ICD-随访技术(002)课件

ICD患者管理

Follow-upMedtronicConfidential--ForInternalUseOnly随访的目的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）MedtronicConfidential--ForInternalUseOnly完整的随访步骤ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnostics与您的医生讨论如何调整参数，满足患者临床需求MedtronicConfidential--ForInternalUseOnly评估电池状态与充电时间ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnosticsMedtronicConfidential--ForInternalUseOnlyQuickLook界面-DataMedtronicConfidential--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.MedtronicConfidential--ForInternalUseOnlyMeasuredValues:AcceptableRangeValueMeasuredAtImplantAcceptableRangeAtFollow-UpAcceptableRangeBatteryVoltage 2batteries 1battery6.1VMicroJewel®,GEMDR3.1VGEMVR,IIandIII2.9VMarquisFamily/EnTrust>4.91V(ERIvalue)>2.55V(ERIvalue)>2.62V(ERIvalue)ChargeTimeGEM

MarquisFamily

EnTrust7-10seconds6-9seconds8-11seconds<14.5seconds(nearERI);ifchargetimeexceeds14.5,setautocapformationintervaltoonemonth.<16seconds(nearERI);singlechargetimeof>16secondstripsthedevicetoautocapintervalofonemonth.Ifasecondchargingperiodexceeds16s,thedevicesetstheEOLstatusmessage.AutoCapFormation6monthintervals/AutoAsneeded,morefrequentcapformationstokeepchargetimesshorter.MedtronicConfidential--ForInternalUseOnlyAutoCapFormationInterval

(ViaParamsIcon/VFTherapies/AutoCapFormation)TheAutosettingformsthecapacitorat6monthintervals.Ifthereisachargeexceeding16seconds,theICDautomaticallychangesthecapformationintervalto1month.Onasecondchargeexceeding16seconds,thedevicesetsanERIindicatorontheQuickLookscreen.MedtronicConfidential--ForInternalUseOnly评估电极阻抗ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnosticsMedtronicConfidential--ForInternalUseOnly电极阻抗在:QuickLook,viaData/BatteryLeadMeasurements,viaTests/LeadImpedanceMedtronicConfidential--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,MedtronicConfidential--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)MedtronicConfidential--ForInternalUseOnly感知评估ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnosticsMedtronicConfidential--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-wave>1.5mV>1mVR-wave>7.0mV>5mVMedtronicConfidential--ForInternalUseOnly自动感知测试

Marquis系列-EGM振幅

EnTrust-Sensing

(TESTS/EGMAMPLITUDEORTESTS/SENSING)设置测试的起搏参数选择开始测试观察自身心律MedtronicConfidential--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).MedtronicConfidential--ForInternalUseOnly起搏阈值ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnosticsMedtronicConfidential--ForInternalUseOnly测试值:可接受范围测试值A.pacingthreshold<1.5V<3VV.pacingthreshold<1V<3VDFT最大输出减去阈值>10Joules常规不测试MedtronicConfidential--ForInternalUseOnlyLeadless™ECG

无导线心电图与体表的LeadI导联心电图相似Can>HVX(SVC)可以用于询问时,测试和记录时，不需再连接体表ECG节省时间!!!MedtronicConfidential--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“Can>HVX”..MedtronicConfidential--ForInternalUseOnly解释Observations和Diagnostics诊断PatientAlert™患者报警ProgrammingObservationsCardiacCompass®EpisodeEvaluation事件评估ProgrammingImpedanceSensingPacingChargetimesCapformationintervalEpisodesObservationsDiagnosticsMedtronicConfidential--ForInternalUseOnly可选择的PatientAlerts

(PARAMS/PATIENTALERT)每六小时响一次MedtronicConfidential--ForInternalUseOnlyPatientAlert举例MedtronicConfidential--ForInternalUseOnlyPatientAlert:事件PatientAlertDataStoresuptotenepisodesEachlogentryincludes:DatetheeventfirstoccurredDescriptiononeventthattriggeredPatientAlertProgrammedthresholdforthePatientAlert,ifapplicableMedtronicConfidential--ForInternalUseOnlyPatientAlert

