{"id":788,"date":"2025-07-31T14:20:44","date_gmt":"2025-07-31T14:20:44","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=788"},"modified":"2025-11-08T22:46:03","modified_gmt":"2025-11-08T22:46:03","slug":"management-of-atrial-arrhythmias-medtronic-pm","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/devices-per-company\/medtronic\/management-of-atrial-arrhythmias-medtronic-pm\/","title":{"rendered":"Management of atrial arrhythmias Medtronic PM"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"788\" class=\"elementor elementor-788\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-42adf80 e-con-full e-flex e-con e-parent\" data-id=\"42adf80\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-a7206b1 e-con-full e-flex e-con e-child\" data-id=\"a7206b1\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d95bbc7 elementor-widget elementor-widget-heading\" data-id=\"d95bbc7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Medtronic - Gestion des arythmies auriculaires<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-30762a9 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"30762a9\" data-element_type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h3&quot;,&quot;h4&quot;],&quot;exclude_headings_by_selector&quot;:[],&quot;no_headings_message&quot;:&quot;No headings were found on this page.&quot;,&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;fas fa-circle&quot;,&quot;library&quot;:&quot;fa-solid&quot;,&quot;rendered_tag&quot;:&quot;&lt;svg class=\\&quot;e-font-icon-svg e-fas-circle\\&quot; viewBox=\\&quot;0 0 512 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&quot;},&quot;minimize_box&quot;:&quot;yes&quot;,&quot;minimized_on&quot;:&quot;tablet&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tG\u00e9n\u00e9ralit\u00e9s\t\t\t<\/h4>\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__30762a9\" aria-expanded=\"true\" aria-label=\"Ouvrir la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__30762a9\" aria-expanded=\"true\" aria-label=\"Fermer la table des mati\u00e8res\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div id=\"elementor-toc__30762a9\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<svg class=\"elementor-toc__spinner eicon-animation-spin e-font-icon-svg e-eicon-loading\" aria-hidden=\"true\" viewbox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M500 975V858C696 858 858 696 858 500S696 142 500 142 142 304 142 500H25C25 237 238 25 500 25S975 237 975 500 763 975 500 975Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a19e78 elementor-widget elementor-widget-heading\" data-id=\"2a19e78\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Changement de mode en raison d'arythmies auriculaires<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1775f21 elementor-widget elementor-widget-text-editor\" data-id=\"1775f21\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Passage en mode asynchrone (nouvelle plate-forme de stimulateur cardiaque)<\/strong><\/p><p>Le stimulateur passe en mode DDIR (mode non programmable) lorsque le crit\u00e8re d'apparition soudaine d'AT\/AF est rempli si la valeur m\u00e9diane des 12 derniers intervalles auriculaires d\u00e9tect\u00e9s est plus courte que l'intervalle AT\/AF programm\u00e9 et si le compteur de preuves d'AF (2 signaux auriculaires d\u00e9tect\u00e9s entre 2 signaux ventriculaires) est sup\u00e9rieur ou \u00e9gal \u00e0 3. Pour \u00e9viter une chute soudaine de la fr\u00e9quence ventriculaire, il r\u00e9duit tr\u00e8s progressivement la fr\u00e9quence de stimulation de la fr\u00e9quence auriculaire synchrone \u00e0 la fr\u00e9quence indiqu\u00e9e par le capteur sur plusieurs cycles de stimulation. Les marqueurs d'\u00e9v\u00e9nements comprennent un marqueur \u201cMS\u201d pour chaque commutation de mode, qu'il s'agisse du mode asynchrone ou synchrone.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c4ed4a3 elementor-widget elementor-widget-image\" data-id=\"c4ed4a3\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a9.