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1、T-wave DiscriminatorConfidentialandProprietary;DoNotCopyorDistributeMedtronicConfidentialandProprietary.InternalUseOnly.2ProtectaSmartShock组成6个特有的减少电击的算法RV电极导线完整性组合电极导线噪音识别和报警电极导线完整性报警提高SVT识别PRLogic+Wavelet双腔和三腔装置SVTlimitnominallyintheVFzone减少T波过感知引起的电击T波识别减少非持续性VT的电击Confirmation+ConfidentialandProp
2、rietary;DoNotCopyorDistribute3T-波识别临床需求:患者受到由于T波过感知引起的不恰当电击2GundersonBD,GilbergJM,SwerdlowCD.Heart Rhythm.2004;1:S244.Abstract.ConfidentialandProprietary;DoNotCopyorDistribute4Case#4:VirtuosoVRConfidentialandProprietary;DoNotCopyorDistribute5TWOS引起的不恰当电击解决方案:降低心室感知灵敏度,程控tip-ringtotip-RVcoil(V3Ddevic
3、e),Wavelet(SCdevice),SensingThresholddecay(SJM)局限性?重新做DFT确认安全性了吗?如果频率过快不能用Wavelet,双腔中没有Wavelet如果改变sensingThresholddecay可能导致VF感知不良TWOS突然发生,不能预防第一次电击ConfidentialandProprietary;DoNotCopyorDistribute6确保所有的R波恰当感知,把心室感知影响降至最低全自动避免由于TWOS引起的第一次电击T-波识别:解决方案!T-波识别ConfidentialandProprietary;DoNotCopyorDistribu
4、te7有效吗?TWOSRiskofshock!Rememberthecasewesawbefore算法抑制治疗ConfidentialandProprietary;DoNotCopyorDistribute8减少由于T-波过感知引起的电击第一个也是唯一的T-波识别技术在保证VT/VF检测敏感性前提下,识别T-波过感知且抑制治疗的发放T-波过感知新方法:全自动不影响VF检测的敏感性感知EGM:在目前的ICD中,信号被过滤而分离R波,这可能过感知T波.InProtecta,感知EGM的微分增加R波与T波振幅之比,识别R-T模式.ConfidentialandProprietary;DoNotCop
5、yorDistribute9T-波识别运行原则1.通过感知信号的微分滤波识别R-波和T-波差分滤波的R-wave差分滤波的T-wave2.确定R-波和T-波识别阈值ConfidentialandProprietary;DoNotCopyorDistribute10T-波识别运行原则3.R波和T波的再评估4.对R波和T波应用识别标准a.R-波(filteredEGM)满足振幅稳定b.T-波(filteredEGM)满足振幅稳定c.R-T对满足间期稳定阈值阈值ConfidentialandProprietary;DoNotCopyorDistribute11T-波识别运行原则4.对R波和T波应用识
6、别标准d.滤波EGM的R/T比例必须小于微分EGM的R/T比例For example: R/T75%*R/Tdiff30.75x8=36e.R-T对必须满足表明交替R和T波的模式标准ConfidentialandProprietary;DoNotCopyorDistribute12T-波识别运行原则4.对R波和T波应用的识别标准f.计算“纠正”的R-R间期ConfidentialandProprietary;DoNotCopyorDistribute13T-波识别运行原则只要20组里有4组满足T-波标准,过感知被诊断, 这意味着只要评估的4组被识别为TWOS判断就能成立.Confidentia
7、landProprietary;DoNotCopyorDistribute14T-波识别复习应用信号频率成分和模式分析识别R-T模式一旦装置感知信号,应用频率成分确定VS是T波还是R波.模式信息确保装置不抑制对VF的治疗.注:这个算法不是消除TWOS.它仅仅尝试抑制对TWOS电击.RRRRTTTConfidentialandProprietary;DoNotCopyorDistribute15程控ON,OFF出厂值 ONTWOS ProgrammingT-波识别T-波识别应用于初始识别和再识别ConfidentialandProprietary;DoNotCopyorDistribute16诊
8、诊断断QuickLookII:ListsVOSepisodessincelastsessionObservationslistsT-waveoversensingepisodesT-波识别ConfidentialandProprietary;DoNotCopyorDistribute17V.OversensingTwaveEpisodeStorage1.MarkerChannel显示每个心室事件被计数两次.2.T-波过感知开始诊断后TW被标注.3.根据每个事件的情况标注TW表示T-波过感知Note: ThisalgorithmdoesnoteliminateTWOS.Itonlyattempt
9、stowithholdshocksforTWOS.诊断T-波识别ConfidentialandProprietary;DoNotCopyorDistribute18Case#4:Protecta SmartShockT-波识别ConfidentialandProprietary;DoNotCopyorDistribute19Case#4:ProtectaPerformance无不恰当电击!ConfidentialandProprietary;DoNotCopyorDistribute20减少T-波过感知引起的电击第一个也是唯一的T-波识别技术在保证VT/VF检测敏感性前提下,识别T-波过感知且
10、抑制治疗的发放T-波过感知新方法:全自动不影响VF检测的敏感性ConfidentialandProprietary;DoNotCopyorDistribute21KnowledgeCheckConfidentialandProprietary;DoNotCopyorDistribute22问题下列哪些关于T-波过感知识别是正确的?1.并能应用于SVTlimit下(快)2.消除T-波过感知3.应用于初始识别和再识别4.分析远场信号(nominalCantoRVCoil)答案ConfidentialandProprietary;DoNotCopyorDistribute23问题下列哪些关于T-波识别是正确的?1.出厂值为OFF,但很容易程控2.消除T-波过感知以避免不恰当的电击3.识别T-波过感知且不影响VT/VF的检测4.需要有第一次因为T-波过感知的电击答案Poster:PooleJE,etal.AnalysisofICDShockElectrogramsintheSCD-HeFTTrial.Heart RhythmSocietyConference.2004.FewerShocks.GreaterLiving.ONLY PROTECTA!