除颤起搏器的临床应用.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
.
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
fortable 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 bine dual chamber pacing with ventricular arrhythmia detection and therapy
Ability to sense atrial activity during arrhythmias
SVT Discrimination: The ability to withhold therapy for non-lethal arrhythmias
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