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_arythmies_a9\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDMyOCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTFcL3BtXzE5X3NpdHVhdGlvbnNfYXJ5dGhtaWVzX2E5LnBuZyJ9\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"605\" height=\"183\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a9.png\" class=\"attachment-large size-large wp-image-4328\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a9.png 605w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a9-300x91.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a9-18x5.png 18w\" sizes=\"(max-width: 605px) 100vw, 605px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-92831c3 elementor-widget elementor-widget-text-editor\" data-id=\"92831c3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ol><li>D\u00e9but d\u2019une  arythmie atriale avec acc\u00e9l\u00e9ration du rythme ventriculaire stimul\u00e9<\/li><li>Le crit\u00e8re d'apparition soudaine d'un AT\/AF est rempli ; MS (changement de mode) marque la transition vers le mode de repli ; transition du mode de stimulation programm\u00e9e vers le mode DDIR<\/li><li>Transition progressive de la fr\u00e9quence de stimulation ventriculaire rapide \u00e0 la fr\u00e9quence servocontr\u00f4l\u00e9e (+40 ms \u00e0 chaque intervalle)<\/li><li>Fin de l'arythmie ; retour au mode programm\u00e9 (sauf pour le mode MVP, pour lequel il y a toujours un retour \u00e0 DDD avant un retour \u00e0 AAI)<\/li><\/ol><p>\u00a0<\/p><p><strong>Passage au mode synchrone de suivi auriculaire (nouvelle plate-forme de stimulateur cardiaque)<\/strong><\/p><p>L'\u00e9pisode se termine lorsqu'un rythme sinusal normal (ou un rythme rythm\u00e9 normal) est identifi\u00e9 pendant 5 intervalles ventriculaires cons\u00e9cutifs, ou si l'intervalle auriculaire m\u00e9dian est sup\u00e9rieur \u00e0 l'intervalle de d\u00e9tection AT\/AF, ou si le compteur AT\/AF est inf\u00e9rieur \u00e0 27 pendant 3 minutes.<\/p><p><strong>Enregistrement des \u00e9pisodes d'arythmie auriculaire<\/strong><\/p><p>Les \u00e9v\u00e9nements auriculaires pathologiques sont enregistr\u00e9s lorsqu'ils provoquent une p\u00e9riode r\u00e9fractaire. Il est possible de visualiser le graphique, les EGM et un texte r\u00e9capitulatif pour les diff\u00e9rents \u00e9pisodes enregistr\u00e9s.<\/p><p>Le rapport du moniteur cardiaque fournit des informations sur les \u00e9pisodes d'AT\/AF et les rythmes ventriculaires, indique le temps pass\u00e9 en AT\/AF et fournit des informations sur l'\u00e9volution du nombre total d'heures d'AT\/AF par jour (graphique).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f54a3a5 elementor-widget elementor-widget-image\" data-id=\"f54a3a5\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a10.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_arythmies_a10\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDMyOSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTFcL3BtXzE5X3NpdHVhdGlvbnNfYXJ5dGhtaWVzX2ExMC5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"605\" height=\"411\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a10.png\" class=\"attachment-large size-large wp-image-4329\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a10.png 605w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a10-300x204.