心臟起搏器培訓(xùn)資料：除顫電極導(dǎo)線(xiàn)

除顫電極導(dǎo)線(xiàn)小電極大學(xué)問(wèn)電極導(dǎo)線(xiàn)的定義(HVlead)Anincrediblysophisticateddevicedesigneddowntothemolecularlevel,withoutwhich,thelumpofmetaltowhichitisconnectedtoiscompletelyuseless…一種分子級(jí)設(shè)計(jì)，精密程度超牛X的裝置。少了它，ICD丫就一廢鐵基本結(jié)構(gòu)電極導(dǎo)體絕緣體除顫線(xiàn)圈導(dǎo)體絕緣體連接桿SprintFamily電極導(dǎo)體絕緣體除顫線(xiàn)圈導(dǎo)體絕緣體連接桿19931996/971997/98200020012004TB/1coilIB/2coils TB/2PassiveActiveSprintSprintQuattro693269426943694569446947ICD除顫系統(tǒng)示意圖ICDHeaderandpocketLeadBodyTissueInterfaceICD除顫系統(tǒng)示意圖LeadBody導(dǎo)線(xiàn)體LeadBody導(dǎo)體與絕緣體除顫線(xiàn)圈陽(yáng)極環(huán)導(dǎo)線(xiàn)體面臨的苛刻條件導(dǎo)體與絕緣體鎖骨下與第一肋骨間靜脈血管三尖瓣導(dǎo)線(xiàn)體面臨的苛刻條件導(dǎo)體與絕緣體鎖骨下與第一肋骨間靜脈血管三尖瓣靜脈血管三尖瓣鎖骨下與第一肋骨間不對(duì)稱(chēng)設(shè)計(jì)的導(dǎo)線(xiàn)體（四極整合）導(dǎo)體與絕緣體低壓環(huán)狀電極電纜高壓除顫電纜SVC抗壓腔低壓螺旋電極線(xiàn)圈高壓除顫電纜HVB抗壓腔的意義Tubingwithoutcompressionlumens:壓力集中在導(dǎo)體管腔之間tubingwithwonderlumens:壓力被外放到導(dǎo)線(xiàn)體外周區(qū)域設(shè)計(jì)對(duì)比MedtronicSprintQuattro?StJudeMedicalRiata?/Durata?

BostonScientificEndotakReliance?GBiotronikLinoxSMART不對(duì)稱(chēng)設(shè)計(jì)和2個(gè)抗壓腔對(duì)稱(chēng)設(shè)計(jì)不對(duì)稱(chēng)設(shè)計(jì)對(duì)稱(chēng)設(shè)計(jì)和1個(gè)抗壓腔更細(xì)的導(dǎo)線(xiàn)體8.6Frenchisodiametricleadbody鎖骨下與第一肋骨間更好的電纜設(shè)計(jì)導(dǎo)體與絕緣體低壓環(huán)狀電極電纜高壓除顫電纜SVC抗壓腔低壓螺旋電極線(xiàn)圈高壓除顫電纜HVBSilver導(dǎo)電性最佳MP35N增加機(jī)械強(qiáng)度鎖骨下與第一肋骨間絕緣材料導(dǎo)體與絕緣體硅樹(shù)脂填充ETFEPTFE聚亞氨酯MedtronicConfidential–InternalUseOnlyConductorsETFECoatedSenseCable1x19-MP35N21.5ohms/ftETFECoatedDefibCables7x7-MP35N/AgCored0.5ohms/ftPacingCoilInsulatedwithEtchedShrinkPTFE5filar-.0035MP35N/Agcore2.4ohms/ft1x19WithETFE7x7WithETFEPacingCoilwithPTFE不同的coating55D聚亞氨酯囊袋中肌肉組織能對(duì)電極導(dǎo)線(xiàn)施加高壓力相對(duì)堅(jiān)硬的聚氨酯（55D）覆蓋電極近端能夠在電極擠壓、電極對(duì)電極和電極對(duì)機(jī)殼的磨損時(shí)提供保護(hù)80A聚亞氨酯在心腔內(nèi)，電極所受外力很小但是需要電極有更多的靈活性以適應(yīng)心臟的運(yùn)動(dòng)一種更柔軟、易彎曲的聚氨酯（80A）用于覆蓋線(xiàn)圈IsoGlide

