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1、Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyICD 患者管理患者管理 Follow-up Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only随访的目的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）Defibrillation SystemsTra
2、ining ManualMedtronic Confidential - For Internal Use Only完整的随访步骤完整的随访步骤ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnostics与您的医生讨论如何调整与您的医生讨论如何调整参数，满足患者临床需求参数，满足患者临床需求Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only评估电
3、池状态评估电池状态与充电时间与充电时间ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnosticsDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyQuick Look 界面界面 - DataDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use
4、 Only观看电池与电极测试详细信息的另外一种方法 通过 Data Icon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.Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyMeasured Values: Acceptable RangeValue MeasuredAt ImplantAcceptable RangeAt Follow-UpAcceptable RangeBattery Voltage2 batteries1 battery6
5、.1 V Micro Jewel, GEM DR3.1 V GEM VR, II and III2.9 V Marquis Family /EnTrust 4.91 V (ERI value) 2.55 V (ERI value) 2.62 V (ERI value)Charge Time GEM Marquis Family EnTrust7 - 10 seconds6 - 9 seconds8 - 11 seconds 14.5 seconds (near ERI); if charge time exceeds 14.5, set auto cap formation interval
6、to one month. 16 seconds trips the device to auto cap interval of one month. If a second charging period exceeds 16s, the device sets the EOL status message.Auto Cap Formation6 month intervals/AutoAs needed, more frequent cap formations to keep charge times shorter.Defibrillation SystemsTraining Man
7、ualMedtronic Confidential - For Internal Use OnlyAuto Cap Formation Interval(Via Params Icon/VF Therapies/Auto Cap Formation)The Auto setting forms the capacitor at 6 month intervals. If there is a charge exceeding 16seconds, the ICD automatically changes the cap formation interval to 1 month. On a
8、second chargeexceeding 16 seconds, the device sets an ERI indicator on the Quick Look screen.Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only评估电极阻抗评估电极阻抗ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnosticsDefibrillation
9、 SystemsTraining ManualMedtronic Confidential - For Internal Use Only电极阻抗在: Quick Look, via Data/Battery Lead Measurements, via Tests/Lead ImpedanceDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only电极阻抗趋势电极阻抗趋势(DATA/QUICK LOOK/ 图标图标-)电极阻抗趋势可以显示： RV Pacing, A Pacing,
10、RV Defibrillation, SVC Defibrillation,Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only注意: GEM 以前的Medtronic ICDs, 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/LEAD IMPEDANCE)Defibrillation SystemsTraining ManualMedtronic Co
11、nfidential - For Internal Use Only感知评估ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnosticsDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only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 1.5 mV 1 mVR-wave 7.0 mV 5 mVDefibrillation
12、SystemsTraining ManualMedtronic Confidential - For Internal Use Only自动感知测试自动感知测试Marquis 系列系列 - EGM 振幅振幅EnTrust - Sensing(TESTS/EGM AMPLITUDE OR TESTS/SENSING)1.设置测试的起搏参数2.选择开始测试3.观察自身心律Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only手动感知测试手动感知测试JEWEL/GEM 系列系列ICD或者或
13、者 检查自动测试检查自动测试(DATA/COLLECTION SET UP)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 (A tip/A ring and V tip/V ring).Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only起搏阈值起搏阈值ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesOb
14、servationsDiagnosticsDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only测试值测试值: : 可接受范围可接受范围测试值随访时可接受范围A. pacing threshold 1.5 V 3 VV. pacing threshold 1 V 10 Joules常规不测试常规不测试Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyLeadless E
15、CG无导线心电图与体表的Lead I 导联心电图相似CanHVX (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!Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only起搏阈值(TESTS/PACING THRESHOLD)进行阈值测试前,为了使用 Leadless EKG,你需要预先程控 EGM 通道为“Can HVX”.Defibrillation SystemsTraining ManualMedtronic Confidential - For Inte
16、rnal Use Only解释Observations 和 Diagnostics诊断Patient Alert患者报警Programming Observations Cardiac CompassEpisode Evaluation事件评估ProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnosticsDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use O
17、nly可选择的Patient Alerts(PARAMS/PATIENT ALERT)每六小时每六小时响一次响一次Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyPatient Alert 举例Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyPatient Alert: 事件Patient Alert Data Stores up to ten episodes
18、Each log entry includes: Date the event first occurredDescription on event that triggered Patient AlertProgrammed threshold for the Patient Alert, if applicableDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyPatient Alert不能程控的不能程控的Life Savers立即报警，并接下来每 20 小时报一次充电回路
