心臟起搏器培訓(xùn)資料：實(shí)時(shí)測(cè)量

1、Real Time Measurements All Photon, Atlas and Epic Familie s 實(shí)時(shí)測(cè)量實(shí)時(shí)測(cè)量 所有所有Photon, Atlas 和和 Epic 系列系列 SJM internal use ONLY Real Time Measurements P/R Wave measurements HVLIC Trends EGM control Cap maintenance Printing SJM internal use ONLY 實(shí)時(shí)測(cè)量實(shí)時(shí)測(cè)量 P/R波測(cè)量波測(cè)量 HVLIC 趨勢(shì)圖趨勢(shì)圖 EGM控制控制 電容器維護(hù)電容器維護(hù) 打印打印 SJM i

2、nternal use ONLY SJM internal use ONLY SJM internal use ONLY Real Time Measurements Real-time measurements Battery voltage Intrinsic signal amplitude Pacing lead impedance Automatically acquired on initial interrogation, if available or (NA) *Temporary pacing available SJM internal use ONLY 實(shí)時(shí)測(cè)量實(shí)時(shí)測(cè)量

3、 實(shí)時(shí)測(cè)量實(shí)時(shí)測(cè)量 電壓電壓 自身信號(hào)振幅自身信號(hào)振幅 起搏導(dǎo)線阻抗起搏導(dǎo)線阻抗 初始詢問(wèn)時(shí)自動(dòng)獲取初始詢問(wèn)時(shí)自動(dòng)獲取(如可測(cè)出如可測(cè)出)或或NA *可進(jìn)行臨時(shí)起搏可進(jìn)行臨時(shí)起搏 SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Battery Voltage Unloaded battery voltage measured upon interrogation or manual measurement via the Real Time Measurement tab Use for ERI indicat

4、ors SJM internal use ONLY 電壓電壓 詢問(wèn)時(shí)或通過(guò)實(shí)時(shí)測(cè)量界面進(jìn)行手動(dòng)測(cè)量，可顯示無(wú)詢問(wèn)時(shí)或通過(guò)實(shí)時(shí)測(cè)量界面進(jìn)行手動(dòng)測(cè)量，可顯示無(wú) 負(fù)載的電池電壓負(fù)載的電池電壓 用于用于ERI指示指示 SJM internal use ONLY P/R Wave Measurements Measures signal amplitudes of the filtered (base to peak) P/R wave. Upon interrogation Brady pacing must not be occurring for the respective chamber, i

5、f so, N/A will appear Manual measurements via the Real Time Measurement tab Monthly P/R wave measurements Will display the measured P/R waves on the FastPath Summary and Real Time Measurements tab SJM internal use ONLY P/R波測(cè)量波測(cè)量 測(cè)量過(guò)濾的測(cè)量過(guò)濾的P/R波信號(hào)振幅波信號(hào)振幅(基線至峰值基線至峰值) 在詢問(wèn)時(shí)在詢問(wèn)時(shí) 所測(cè)量的心腔不能出現(xiàn)心動(dòng)過(guò)緩起搏，否則將顯示所測(cè)量的

6、心腔不能出現(xiàn)心動(dòng)過(guò)緩起搏，否則將顯示N/A 通過(guò)實(shí)時(shí)測(cè)量界面進(jìn)行手動(dòng)測(cè)量通過(guò)實(shí)時(shí)測(cè)量界面進(jìn)行手動(dòng)測(cè)量 每月每月P/R波測(cè)量波測(cè)量 在在FastPath小結(jié)和實(shí)時(shí)測(cè)量界面上顯示測(cè)得的小結(jié)和實(shí)時(shí)測(cè)量界面上顯示測(cè)得的P/R波振幅波振幅 SJM internal use ONLY Automatic Intrinsic P/R Wave Measurements Daily Real Time Measurements in the II Family of ICDs performed daily Measured every 23 hours No changes to pacing parame