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_a10-18x12.png 18w\" sizes=\"(max-width: 605px) 100vw, 605px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f05361b elementor-widget elementor-widget-heading\" data-id=\"f05361b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Gestion du flutter chez Medtronic<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6d64ef7 elementor-widget elementor-widget-text-editor\" data-id=\"6d64ef7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Algorithme de d\u00e9tection du flottement masqu\u00e9<\/strong><\/p><p>Cet algorithme recherche la pr\u00e9sence d'un signal auriculaire qui n'est pas vu parce qu'il se situe dans la p\u00e9riode de suppression auriculaire apr\u00e8s la stimulation ventriculaire :<\/p><ul><li>il y a une succession de cycles rapides AS-VP<\/li><li>il y a 8 intervalles AS-AS cons\u00e9cutifs qui sont inf\u00e9rieurs \u00e0 deux fois la somme du d\u00e9lai AV + la suppression auriculaire post-stimulation ventriculaire et inf\u00e9rieurs \u00e0 deux fois l'intervalle correspondant au taux de d\u00e9tection de l'arythmie auriculaire.<\/li><\/ul><p>\u00a0<\/p><p>Dans ce cas, au 9\u00e8me cycle, l'algorithme augmente le PVARP pour amener l'\u00e9v\u00e9nement auriculaire suivant (AR) dans la p\u00e9riode r\u00e9fractaire, ne pas stimuler le ventricule sur un battement, et d\u00e9masquer l'onde de flutter suivante (AS), qui n'est plus cach\u00e9e dans le blanking auriculaire post-stimulation ventriculaire.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cef8f50 elementor-widget elementor-widget-image\" data-id=\"cef8f50\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_f5.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_arythmies_f5\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDMzMCwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTFcL3BtXzE5X3NpdHVhdGlvbnNfYXJ5dGhtaWVzX2Y1LnBuZyJ9\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"605\" height=\"161\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_f5.png\" class=\"attachment-large size-large wp-image-4330\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_f5.png 605w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_f5-300x80.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_f5-18x5.png 18w\" sizes=\"(max-width: 605px) 100vw, 605px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c1f3b6b elementor-widget elementor-widget-text-editor\" data-id=\"c1f3b6b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Cet algorithme \u00e9tait pr\u00e9sent sur les anciennes plates-formes de stimulateurs cardiaques o\u00f9 la suppression post-ventriculaire de l'oreillette \u00e9tait absolue. Il convient de noter que sur les plates-formes plus r\u00e9centes, la suppression atriale post-ventriculaire n'est plus absolue (lorsque le PVAB est programm\u00e9 sur partiel ou partiel+), et qu'un signal tombant dans la p\u00e9riode de suppression est pris en compte pour le diagnostic des arythmies, ce qui limite l'utilit\u00e9 de ce type d'algorithme.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f07fc50 elementor-widget elementor-widget-heading\" data-id=\"f07fc50\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Algorithme de pr\u00e9vention de la FA chez Medtronic<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9a1ee3d elementor-widget elementor-widget-text-editor\" data-id=\"9a1ee3d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Stimulation atriale non-comp\u00e9titive<\/strong><\/p><p>L'arythmie auriculaire peut \u00eatre d\u00e9clench\u00e9e si un \u00e9v\u00e9nement auriculaire stimul\u00e9 se produit pendant la p\u00e9riode vuln\u00e9rable de l'oreillette. La stimulation auriculaire non comp\u00e9titive (NCAP) est con\u00e7ue pour emp\u00eacher le d\u00e9clenchement d'une arythmie auriculaire en stimulant pendant la p\u00e9riode r\u00e9fractaire relative de l'oreillette.<\/p><p>Lorsque le NCAP est programm\u00e9 sur On, un \u00e9v\u00e9nement auriculaire r\u00e9fractaire d\u00e9tect\u00e9 pendant le PVARP d\u00e9clenche une p\u00e9riode NCAP programmable pendant laquelle aucune stimulation auriculaire ne peut avoir lieu.<\/p><p>Lorsque la stimulation auriculaire est retard\u00e9e par le fonctionnement du NCAP, le stimulateur tente de maintenir une fr\u00e9quence ventriculaire stable en r\u00e9duisant le d\u00e9lai AV stimul\u00e9 suivant. Cependant, il ne raccourcit pas le d\u00e9lai AV stimul\u00e9 \u00e0 moins de 30 ms.