除颤起搏器的临床应用课件讲解.ppt

除颤起搏器的临床应用 山东省千佛山医院 心内科 闫素华 Contents ICD History Basic functions of defib Sensing, detection and therapies ICD indications—who gets one or not Implant procedure—how do we test the device . Basic Functions of ICD Automatically detect and treat Ventricular Tachycardia (VT) Antitachycardia pacing (ATP) Cardioversion Automatically detect and treat Ventricular Fibrillation (VF) Defibrillation Brady pacing VVI, VVIR, DDDR How it works Sensing Detection Therapy  Three Zone Detection VT FVT VF Therapies ATP Burst Ramp Ramp+ Cardioversion Defibrillation ICD Indications, who gets one or not Implant Procedure Insertion of defib leads Test pacing parameters through analyzer of P / R wave, lead impedances, and pacing threshold Connect defib leads with defib box Test pacing impedance, threshold through the box Induce VF, implant success criterion: two consecutive times or 3 out of 4 successful defibrillation, 10 J safety margin. Turn of detection, close the wound Final programming * * History of ICDs Internal defibrillator Late 1940’s to 1950’s Unit shown is from the early 1960’s Pioneer of ICD Technology Michel Mirowski, MD Dedicated his life to developing the ICD after his research partner died in his arms from a ventricular arrhythmia Created the first implantable ICD, which started clinical trials in 1980 1985 - First approved ICD Bulky, heavy Short-lived (18m) Abdominal implant Thoracotomy required Non-programmable Limited therapy options Ventak is a trademark of Cardiac Pacemakers, Inc. The next milestone for ICDs Pectoral implants approved by the FDA in 1995 More comfortable for patients Faster implants Smaller but just as powerful as older devices “Active Can” Technology TraditionalSystem RV-Can Evolution of ICD Technology 1991 1995 The First ICDs FeaturedEpicardial Leads Transvenous Leadsand Advanced TherapyIncrease Effectivenessof ICD Therapy Pectoral ICDsReduce Costs andIncrease Surgical Ease 1985 “Dual Chamber” ICDs Introduced in 1997 Combine dual chamb