不能程控的

Life

Savers立即报警，并接下来每20小时报一次充电回路暂停(充电时间

>30秒)Electricalreset电重置起搏模式为DOO或VOO在没有SVCCoil的电极，ActiveCan程控为OFFMedtronicConfidential--ForInternalUseOnly回顾所有诊断信息

CardiacCompass汇总14个月ICD-与患者病情相关的信息:询问和再程控时间信息

V.和A.事件趋势缓慢心律失常起搏趋势心率变异性和相关的趋势MedtronicConfidential--ForInternalUseOnly患者/随访信息Program/InterrogateVisitDateLast/CurrentSessionMedtronicConfidential--ForInternalUseOnly心室事件趋势#VT/VFEpisodes(dailyhistogram)>1shock/dayV.RateduringVT/VFMedtronicConfidential--ForInternalUseOnly心房事件趋势AT/AFBurdenpeakingV.RateduringAT/AFMedtronicConfidential--ForInternalUseOnly缓慢心律失常趋势PercentPacing/Day—A.andV.MedtronicConfidential--ForInternalUseOnly心衰趋势AverageDay/NightRatePatientActivityLevel(Hours/Day)HeartRateVariabilityNotetheworseningHFtrendsforthispatientinJuneMedtronicConfidential--ForInternalUseOnly事件评估MedtronicConfidential--ForInternalUseOnly从事件列表开始TheEpisodeLogisalistofarrhythmicepisodesdetectedcontaining:TypeofepisodeTherapydeliveredSuccessoflasttherapydeliveredDateandtimeofepisodesDurationofepisodeAverageAandVcyclelengthMaximumVcyclelengthEGMavailabilityUsetheViewfiltertodisplayonlyepisodeswithspecificcharacteristicsthatyouortheclinicianareinterestedinMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AF,IrregularConductedVrhythmwithSuddenregularizedVTonset,unsuccessfulBursttherapyacceleratingrhythmintoVFzone.34JshocksuccessfullyterminatedVarrhythmiaandAFMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AandVdisassociateuponsuddenonset,irregularintervalVF;firstVFtherapyof20Jwassuccessful;shortepisodedurationMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AtrialarrhythmiaconductedfastandirregularintheV–therapywithheldappropriatelyMedtronicConfidential--ForInternalUseOnlyIntervalPlot练习AVdissociated,suddenonset,regularintervalVTsuccessfullyterminatedwithATPMedtronicConfidential--ForInternalUseOnlyFlashback®

提供信息分析

心律失常的突发性FlashbackMemorydataProvidedformostrecentVT,VF,AT/AFepisodesandmostrecentinterrogationUpto2000V-VandA-AintervalsandstoredmarkerdataAgoodwayofdeterminingarrhythmiaonsettrendsAFconductedfastandirregulartotheventricleMedtronicConfidential--ForInternalUseOnlyFlashback练习A:V1:1associationwithPVCsdeterioratingintoasuddenonset,irregularinterval,VTMedtronicConfidential--ForInternalUseOnlyEGMStrip

练习AT/AFepisodeappropriatelydetectedwithA>VAlwayslineupdevicesensing(usingmarkers)witheventsonstoredEGMUsezoombuttontoseeallnecessaryelementsofEGMStripMedtronicConfidential--ForInternalUseOnlyEGMStrip练习Atrialtachycardiawithsuddenonset,regular,330msVTdetectedappropriatelyEGMStrip练习VFdetectedappropriately,capacitorcharged,shocksynchronized,andsuccessfullyterminatedarrhythmiaMedtronicConfidential--ForInternalUseOnlyEGMStrip练习DetectedVTsuccessfullypaceterminatedwithaRamptherapyMedtronicConfidential--ForInternalUseOnlyEpisodeText—事件文字信息EpisodeTextprovidesacompletesummaryofwhattheICDdetected,therapydeliveredincludingHVLIandchargetimeifapplicable,anySVTdiscrimination,andselectprogrammedparametersatthetimeoftheepisode.MedtronicConfidential--ForInternalUseOnly将所有的放在一起考虑…应用所有的诊断资料来评估一个事件:EpisodeLogIntervalPlotFlashback(如果有)EGMStripEpisodeTextMedtronicConfidential--ForInternalUseOnlyCase1:IntervalplotMedtronicConfidential--ForInternalUseOnly