起搏器的电干扰反应  

Responses of implanted pacemaker to electrical interference

作　　者：冯义柏[1] 李欲舒[1] 王祥[1] 方宏[1] 毛弈 

机构地区：[1]同济医科大学协和医院暨心血管病研究所,武汉430022

出　　处：《中华心律失常学杂志》1999年第3期177-179,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　研究在体心脏起搏器对不同强度和频率电干扰的反应。方法　对１０ 例植入ＣＰＩＤｅｌｔａ ９３７ 型ＤＤＤ心脏起搏器的患者，使用程序胸壁刺激试验（ＰＣＷＳ）测定起搏器对电干扰的反应。起搏器的植入时间平均为３９．５±１５．８个月，均在使用期内，且运转正常。结果　使用较低输出电压（平均０．５±０．１２ Ｖ），连续递增刺激（频率平均１２５～１１８５±４０．１ ｐｐｍ 范围内）可使在体心脏起搏器触发心室同步快速起搏，此刺激频率范围即为起搏器的干扰触发区（ＩＴＡ）。使用较高输出电压（平均１．１６±０．４Ｖ），连续递增刺激（频率平均９０～１２３６±３１７ ｐｐｍ 范围内）可使在体心脏起搏器完全抑制，此刺激频率范围即为起搏器的全抑制区（ＣＩＡ）。分别继续增大刺激频率，在体心脏起搏器则自动转化成ＤＯＯ方式以下限频率起搏。刺激脉宽均为２ ｍ ｓ。结论　ＤＤＤ起搏器对不同强度和不同频率的电干扰具有复杂的反应方式。此种患者应避免ＩＴＡ和ＣＩＡ频率范围内的电干扰。Objective To study the responses of implanted pacemaker to various strength and frequency interference. Methods The pacemaker response to interference were determined with programmed chest wall stimulation(PCWS)test in 10 patients with Model Delta 937 DDD pacemakers implanted.The pacemakers,which had been implanted for 39 5±15 8 months,were still during their designed life span and all were functioning normally. Results With lower output voltage,incremental PCWS,an interference triggered area(ITA)of mean 125～1185±40 1 ppm was observed,and within this rate range,the PCWS caused the implanted pacemakers to trigger rapid synchronous ventricular pacing at the upper tracking rate.With higher output voltage,incremental PCWS,a completely inhibited area(CIA)of mean 90～1236±317 ppm was detected.Only if the stimulation rate was even faster than ITA of lower ouput and CIA of higher output,the pacemaker would revert to DOO mode with lower rate limit.In this study,the lower and higher output stimulus pulses were 0 5±0 12 and 1 16±0 4 V,respectively,with 2 ms pulse width. Conclusion Our findings indicated that the DDD pacemaker revealed complex responses to electrical interference,depending on the strength and frequency of the interference.Patients had a DDD pacemaker implanted should avoid the electrical interference with frequency range of ITA and CIA,both of which could be detected by PCWS simply and safely.

关 键 词：电干扰 心脏起搏器 DDD型 

分 类 号：R654.2[医药卫生—外科学] R318.11[医药卫生—临床医学]