<\/p><p>L\u2019intervalle SANC est de 400 ms pour 1 cycle de stimulation \u00e0 chaque fois qu\u2019une r\u00e9ponse aux ESV ou une intervention anti-TRE se produit.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ac63eb2 elementor-widget elementor-widget-image\" data-id=\"ac63eb2\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa7.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_arythmies_fa7\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDMzMSwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTFcL3BtXzE5X3NpdHVhdGlvbnNfYXJ5dGhtaWVzX2ZhNy5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"224\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa7.png\" class=\"attachment-large size-large wp-image-4331\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa7.png 605w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa7-300x111.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa7-18x7.png 18w\" sizes=\"(max-width: 605px) 100vw, 605px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9cceeb3 elementor-widget elementor-widget-text-editor\" data-id=\"9cceeb3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Stimulation de la pr\u00e9f\u00e9rence auriculaire<\/strong><\/p><p>La stimulation auriculaire pr\u00e9f\u00e9rentielle (APP) est con\u00e7ue pour r\u00e9duire l'incidence des tachyarythmies auriculaires en r\u00e9agissant aux changements de fr\u00e9quence auriculaire en acc\u00e9l\u00e9rant la fr\u00e9quence de stimulation jusqu'\u00e0 ce qu'une fr\u00e9quence de stimulation stable soit atteinte, qui est l\u00e9g\u00e8rement plus rapide que la fr\u00e9quence spontan\u00e9e. Apr\u00e8s chaque \u00e9v\u00e9nement auriculaire non r\u00e9fractaire d\u00e9tect\u00e9, le dispositif diminue l'intervalle de stimulation auriculaire de la valeur de d\u00e9cr\u00e9mentation de l'intervalle programm\u00e9e. Les impulsions de stimulation auriculaire d\u00e9livr\u00e9es pour l'APP sont annot\u00e9es PP (stimulation proactive) sur le marqueur d'\u00e9v\u00e9nement.<\/p><p>Si l'\u00e9v\u00e9nement auriculaire suivant est un autre \u00e9v\u00e9nement non r\u00e9fractaire d\u00e9tect\u00e9, l'intervalle de stimulation est \u00e0 nouveau d\u00e9cr\u00e9ment\u00e9. Cette progression se poursuit jusqu'\u00e0 ce que la fr\u00e9quence de stimulation d\u00e9passe la fr\u00e9quence spontan\u00e9e, ce qui donne un rythme auriculaire stimul\u00e9. Cependant, la valeur maximale programm\u00e9e de la fr\u00e9quence fournit une limite de fr\u00e9quence pour la stimulation auriculaire pr\u00e9f\u00e9r\u00e9e. Apr\u00e8s une p\u00e9riode programmable de stimulation auriculaire de 100%, le stimulateur cardiaque diminue progressivement la fr\u00e9quence de stimulation \u00e0 la recherche du prochain battement spontan\u00e9. Le prochain battement sinusal relance la pr\u00e9f\u00e9rence de stimulation<\/p><p><strong>Stabilisation du rythme auriculaire<\/strong><\/p><p>La stabilisation du rythme auriculaire (ARS) est une fonction programmable con\u00e7ue pour emp\u00eacher une pause sinusale apr\u00e8s une PAC (s\u00e9quences de cycles courts et longs qui peuvent provoquer le d\u00e9marrage brutal de certaines tachyarythmies auriculaires). Elle r\u00e9pond \u00e0 une AES en augmentant instantan\u00e9ment la fr\u00e9quence de stimulation auriculaire, puis en la ralentissant progressivement jusqu'\u00e0 la fr\u00e9quence spontan\u00e9e, la fr\u00e9quence de stimulation programm\u00e9e ou la fr\u00e9quence du capteur.<\/p><p>Lorsque le dispositif est activ\u00e9 par un PAC, il d\u00e9livre une impulsion de stimulation \u00e0 l'intervalle pr\u00e9matur\u00e9 augment\u00e9 d'un pourcentage de cet intervalle (d\u00e9fini par le param\u00e8tre de pourcentage d'incr\u00e9mentation de l'intervalle programm\u00e9). Pour chaque \u00e9v\u00e9nement auriculaire d\u00e9tect\u00e9 ou stimul\u00e9 par la suite, le dispositif continue d'augmenter chaque intervalle de stimulation du pourcentage programm\u00e9 de l'intervalle pr\u00e9c\u00e9dent. Le param\u00e8tre de fr\u00e9quence maximale fixe une limite pour l'ARS. Les impulsions de stimulation auriculaire d\u00e9livr\u00e9es pour l'ARS sont annot\u00e9es PP (Proactive Pacing) sur le marqueur d'\u00e9v\u00e9nement.