGM AnswersMagnet Placement; Pt in AF; how often does this occur? any symptoms? Patient on appropriate medical therapyNot listed but probably High V-rate; Noise on V-lead; What was the patient doing? Attempt prov

14、ocative measure to recreate noise, check impedances during manipulation. How often did you get this EGM? Reprogram to Uni if necessary. Replace lead if impedances are out of range. Have patient stay away from source if caused by EMI.AMS entry due noise on A lead leading to inappropriate AMS; find ca

15、use of noise!SJM internal use ONLY EGM AnswersFreeze capture; Is this QRS or T-wave oversensing? QRS oversensing but event is in VREF. How do we know it is Ventricular oversensing vs. Atrial oversensing? Check out the tick marks. Not much to worry about since the event occurs in the refractory perio

16、d but we may consider decreasing V-sensitivityPVC; 4th and 6th beats are PVC with the same morphology. The interceding event (5th beat) is a normally conducted V-event maybe evoked by a retrograde P-wave although, the P-wave may be an antegrade P-wave and the patient has a high grade 1st AVB. After

17、the second PVC, the patient again has that same A/V intrinsic event but the conducted R wave occurs coincidentally in the crosstalk detection window. Check out how often this occurs. Not much to reprogramSJM internal use ONLY EGM AnswersAMS episode but Retrograde conduction is occurring. Once we exit AM