涂層SprintQuattro6944’s獨(dú)有的IsoGlide

意味著導(dǎo)線(xiàn)體與線(xiàn)圈接口沒(méi)有隆起9F鞘鞘直徑變小,使得血液回流更少更容易通過(guò)三尖瓣表面更光滑增加導(dǎo)線(xiàn)的韌性最大程度減少導(dǎo)線(xiàn)表面纖維化IsoGlide

導(dǎo)線(xiàn)體部(RVcoilshown)除顫線(xiàn)圈除顫線(xiàn)圈雙觸點(diǎn)設(shè)計(jì)用于降低DFT通過(guò)有限元分析得出：可以節(jié)約8%的除顫能量1冗余觸點(diǎn)可以提高可靠性1.Finiteelementanalysisperformedonelectrodecoilswithdual

connectionsandwithdistal-onlyconnections.雙觸點(diǎn)設(shè)計(jì)6942Dualconnection6936Proximalconnection3ohms1ohms5ohms1ohms2.5ohms8ohmsTotal3.5ohmsTotal雙觸點(diǎn)設(shè)計(jì)6942Dualconnection6936ProximalconnectionMoreuniformcurrentdistributionDualconnectionandlowerresistancecoil6944雙觸點(diǎn)設(shè)計(jì)Defibfieldofdistalonlydefibcoilconnection(Guidant,St.Jude)Defibfieldofdualdefibcoilconnections(Medtronic,Biotronik)硅樹(shù)脂內(nèi)填充SiliconeBackfillNon-Backfilled硅樹(shù)脂內(nèi)填充帶來(lái)的利益減少組織長(zhǎng)入1降低拔除力度1在植入過(guò)程中穩(wěn)定線(xiàn)圈1在拔除時(shí)保持電極導(dǎo)線(xiàn)完整性11WilkkoffBL,etal.PacingClinElectrophysiol.March2005;28(3):205-211.Forcetoremoveleadsmeasuredafterleadsimplantedinsheepfor14months:3leadswithnon-coatedcoils(>2kg)3leadswithsiliconebackfill(<1kg)3leadswithePTFEcoatedcoils(<1kg)結(jié)論:硅樹(shù)脂填充或ePTFE覆蓋

線(xiàn)圈有利于經(jīng)靜脈電極導(dǎo)線(xiàn)拔除硅樹(shù)脂填充除顫線(xiàn)圈有利于在經(jīng)靜脈拔除電極導(dǎo)線(xiàn)時(shí)減少組織損傷無(wú)填充或涂層的后果與RelianceG對(duì)比注意ePTFE沒(méi)有覆蓋到遠(yuǎn)端部分(也沒(méi)有充填,悲??！)不能阻止纖維組織向內(nèi)生長(zhǎng)RelianceG8.2FrSprintFidelis6.6FrSiliconebackfilledcoilsePTFEcoveredcoils第一個(gè)長(zhǎng)期人類(lèi)研究結(jié)果使用RelianceG(model0165)隨著時(shí)間延長(zhǎng)起搏閾值明顯增加25%因?yàn)槠鸩撝档脑黾有枰匦路胖秒姌O導(dǎo)線(xiàn).ePTFE

涂層的問(wèn)題CHRONICLEADPARAMETERSOFEXPANDEDPOLYTETRAFLUOROETHYLENE(EPTFE)COATEDLEADSINHUMANS,Hyderetal,HRSAbstracts,P6-81,2005.CoatedRVCoilIntegratedBipolar(PacingoccursTip-RVcoil)雙線(xiàn)圈設(shè)計(jì)AXB雙除顫線(xiàn)圈:AX>B更低且穩(wěn)定的DFTLeadlessECG雙線(xiàn)圈設(shè)計(jì)AXB單除顫線(xiàn)圈:A>B植入簡(jiǎn)單易拔出程控關(guān)閉SVC或CAN陽(yáng)極環(huán)設(shè)計(jì)陽(yáng)極環(huán)ConductorcabletoanodecrimpjointisareliableconnectionTensi-LockTMcabledesignsecuresthetipassemblyandprovidesgreaterleadstrengthTipsealdesignedtoreducefluidingressandfacilitatereinsertionofastyletSolidtiphousingprotectsinternalmechanismsfromdamage真雙極和集成雙極感知真雙極TrueBipolar集成雙極IntegratedBipolarTipTipRVElectrodeRingRVElectrodeNoRing真雙極的優(yōu)勢(shì)研究顯示:11％的使用集成雙極感知導(dǎo)線(xiàn)的雙腔ICD，有P波過(guò)感知現(xiàn)象

