Preparation And Clinical Research Of R-wave Triggered High-frequency Electrosurgical System

Purpose:To prepare a pacemaker noise reversion(NR)triggered by R wave of body surface electrocardiogram(ECG),which can be activated and triggered in the relative refractory period of the pacemaker ventricular channel.For patients implanted and dependent on pacemakers,a high frequency electrotome system triggered by R wave can be used without routine preoperative programming of the working mode of pacemakers.In addition,the safety and effectiveness of the high frequency electrotome system applied to patients with implanted pacemakers were studied,and the possible shortcomings of the high frequency electrotome system were explored and improved.Method:1.Prepare R-wave triggered high-frequency electrotome prototype.The host of R-wave triggered high-frequency electrotome prototype adopts Shanghai Hutong GD350-B system,which has been widely used and mature in the market,and the control loop of the electrotome system adopts Shenzhen Langruihuikang ECG acquisition module.Control module uses the stmicroelectronics(ST)company 32-bit MCU STM32F103C8T6,via a serial port to communicate with the ECG collection module,data after processing,via a serial port to send data to the control module,control module to monitor the foot switch state,when either switch on the pedal switch and need R wave synchronized trigger,When the control module finds the R wave signal,it controls the output of the high frequency electrotome accordingly.2.Test the real-time performance of starting R wave and triggering the output of high frequency electrotome.The collected ECG signal is sent to the test development board through the R wave controller,and the test development board will convert the received data into analog signals for real-time output.By measuring the starting time of the high frequency electrotome and the time difference between the output signal and the analog signal,the real time of the recognition R and the starting output of the electrotome can be obtained.3.Study of the high frequency electricity knife system applied to the efficacy and safety of patients with implanted pacemaker,choose between September 2020 and April 2021 were admitted for the first affiliated hospital of kunming medical university heart medicine,always ordinary implantable cardiac pacemaker for battery depletion pacemaker operation is proposed replacement of 15 cases,including 5 patients with pacemaker dependent,10 cases of the patients with pacemaker dependent,Open pacemaker program-controlled apparatus body surface electrocardiogram(ECG),preoperative program-controlled instrument after shows in figure and body surface electrocardiogram(ECG),ventricular cavity marked channel interface,measured ventricular pacing(VP)or ventricular perception(VS)events tag starting to body surface electrocardiogram between R wave peak period,intraoperative use of R wave to trigger bleeder type electric knife an electrocautery unit of blood,Observed whether the noise reversal function of the pacemaker was triggered successfully during the process of electroknife,whether the pulse release of the pacemaker was inhibited,and the electrode parameters of the pacemaker were programmed again after the operation.Result:1.Real-time detection results of high frequency electrotome output when R wave of body surface electrocardiogram is started and triggered show that the delay time between the waveform of high frequency electrotome start signal and that of the waveform of high frequency electrotome output is 5.6ms and 33.6ms.2.The delay of electrotome output and the initiation of VP and VS markers in pacemaker lumen map were 128.67±19.89ms and 119.07±12.26ms,respectively.3.15 patients were triggered by the R wave type high frequency electric knife to recognize R wave after start-up electrotome,an electrocautery unit of blood electrotome jamming signal in pacemaker ventricular channel VRP and continuous restart VRP,trigger function of NR,pacemaker pacemaker in the lower frequency,and not restrain pulse distribution,trigger NR success rate was 100%,no appear pacemaker pulse is restrained phenomenon,There was no rapid heart rate or new arrhythmia,QRS broadening and ST-T change during the use of high-frequency electrotome.4.Pacemaker replacement was successfully completed in all patients,and pacemaker function was normal in all patients through postoperative programmed control test.There were no statistically significant differences in pacemaker ventricular electrode perception,threshold and impedance between patients after surgery and those before surgery(P>0.05),and no changes in pacemaker electrode parameters before and after surgery.Conclusion:The R-wave triggered high frequency electrotome system can use the body surface ECG R wave as the starting signal of the electrotome and trigger the noise reversal of the pacemaker in the relative refractory period of the ventricular channel of the pacemaker,so it can be safely applied to pacemaker dependent patients.