7、ters will occur so intrinsic event must occur SJM internal use ONLY 自動(dòng)自身自動(dòng)自身P/R波測(cè)量波測(cè)量 II系列系列ICD中，每天實(shí)時(shí)測(cè)量中，每天實(shí)時(shí)測(cè)量P/R波振幅波振幅 每每23h測(cè)量一次測(cè)量一次 測(cè)量時(shí)，起搏參數(shù)不會(huì)改變，所以必須有自身節(jié)律測(cè)量時(shí)，起搏參數(shù)不會(huì)改變，所以必須有自身節(jié)律 SJM internal use ONLY Pacing Lead Impedance (PLI) Upon initial interrogation and every month, the device delivers a sync

8、hronous impulse with the first sensed event for the appropriate chamber. If no sensed event occurs, a single pacing stimulus at 5.0V and 1.0ms is delivered at the end of the pacing interval. The impedance measured data is placed in the PLI Trend and will be displayed on the Real Time Measurements an

9、d FastPath Summary SJM internal use ONLY 起搏導(dǎo)線阻抗起搏導(dǎo)線阻抗 (PLI) 初始詢問(wèn)和每月測(cè)量時(shí)，初始詢問(wèn)和每月測(cè)量時(shí)，ICD在相應(yīng)心腔內(nèi)發(fā)放一個(gè)與在相應(yīng)心腔內(nèi)發(fā)放一個(gè)與 第一個(gè)感知事件同步的脈沖第一個(gè)感知事件同步的脈沖 如果沒(méi)有感知事件，一個(gè)如果沒(méi)有感知事件，一個(gè)5.0V/1.0ms的起搏刺激在起的起搏刺激在起 搏間期結(jié)束時(shí)發(fā)放搏間期結(jié)束時(shí)發(fā)放 測(cè)得的阻抗數(shù)據(jù)被記錄在測(cè)得的阻抗數(shù)據(jù)被記錄在PLI趨勢(shì)中，并顯示于實(shí)時(shí)測(cè)趨勢(shì)中，并顯示于實(shí)時(shí)測(cè) 量和量和FastPath小結(jié)中小結(jié)中 SJM internal use ONLY Automatic PLI

10、Daily Real Time Measurements in the II Family of devices Performed every 23 hours If out of range, will trigger Patient Notifier Will measure atrial, RV and LV impedances in HF devices SJM internal use ONLY 自動(dòng)自動(dòng)PLI II系列系列ICD中的每天實(shí)時(shí)測(cè)量中的每天實(shí)時(shí)測(cè)量 每每23h進(jìn)行一次進(jìn)行一次 如果超出范圍，將觸發(fā)病人提示如果超出范圍，將觸發(fā)病人提示 將測(cè)量心房、將測(cè)量心房、RV和和

11、LV阻抗阻抗(HF ICD) SJM internal use ONLY HVLIC High voltage lead integrity check Check the integrity of the HV lead at implant May be different from high energy shock impedance 12 volt synchronous shock delivered through the HV lead Impedance range - 30 to 100 ohms 200 ohms indicates an open circuit 200

12、提示斷路提示斷路 30提示絕緣層破損提示絕緣層破損 自動(dòng)更新趨勢(shì)；不顯示于脈沖發(fā)生器充電記錄中自動(dòng)更新趨勢(shì)；不顯示于脈沖發(fā)生器充電記錄中 可能有助于可能有助于troubleshooting 需要患者處于安靜狀態(tài)需要患者處于安靜狀態(tài) SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Trends Signal amplitudes (P and R) Pacing lead impedance (A and V) Unloaded battery voltage (ERI Indicator) Capture th

13、resholds High voltage lead impedance Real-time measurement data Automatically updates trend data every 30 days (This data is stored for the life of the device) SJM internal use ONLY 趨勢(shì)圖趨勢(shì)圖 信號(hào)振幅信號(hào)振幅 (P 和和 R) 起搏導(dǎo)線阻抗起搏導(dǎo)線阻抗 (A 和和 V) 無(wú)負(fù)載的電池電壓無(wú)負(fù)載的電池電壓 (ERI 提示提示) 起搏閾值起搏閾值 除顫導(dǎo)線阻抗除顫導(dǎo)線阻抗 實(shí)時(shí)測(cè)量數(shù)據(jù)實(shí)時(shí)測(cè)量數(shù)據(jù) 每每30天自動(dòng)更

