The Research On The High-frequency Electric Knife System For Patients With Pacemaker Dependence

Background:High frequency electromagnetic interference signals generated by high frequency electric knife can affect implanted electronic devices,inhibit pacemaker pulse,especially for the patients implanted and rely on the pacemaker,which may lead to a risk of cardiac arrest.The current solution is to set the pacemaker to an asynchronous pacing mode before surgery,but this may cause competitive rhythms and even induce arrhythmia.However,interference signal in the ventricular refractory period(VRP),which follows the electrocardiogram(ECG)R wave,can trigger pacemaker noise reversion instead of inhibiting pacing pulse,indicating that the R wave can be used as a starting signal for an electric knife when used in patients with pacemaker dependence.Objective:Through follow-up pacemaker and programme working mode of the proposed surgical or cavity mirror patients with implanted pacemaker,observe the amount of time,manpower and material resources and risk of the solution,explore the feasibility and the methodology of the high frequency electricity knife based on biomedical signal trigger,explore the new strategy to solve high frequency electric knife electromagnetic interference problem of patients with pacemaker dependence.Methods:1?Selected from September 2017 to December 2018 admitted the First Affiliated Hospital of Kunming Medical University,39 cases of patients implanted permanent pacemaker and now in the cavity of surgical operation or microscopic surgery,including single chamber pacemaker implanted in 5 cases and dual chamber pacemaker implanted in 34 cases.Preoperative routine follow-up pacemaker and set the pacemaker to an asynchronous pacing mode(VOO or DOO)before surgery,electrical monitoring during operation,adjustment for synchronous mode(VVI or DDD)after surgery,and record every time programmable length and period of time between two follow-up.2?Based on the time period and function of the pacemaker,present the body surface electrocardiogram(ECG)signal control high frequency electric knife system solutions and discuss its feasibility and limitations.Results:1?Patients' surgical site statistics,there are 21 cases(53.8%)upon the umbilicus,18 cases(46.2%)below the umbilicus.The time for pacemaker follow-up preoperative and postoperative were 46.9±18.8 minutes and 31.5±11.5 minutes,the time interval between two follow-up was 5.76±1.99 hours.19 cases(76%)appeared competitive rhythms during surgery,programmed pacemaker again and improve the lower rate,then did not appear competitive rhythms again.Intraoperative use of electric knife are single cutting and bipolar electric coagulation mixing.39 patients were successfully completed surgery safely and high frequency electric knife used in patients with no new arrhythmia,QRS wave width increasing,ST segment changes,or arterial blood pressure or oxygen saturation decreases obviously.Pacemaker parameters such as the battery voltage,impedance,and the electrode impedance,sense and threshold have no difference before and after operation(P>0.05).Pacemaker work are normal.2?Based on ECG P wave or R wave signal to trigger the high frequency electric knife can be used in patients pacemaker dependence in theory,but compared with the R wave trigger project,P wave trigger project has poorer feasibility.Conclusion(s):1?In patients with pacemaker dependence using the high frequency electric knife,pacemaker must be programmed to work for a asynchronous pacing mode,the process is time-consuming,laborious,and a possible of competitive rhythms.2?The ECG R wave as a driving signal of high frequency electric knife,by triggering noise reversion function applied to the patients with pacemaker dependent is feasible.