集成雙極感知導(dǎo)線(xiàn)與真雙極感知導(dǎo)線(xiàn)相比，T波和P波過(guò)感知更易出現(xiàn)Weretkaetal.PACE.2003;26:65-70可程控的除顫電極感知極性Tensi-Lock陽(yáng)極環(huán)ConductorcabletoanodecrimpjointisareliableconnectionTensi-LockTMcabledesignsecuresthetipassemblyandprovidesgreaterleadstrengthTipsealdesignedtoreducefluidingressandfacilitatereinsertionofastyletSolidtiphousingprotectsinternalmechanismsfromdamageTensi-LockTM提供更大的電極強(qiáng)度1,這會(huì)有利于電極導(dǎo)線(xiàn)拔除2,3MedtronicDataonFile–comparesMedtronicleadsonly.SmithMC,LoveCJ.(2008),ExtractionofTransvenousacingandICDLeads.PacingandClinicalElectrophysiology,31:736–752WilkoffBL,Al-KhadraAS.TheTechniqueofTransvenousLeadExtraction.NonpharmachologicalTherapyofArrhythmiasforthe21stCentury:TheStateoftheArt.FuturaPublishingCo,Inc.,Armonk,NY,1998.Tensi-LockTensi-Lock是Medtronic特有的SprintFidelisSprintQuattro它就像內(nèi)置固定鋼絲增加電極導(dǎo)線(xiàn)頭端的抗張強(qiáng)度一旦拉出，頭端更可能保持完整沒(méi)有Tensi-Lock,電極導(dǎo)線(xiàn)頭端會(huì)松開(kāi)和分開(kāi)Tensi-LockRelianceGSprintFidelis沒(méi)有電纜的，柔軟，易彎的部分牢固的電纜焊接在ringandtip裝置上增加頭端的抗張強(qiáng)度，在拉出時(shí)使頭端不易與電極導(dǎo)線(xiàn)體分離競(jìng)爭(zhēng)對(duì)手的電極導(dǎo)線(xiàn)有電纜，但…電纜沒(méi)有接觸頭端裝置,在拉出時(shí)易松開(kāi)和分開(kāi)與組織接觸部分-電極TissueInterface6944被動(dòng)電極頭端8mm12mm四極整合技術(shù)激素釋放高阻抗Haloe?

頭端電極(>750

)環(huán)形翼狀電極頭端 58,65,75,和100cm導(dǎo)線(xiàn)體部,除顫線(xiàn)圈=8.2Fr9Fr(不保留導(dǎo)引鋼絲)10.5Fr(保留導(dǎo)引鋼絲)6947主動(dòng)電極頭端四極整合技術(shù)激素釋放高阻抗Haloe?

頭端電極(>750

)螺旋電極頭端 65,75,和100cm導(dǎo)線(xiàn)體部,除顫線(xiàn)圈=8.6Fr9Fr(不保留導(dǎo)引鋼絲)11Fr(保留導(dǎo)引鋼絲)6947螺旋頭端伸出/回收

接口與囊袋ICDHeaderandpocketDF-1和DF-4IS-1BIDF-1RVSVCDF-1之貼心設(shè)計(jì)GuidantLongIS-1TerminalPin29,900LeadsaffectedHighstressattheendofthe

terminalpinoutsideoftheheaderBreachofconnectorinsulationtoRVcoilconductorsEdgeofDeviceHeaderTheBadGuysTheGoodGuysDF-1之貼心設(shè)計(jì)緩解三叉分支受力緊張當(dāng)連接線(xiàn)彎曲時(shí)，分叉口處邊緣需要承受很大的力量，在呈極銳角時(shí)可能會(huì)折斷漸縮的分叉設(shè)計(jì)使平滑了彎曲程度DF-4之貼心設(shè)計(jì)Helicalpatternusedforcablestominimizestressexperiencedwithbending光滑的ICD機(jī)殼MedtronicSurface CompetitiveSurfaceICDheader