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EECP ECG Triggering Troubleshooting
EECP ECG Triggering Troubleshooting
It appears at first glance that the larger wave is the diastolic, but it is deceiving. A line drawn through the R wave will only intersect some part of the preceding diastolic wave. It cannot touch any part of a systolic wave due to the electromechanical delay involved with measuring the finger plethysmogram. Even the Peak and Area measurements from the device are inaccurate due to the timing being so far off.
Troubleshooting ECG triggering problems: Device is double counting heart rate from two trigger signals per beat. This put the sensed heart rate level past the 125 beats per minute upper threshold and does not allow counterpulsation to begin. Change lead placement for less prominent T wave or in some cases P wave.
Troubleshooting ECG triggering: effects of a rate responsive pacemaker increases HR and makes it more challenging to identify the systolic versus diastolic waves. Notice the late deflation. Using the 1:2 trigger allows for easier identification of the systolic and diastolic waves
1:1 Trigger
1:2 Trigger
Troubleshooting ECG
Another example of HR double counting. This time also triggering from the T wave. HR registers as 172, beyond the upper limits of HR parameters. No counterpulsation can begin. Try different lead placement that provide positive QRS complex. Use 12 lead ECG to help determine which leads might be helpful.
Atrial Fibrillation
Device triggering is based on analysis of several previous R-R intervals, so inflation duration can be estimated for future beats. Atrial fibrillation confounds this and leads to long periods of no cuff inflation on long beats. Inflation timing can still be adjusted with accuracy while the deflation marker will fluctuate significantly. The treatment will generally be better tolerated in patients with good rate control while in atrial fibrillation.