14、新趨勢(shì)數(shù)據(jù)天自動(dòng)更新趨勢(shì)數(shù)據(jù) (該數(shù)據(jù)存儲(chǔ)于該數(shù)據(jù)存儲(chǔ)于ICD整個(gè)使用壽命中整個(gè)使用壽命中) SJM internal use ONLY Intrinsic Signal Amplitudes SJM internal use ONLY 自身信號(hào)振幅自身信號(hào)振幅 SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Longevity Estimation Programmed outputs for bradycardia pa

15、cing % time spent pacing No. of times the device has charged High-Voltage shocks Capacitor maintenances. 2.55V plateau, approximates 40% of the of the batteries longevity Lithium / silver vanadium oxide battery SJM internal use ONLY 壽命預(yù)估的計(jì)算壽命預(yù)估的計(jì)算 常規(guī)起搏的程控輸出值常規(guī)起搏的程控輸出值 起搏所占百分比起搏所占百分比 ICD的充電次數(shù)的充電次數(shù) 高電

16、壓除顫高電壓除顫 電容器維護(hù)電容器維護(hù) 2.55V的平臺(tái)期，還剩下約的平臺(tái)期，還剩下約40%的電池使用壽命的電池使用壽命 鋰鋰/銀釩氧化電池銀釩氧化電池 SJM internal use ONLY Lithium / silver vanadium oxide battery 2.55V plateau, approximately 40% of the of the batteries longevity SJM internal use ONLY 鋰鋰/銀釩氧化電池銀釩氧化電池 2.55V 的平臺(tái)期，還剩下約的平臺(tái)期，還剩下約40%的電池使用壽命的電池使用壽命 典型的銀釩氧化電池放電曲線典

17、型的銀釩氧化電池放電曲線 電池電壓電池電壓 mv 容量容量mAh SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Manual Updates Manual update of trends can be updated from any testing screen If any of the automatic updates hav

18、e occurred within the last 24 hours, the user will be given the following options Replace previous data with the new data Keep previous data and do not trend the new data Trend both data sets SJM internal use ONLY 手動(dòng)更新手動(dòng)更新 可以從任何測(cè)試界面中手動(dòng)更新趨勢(shì)可以從任何測(cè)試界面中手動(dòng)更新趨勢(shì) 如果在最近如果在最近24h內(nèi)進(jìn)行過(guò)任何自動(dòng)更新，使用者將獲得內(nèi)進(jìn)行過(guò)任何自動(dòng)更新，使用者

19、將獲得 以下選項(xiàng)以下選項(xiàng) 用新的數(shù)據(jù)更換以前的數(shù)據(jù)用新的數(shù)據(jù)更換以前的數(shù)據(jù) 保持以前的數(shù)據(jù)，不需要將新的數(shù)據(jù)記入趨勢(shì)中保持以前的數(shù)據(jù)，不需要將新的數(shù)據(jù)記入趨勢(shì)中 保持以前的數(shù)據(jù)，并將新的數(shù)據(jù)記入趨勢(shì)中保持以前的數(shù)據(jù)，并將新的數(shù)據(jù)記入趨勢(shì)中 SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Patient Notifiers New vibratory alert in the II Family devices Feels like a cell phone vibrating For those patient

20、s with hearing difficulty No tones Just a vibration of the device SJM internal use ONLY 病人提示病人提示 II系列系列ICD中的振動(dòng)報(bào)警中的振動(dòng)報(bào)警(新新) 感覺(jué)像手機(jī)振動(dòng)感覺(jué)像手機(jī)振動(dòng) 針對(duì)聽(tīng)力困難的患者針對(duì)聽(tīng)力困難的患者 沒(méi)有聲音沒(méi)有聲音 只有振動(dòng)只有振動(dòng) SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Patient Notifie

21、r Vibratory parameters- (nominally On) Vibration duration Programmable from 2 to 16 sec 2 second steps Default is 6 sec Number of notifications Programmable from 1 to 16 single increments Default is 4 Time between notifications Programmable 10 or 22 hours Default is 10 hours Vibratory Alert test ava