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-786be40 elementor-widget elementor-widget-image\" data-id=\"786be40\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa8.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-title=\"pm_19_situations_arythmies_fa8\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NDMzMiwidXJsIjoiaHR0cHM6XC9cL2NhcmRpb2Nhc2VzLmNvbVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyNVwvMTFcL3BtXzE5X3NpdHVhdGlvbnNfYXJ5dGhtaWVzX2ZhOC5wbmcifQ%3D%3D\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"246\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa8.png\" class=\"attachment-large size-large wp-image-4332\" alt=\"\" srcset=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa8.png 605w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa8-300x122.png 300w, https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/11\/pm_19_situations_arythmies_fa8-18x7.png 18w\" sizes=\"(max-width: 605px) 100vw, 605px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-216be87 elementor-widget elementor-widget-text-editor\" data-id=\"216be87\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Post Mode-Switch Overdrive Pacing (rythme de la surmultiplication)<\/strong><\/p><p>La stimulation apr\u00e8s le changement de mode (PMOP) est une fonction programmable qui fournit une stimulation auriculaire rapide \u00e0 la fin d'un changement de mode.<\/p><p>Apr\u00e8s un changement de mode, l'appareil augmente la fr\u00e9quence de stimulation battement par battement (en diminuant l'intervalle de stimulation de 15 ms par impulsion pour Adapta et de 70 ms pour Advisa) jusqu'\u00e0 ce qu'il atteigne la fr\u00e9quence de stimulation rapide programm\u00e9e. Il continue la stimulation DDIR \u00e0 la fr\u00e9quence rapide pendant la dur\u00e9e de stimulation rapide programm\u00e9e. Il r\u00e9gule ensuite le retour au mode synchrone auriculaire programm\u00e9 en ralentissant progressivement la fr\u00e9quence jusqu'\u00e0 ce qu'elle atteigne la fr\u00e9quence de stimulation programm\u00e9e, la fr\u00e9quence minimale programm\u00e9e ou la fr\u00e9quence du capteur.<\/p><p><strong>R\u00e9ponse \u00e0 l'AF men\u00e9e<\/strong><\/p><p>La r\u00e9ponse \u00e0 la FA conduite, appel\u00e9e stabilisation de la fr\u00e9quence ventriculaire pour les anciens stimulateurs cardiaques, est con\u00e7ue pour r\u00e9guler la fr\u00e9quence ventriculaire pendant la FA. Le stimulateur modifie la fr\u00e9quence de stimulation battement par battement pour se rapprocher de la fr\u00e9quence ventriculaire intrins\u00e8que moyenne. Les longues pauses sont \u00e9limin\u00e9es, ce qui r\u00e9duit l'irr\u00e9gularit\u00e9 de la fr\u00e9quence ventriculaire. La r\u00e9ponse \u00e0 la FA conduite ne fonctionne qu'en mode asynchrone. Par cons\u00e9quent, lorsque l'appareil est programm\u00e9 en mode DDD ou DDDR, la r\u00e9ponse AF conduite ne fonctionne que lors du passage en mode VDIR ou DDIR. Pour programmer la r\u00e9ponse AF conduite sur On, la commutation de mode doit \u00eatre r\u00e9gl\u00e9e sur On.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Medtronic &#8211; Management of atrial arrhythmias Content Mode switch due to atrial arrhythmias Switching to asynchronous mode (new pacemaker platform) The pacemaker switches to DDIR mode (non-programmable mode) when the sudden onset of AT\/AF criterion is met if the median value of the 12 most recent detected atrial intervals is shorter than the programmed AT\/AF [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":49,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-788","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - 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