19、暂停 (充电时间 30 秒)Electrical reset 电重置起搏模式为 DOO 或 VOO在没有SVC Coil的电极，Active Can 程控为OFFDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only回顾所有诊断信息回顾所有诊断信息 Cardiac Compass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Defibrillation SystemsTraining Manual
20、Medtronic Confidential - For Internal Use Only患者/随访信息Program/InterrogateVisit DateLast/Current SessionDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only心室事件趋势# VT/VF Episodes(daily histogram) 1 shock/dayV. Rate during VT/VFDefibrillation SystemsTraining ManualMedtron
21、ic Confidential - For Internal Use Only心房事件趋势AT/AF Burden peakingV. Rate during AT/AFDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only缓慢心律失常趋势Percent Pacing/DayA. and V.Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only心衰趋势Average Da
22、y/Night RatePatient Activity Level(Hours/Day)Heart Rate VariabilityNote the worsening HF trends for this patient in JuneDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only事件评估事件评估Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only从事件列表开
23、始The Episode Log is a list of arrhythmic episodes detected containing: Type of episode Therapy delivered Success of last therapy delivered Date and time of episodes Duration of episode Average A and V cycle length Maximum V cycle length EGM availabilityUse the View filter to display only episodes wi
24、th specific characteristics that you or the clinician are interested inDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyInterval Plot 练习AF, Irregular Conducted V rhythm with Sudden regularized VT onset, unsuccessful Burst therapy accelerating rhythm into VF zone. 34
25、J shock successfully terminated V arrhythmia and AFDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyInterval Plot 练习A and V disassociate upon sudden onset, irregular interval VF; first VF therapy of 20J was successful; short episode duration Defibrillation SystemsTr
26、aining ManualMedtronic Confidential - For Internal Use OnlyInterval Plot 练习Atrial arrhythmia conducted fast and irregular in the V therapy withheld appropriatelyDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyInterval Plot 练习AV dissociated, sudden onset, regular in
27、terval VT successfully terminated with ATPDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyFlashback 提供信息分析心律失常的突发性Flashback Memory data Provided for most recent VT, VF, AT/AF episodes and most recent interrogation Up to 2000 V-V and A-A intervals and stored marker
28、data A good way of determining arrhythmia onset trendsAF conducted fast and irregular to the ventricleDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyFlashback 练习练习A:V 1:1 association with PVCs deteriorating into a sudden onset, irregular interval, VTDefibrillation
29、 SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyEGM Strip 练习AT/AF episode appropriately detected with AVAlways line up device sensing (using markers) with events on stored EGMUse zoom button to see all necessary elements of EGM StripDefibrillation SystemsTraining ManualMedtronic
30、 Confidential - For Internal Use OnlyEGM Strip 练习Atrial tachycardia with sudden onset, regular, 330ms VT detected appropriatelyDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyEGM Strip 练习VF detected appropriately, capacitor charged, shock synchronized, and successf
31、ully terminated arrhythmiaDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyEGM Strip 练习Detected VT successfully pace terminated with a Ramp therapyDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyEpisode Text事件文字信息Episode Text provi
32、des a complete summary of what the ICD detected, therapy delivered including HVLI and charge time if applicable, any SVT discrimination, and select programmed parameters at the time of the episode. Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only将所有的放在一起考虑将所有的放在一起考
33、虑应用所有的诊断资料来评估一个事件: Episode Log Interval Plot Flashback (如果有) EGM Strip Episode Text Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 1: Interval plotDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 1: EGM stripDefibrillati
34、on SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 1: Episode textDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 2: Interval plotDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 2: EGM stripDefib
35、rillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 3: 如果需要可以从点图上如果需要可以从点图上移去心房点图移去心房点图Defibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyCase 3: 更易于观察更易于观察VT间期间期的规律性的规律性Defibrillation SystemsTraining ManualMedtronic Confidential - For I
36、nternal Use OnlyCase 3: Episode textDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlySummaryProgrammingImpedanceSensingPacingCharge timesCap formation intervalEpisodesObservationsDiagnosticsDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use OnlyPresenting Rhythm：当前心律Battery：电池Lead：阻抗Sensing：感知Threshold：阈值Observation and Episodes：事件Program & Print：程控及打印PBL STOPPBLSTOPDefibrillation SystemsTraining ManualMedtronic Confidential - For Internal Use Only存盘存盘Floppy DiskFloppy Disk
