美敦力产品寿命介绍.ppt

*,Cliquez et modifiez le titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,Improved longevities,Cliquez et modifiez le titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,美敦力产品寿命介绍,我们需要什么样的起搏产品？,How Long will it last？,156,人的随机调查,包含准备植入的患者，刚植入的患者，植入后常规随访的患者,包含各种年龄，各种性别，各种体型的患者,90%,以上的患者表示和小体积的机器相比，他们,更喜欢体积大的寿命长,的产品,1 Wild DM et al.Pacemaker and implantable cardioverter defibrillators:device longevity is more important than smaller size.The patients viewpoint.PACE 2004;27:15261529,为什么需要长寿命的起搏产品？,更少的更换意味着：,感染风险,因更换而住院的花费以及购买起搏器的花费,感染的几率,初次植入,更换,AA Harcombe,2,1.4%,6.5%,BL Wikoff,3,0.5%,以下,2-7%,2-Harcombe AA et al.Late complications following permanent pacemaker implantation or elective unit replacement.Heart 1998;80:240244,3-Wilkoff BL.How to treat and identify device infections.Heart Rhythm 2007;4:1467-1470,4-Catanchin A.Pacemaker infection:a 10-year experience.Heart Lung Circ 2007 Dec;16(6):434-9,更换和二次手术导致感染的风险是第一次手术的,5,倍。,4,费用比较,5-www.pacemaker.dk,首次植入起搏器后,20%,的患者存活超过,14,年,1,2,3,4,1,2,3,为起搏器或者更换住院所花费的费用将会持续,6,到,8,年。,5,影响起搏器寿命的因素,起搏器,人体,起搏器与心肌的接触,起搏器方面,电池容量,微处理芯片驱动程序：诊断功能，,EGM,，遥测功能，感知，特殊功能,必须保持运行的程序：保持起搏器输出和芯片运行,1),2),起搏器参数设置及工作状态,起搏器输出（电压和脉宽）,60 bpm;0,4 ms,100%pacing;500,6,3.5V,7.1,年,2.5V,9,年,+12%,起搏器电极阻抗,60 bpm;2,5 V;0,4 ms,100%pacing,6,500,7.4,年,1000,8.2,年,+10%,3),病人,起搏比例,SND+3AVB,患者,=50%,心房起搏,+100%,心室起搏,SND,患者,=50%,心房起搏,+5%,心室起搏,神经反射性晕厥患者,=1%,心房和心室起搏,低限频率：生活方式，年龄，变时性功能,特殊算法：,RDR,，,MVP,，,APP,Adapta家族创新的电路设计,新的起搏电路技术,3,片集成电路,1,片集成电路,现代的集成电路技术：,3,m&,1.5,m,集成电路,0.25,m,集成电路,更低的日常电流损失,更低的微处理芯片和电路板能耗,延长寿命,分配给当前程序的电量,6-Improved longevity in Adapta,Versa,Sensia and Relia pacemakers.Medtronic 2009,Adapta家族产品延长多少寿命？,Adapta,家族产品平均能够延长,24%,的使用寿命,*,双腔起搏器，标准电池,60 bpm,2,5V,0,4 ms,100%pacing,1000 Ohm,长寿命产品的表现？,各种电池容量比较,Estimated longevity(years)*,Battery,Volume(cc),Model,Before,Now,Large,13,1 cc,ADDRL1/SEDRL1,10,1,12,6,Medium,12,1 cc,ADDR01/SEDR01,8,2,10,2,-,外观尺寸仅仅相差,1cc,植入Adapta ADDR L1一周,植入后一周，按出厂设置。预估寿命已经超出医生及病人预期,由于术中病人,AF,，自动阈值管理功能运行结果正常，让医生非常满意,112,天后随访起搏器的预估寿命让人惊喜,起搏器的寿命进一步延长,MVP,不必要的右心室起搏会增加病人发生房颤和心衰的风险,9,MVP,可以减少,99%,不必要的右心室起搏,11-14,延长一年起搏器寿命,9-Sweeney MO,Hellkamp AS,Ellenbogen KA,et al,for the MOde Selection Trial(MOST)Investigators.Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.Circulation June 17,2003;107(23):2932-2937,10-Gillis AM,Prerfellner H,Israel CW et al.Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease and AV block.PACE July 2006;29(7):697-705,自动阈值管理,心房和心室的自动阈值管理功能,根据心房和心室的阈值自动调整输出电压和脉宽,.,自动阈值管理功能能够增加患者起搏的安全性,11-14,11-Bondke H,Schoenfeld G,Eisert C,Baumann G.Longevity increase of cardiac pacemakers of the Medtronic Kappa 700 series using capture managment while maintaining appropriate safety margin(Conference Abstract).Eur Heart J 2001 Sep;22(Abstr Suppl):445,12-OHara GE et al.First clinical experience with a new pacemaker with ventricular capture management feature.PACE 1998;21(II):892.Abstract 412,13-Sperzel J et al.The European Kappa registry:automatic ventricular capture management.Europace Supplements 2002;3:A53.Abstract 85P/21,14-Sperzel J.Automatic measurement of atrial pacing thresholds in dual-chamber pacemakers:Clinical experience with atrial capture management.Heart Rhythm 2005;2:12031210,增加,1.9,年起搏器寿命,那么它能工作多久呢？,增加到,12,年,!,Thank you!,