Brownlee J R, Serwer G A, Dick M, Bauld T, Rosenthal A
Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor 48109.
Am J Dis Child. 1989 Jan;143(1):105-7. doi: 10.1001/archpedi.1989.02150130115028.
Two children with cardiac pacemakers are described who experienced cardiorespiratory arrest not detected by the electrocardiographic (ECG) monitor. The pacemaker stimuli were interpreted by the monitor as a QRS complex with inhibition of the heart rate alarm, demonstrating the need for reliable non-ECG monitoring in patients with pacemakers. A review of all deaths in children with pacemakers in the last ten years also shows the high association of respiratory failure in patients with congenital heart disease and a pacemaker, underscoring this need. Various non-ECG monitoring modalities are discussed. Finally, analysis of the ECG monitor characteristics contributing to inappropriate sensing of the pacemaker stimulus was performed, showing the direct relation between the pacemaker stimulus amplitude seen by the monitor and the monitor sensitivity with inappropriate sensing, and the inverse relation between the monitor bandwidth and inappropriate sensing. Recommendations for monitor adjustment when monitoring patients with pacemakers are provided.
本文描述了两名植入心脏起搏器的儿童，他们经历了心肺骤停，但心电图（ECG）监测仪未检测到。监测仪将起搏器刺激信号解读为QRS波群，并抑制了心率警报，这表明起搏器患者需要可靠的非心电图监测。回顾过去十年中所有植入起搏器儿童的死亡情况，也显示出先天性心脏病合并起搏器患者呼吸衰竭的高度相关性，凸显了这种需求。文中讨论了各种非心电图监测方式。最后，对导致起搏器刺激信号感知异常的心电图监测仪特性进行了分析，结果表明监测仪所看到的起搏器刺激信号幅度与监测仪灵敏度和感知异常之间存在直接关系，而监测仪带宽与感知异常之间存在反比关系。文中还提供了监测起搏器患者时调整监测仪的建议。