22、ilable SJM internal use ONLY 病人提示病人提示 振動(dòng)報(bào)警參數(shù)默認(rèn)值為打開(kāi)振動(dòng)報(bào)警參數(shù)默認(rèn)值為打開(kāi) 振動(dòng)持續(xù)時(shí)間振動(dòng)持續(xù)時(shí)間 可程控可程控: 2 16s 步幅步幅 2s 默認(rèn)值默認(rèn)值 6s 提示數(shù)提示數(shù) 可程控可程控: 1 16次次 步幅步幅 1次次 默認(rèn)值默認(rèn)值 4次次 提示間隔時(shí)間提示間隔時(shí)間 可程控可程控: 10 22h 默認(rèn)值默認(rèn)值10h 病人提示測(cè)試病人提示測(cè)試 SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Triggers- Nominal “ON” SJM intern

23、al use ONLY 觸發(fā)器默認(rèn)值觸發(fā)器默認(rèn)值“打開(kāi)打開(kāi)” SJM internal use ONLY Allow the Patient to Experience the Notifier SJM internal use ONLY 使患者先感受一下振動(dòng)提示使患者先感受一下振動(dòng)提示 SJM internal use ONLY Real Time EGM Control EGM speed, marker, position Alternate EGM source recording options Freeze maybe useful for troubleshooting SJM

24、internal use ONLY 實(shí)時(shí)實(shí)時(shí)EGM控制控制 EGM速度、標(biāo)記和位置速度、標(biāo)記和位置 改變改變EGM源記錄選項(xiàng)源記錄選項(xiàng) 凍結(jié)圖形可能對(duì)凍結(jié)圖形可能對(duì)Troubleshooting有幫助有幫助 SJM internal use ONLY Real Time EGM Control SJM internal use ONLY 實(shí)時(shí)實(shí)時(shí)EGM控制控制 SJM internal use ONLY Real Time EGM Control SJM internal use ONLY 實(shí)時(shí)實(shí)時(shí)EGM控制控制 SJM internal use ONLY Real Time EGM Cont

25、rol Please note the Cathode and Anode selection box setup is different from the Brady Merlin interface SJM internal use ONLY 實(shí)時(shí)實(shí)時(shí)EGM控制控制 請(qǐng)注意請(qǐng)注意: 陰極和陽(yáng)極選項(xiàng)與心動(dòng)過(guò)緩界面不同陰極和陽(yáng)極選項(xiàng)與心動(dòng)過(guò)緩界面不同 SJM internal use ONLY Capacitor Maintenance Periodic charging of the capacitors to keep the dielectric intact to mitigate

26、leakage Performed automatically 1 to 6 months in 1 month intervals Nominal: 3 months Charging of the high voltage capacitors to their maximum voltage during an arrhythmia causes the maintenance timer to be reset SJM internal use ONLY 電容器維護(hù)電容器維護(hù) 周期性電容器充電可保持電解質(zhì)完整，以減少漏電周期性電容器充電可保持電解質(zhì)完整，以減少漏電 自動(dòng)進(jìn)行自動(dòng)進(jìn)行 1

27、 6個(gè)月，步幅個(gè)月，步幅1個(gè)月個(gè)月 默認(rèn)值默認(rèn)值: 3個(gè)月個(gè)月 心律失常發(fā)作時(shí)電容器充電至最大電壓，可導(dǎo)致維護(hù)定心律失常發(fā)作時(shí)電容器充電至最大電壓，可導(dǎo)致維護(hù)定 時(shí)器重設(shè)時(shí)器重設(shè) SJM internal use ONLY SJM internal use ONLY SJM internal use ONLY Capacitor Maintenance Capacitor maintenance schedule auto adjusts Every three months at BOL Every month when battery voltage reaches 3.05 V in o

