起搏导线单、双极的考虑_陈建明.ppt

文 献 4. 膈神经刺激与极性构成 发生率约为2-3% 是植入失败的原因之一 随体位和呼吸而变化 后静脉或后侧静脉最常见 心大静脉较少见 膈神经刺激的解决方案 改变导线的位置或变换头端方向 阈值的安全范围内降低起搏输出电压(考虑心脏起搏阈值和膈神经刺激阈值) 需要左室电极重置或关闭左室电极 改变当前导线的起搏极性配置 使用新型导线 SJM Promote CRT-D提供一个额外的左室起搏配置，有助于无创管理膈肌/膈神经刺激和左室起搏阈值的升高 LV环至RV线圈 (新) LV头端至RV线圈 LV头端至LV环 LV环至RV线圈 LV头端至LV环 LV头端至RV线圈 VectSelect?－可程控的左室起搏配置 目标: Promote CRT-D中的VectSelect功能在临床应用中的表现 结论: 正因为VectSelect 提供了额外的左室起搏极性配置，所以可以减少临床上因膈肌/膈神经刺激而必需的左室导线重置手术 文 献 Medtronic双阴极电极避免膈神经刺激 4196 St Jude Medtronic Boston Scientific VectSelect? ? VectSelect? LV双极 LV Tip – RV Coil, LV Ring – RV Coil ? LV双极 LV Tip – RV Coil, LV Ring – RV Coil ? LV双极 双极反转 LV Tip – RV Coil LV Ring – RV Coil 可程控LV脉冲配置提供了一种针对膈神经和膈肌刺激的非侵入性管理 小 结 单、双极左室导线具有各自的特点和临床应用 价值 双极导线具有的多种极性构成在避免右心室阳极夺获，减少膈神经刺激以及降低左室起搏阈值等具有多方面的益处，如果解剖结构允许，应尽量鼓励植入左室双极导线 * Larger spike: Since the electrodes are located at a relatively large distance from each other, detected surface EKG signals are usually larger. Smaller diameter: This occurs since there抯 only one conductor coil, and the insulator between the two conductor coils is eliminated. Less rigid: This occurs since there抯 only one conductor coil and one layer of insulation. Susceptibility to oversensing: In the time it takes intracardiac signal to traverse the relatively large distance between electrodes, an extracardiac signal that appears at either electrode could be detected by the indifferent electrode. Older IPGs where also susceptible to extracardiac signals, but today抯 modern IPGs have sense filters to avoid this problem. Extracardiac stimulation: Pacemaker current flowing between the electrodes encompasses extracardiac tissues. Muscle stimulation near the pocket site is due to current flow associated with the electrical current at the indifferent electrode in the pacemaker. * Today, the most common bipolar lead construction is co-axial where an insulated layer separates two multifilar conductor coils positioned in concentric fashion. A few bipol