28、lder model St. Jude branded devices (Photon, Photon micro, etc.) 2.86 V in newer model St. Jude branded devices (Epic +, Atlas +, etc.) Every three months at 2.6 V ERI is 2.45 volts (St. Jude branded ICDs) SJM internal use ONLY 電容器維護(hù)電容器維護(hù) 電容器維護(hù)的時(shí)間自動(dòng)調(diào)整電容器維護(hù)的時(shí)間自動(dòng)調(diào)整 BOL時(shí)，每時(shí)，每3個(gè)月個(gè)月 當(dāng)電池電壓達(dá)到以下情況時(shí)，每個(gè)月測(cè)量一次當(dāng)

29、電池電壓達(dá)到以下情況時(shí)，每個(gè)月測(cè)量一次 3.05V舊的舊的SJM ICD (Photon, Photon micro等等) 2.86V新的新的SJM ICD (Epic +, Atlas +等等) 電池電壓電池電壓 2.6V時(shí)，每時(shí)，每3個(gè)月一次個(gè)月一次 電池電壓電池電壓2.45V時(shí)，顯示時(shí)，顯示ERI (SJM ICD) SJM internal use ONLY Capacitor Maintenance Ventritex branded devices Every three months at BOL Every month when battery voltage reaches

30、2.9 V Every three months at 2.6 V SJM internal use ONLY 電容器維護(hù)電容器維護(hù) Ventritex ICD BOL時(shí)，每時(shí)，每3個(gè)月一次個(gè)月一次 當(dāng)電池電壓達(dá)到當(dāng)電池電壓達(dá)到 2.9V時(shí)，每個(gè)月一次時(shí)，每個(gè)月一次 當(dāng)電池電壓達(dá)到當(dāng)電池電壓達(dá)到 2.6V時(shí)，每時(shí)，每3個(gè)月一次個(gè)月一次 SJM internal use ONLY Capacitor Maintenance If you change the cap maintenance interval, the device will complete the present interv

31、al before changing to the new schedule To start the new interval right away, do a manual capacitor maintenance SJM internal use ONLY 電容器維護(hù)電容器維護(hù) 如果你改變了電容器維護(hù)的間隔時(shí)間，那么如果你改變了電容器維護(hù)的間隔時(shí)間，那么ICD將在新的將在新的 間隔時(shí)間開(kāi)始之前，完成現(xiàn)在最后一次間隔時(shí)間的充電間隔時(shí)間開(kāi)始之前，完成現(xiàn)在最后一次間隔時(shí)間的充電 如果需要馬上啟動(dòng)新的間隔時(shí)間，則需手動(dòng)做一次電容器如果需要馬上啟動(dòng)新的間隔時(shí)間，則需手動(dòng)做一次電容器 維護(hù)維護(hù) S

32、JM internal use ONLY Turbo Cap Reform II Family During manual and automatic capacitor maintenance The device will charge to max output then wait 10 seconds and charge again The second charge tops off what has bled-down after 10 seconds During a manual capacitor maintenance, a pop up screen will stat

33、e “A 10 second optimization phase is now in progress” demonstrating the Turbo Cap Reform feature Purpose Decrease charge times by up to a second SJM internal use ONLY Turbo電容器重整電容器重整II系列系列 在手動(dòng)和自動(dòng)電容器維護(hù)期間在手動(dòng)和自動(dòng)電容器維護(hù)期間 ICD將充電至最大輸出，然后等將充電至最大輸出，然后等10s，再次充電至最高，再次充電至最高 電壓電壓 在手動(dòng)電容器維護(hù)期間，一個(gè)對(duì)話框?qū)@示在手動(dòng)電容器維護(hù)期間，一個(gè)對(duì)話框?qū)@示“正在進(jìn)行正在進(jìn)行 一個(gè)一個(gè)10秒鐘的優(yōu)化過(guò)程秒鐘的優(yōu)化過(guò)程”，證實(shí)了，證實(shí)了Turbo電容器重整的電容器重整的 功能功能 目的目的 使充電時(shí)間縮短多達(dá)使充電時(shí)間縮短多達(dá)1s SJM internal use ONLY Printing Printing of reports can be done upon interrogation or from the Wrap Up Overview screen There are additional print buttons on various screen thro