1. 系統軟體硬體介紹 2. 擴大器及轉接盒連接

3. 系統功能介紹

台北榮總 心臟科黃代勳

Ensite Velocity System 基本連接設定

Confidential – Internal use

only – not for further

distribution

SJM Approach to Capital Equipment

HANSEN REMOTE

NAVIGATION

EPWORKMATERECORDING

SYSTEM

FLUORO

VIEWMATE II ULTRASOUND

COOL POINT PUMP

RF GENERATOR

LEADERSHIP IN ABLATION

TECHNOLOGY

EP4 STIMULATOR

EP Lab

EHR

ENSITE SYSTEM

Confidential – Internal use

only – not for further

distribution

1992: ESIFounded

1995: First Human Study,

London

1998: 1st Product Release

and Platform

2000: 2nd generation

2001: 3rd generation

2003: NavX,4th generation

2003: v4.2 New Platform

2004: v4.2.1 release

2004: v5.0 software

2005: v5.1 release

2005: SJM acquisition

1999: v1.1 software

2002: v3.2 release

2003: v4.1 release

2006: First commercial

CFE algorithm

2006: v6.0 software

2007: v7.0, Fusion

2008: v8.0 software

EnSite’s Consistent Innovation and Investment in EP

Ensite Velocity/Mode EE3000

Coronary Artery Disease & Anatomy OverviewAP2928217 Rev A

4Company Confidential. Internal use only. Not to be reproduced, distributed, or excerpted.© 2008 Abbott Laboratories

Ensite Velocity EE3000 Mapping System系統包括：A. 主機 Workstation ( 圖像處理電腦 ) Dual Intel 2.66G Xeon processors 4GB main memory 、 400GB patient data storage Linux operating system DVD 光碟燒錄器 Monitor 21 吋液晶顯示器以上 Version

Velocity Software package 分析軟體安裝於電腦 Fiber optic cable ( 光纖電纜 )

B.Patient Interface Unit (PIU) ( 病患介面裝置 )

High gain low noise amplifiers Low pass, High pass filter 128 channels standard high level analog input

B.Patient Interface Unit (PIU) ( 病患介面裝置 )1.Generator Module ( 電燒器模組 )2.Navx Module ( 體外定位貼片模組 )3.Recording Module ( 記錄器模組 )4.ECG cable ( 心電圖電纜 )5.6.Array Module ( 氣球電極導管模組 )

C.Accessory1.IsolationTransformer ( 隔離變壓器 )2.Connecttion Modules 信號連接模組

D Input From Other Equipment

A.System Connections

Coronary Artery Disease & Anatomy OverviewAP2928217 Rev A

6Company Confidential. Internal use only. Not to be reproduced, distributed, or excerpted.© 2008 Abbott Laboratories

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A.The EnSite Velocity DWS4, Amplifier and Remote Monitor

Full System Connection

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A.Versimo Segmentation Tool (CT/MRI Merge)

1.Versimo Segmentation Tool ( 安裝於 Workstation 內軟體功能，可將院內或外院

CT.MR 影像經製後併入 Ensite 系統和 Ensite 系統所做的

Geometry 並列，進而可進行 Geometry 和 CT.MR 影像同步翻轉及切割； Geometry 可和 CT.MR 影像 相對照後能更精確得知心臟房室內結構 . CT Dicom3 formet 0.1mm slice) New Software Including: 1.Field Scaling ( 使用導管電極間距 . 校準 Navx 立體圖 ) 2.CAFÉ Analysis ; 3.CT/MRI Fusion to EnSite 3D Maps

A.Display Workstation

Coronary Artery Disease & Anatomy OverviewAP2928217 Rev A

10Company Confidential. Internal use only. Not to be reproduced, distributed, or excerpted.© 2008 Abbott Laboratories

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B.Velocity Amplifier and Cart

The sampling rate has been increased from 1200 Hz to 2000 Hz

The NavX patch switching frequency is now >500 Hz

The Array locator frequency is now 200Hz regardless of the number of electrodes located.

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B.The EnSite Velocity Amplifier

The new Velocity Amplifier weighs 40lbs less than the Classic Amp.

The Velocity Amplifier will never need to be calibrated in the field.

To install the Velocity Amplifier, unpack it from the crate, plug it in, turn it on and wait 15 minutes. You are good to go.

Primary field maintenance of the Amplfier will be faster and easier.

B.Patient Interface Unit (PIU) ( 病患介面裝置 ) / Amplifer

Coronary Artery Disease & Anatomy OverviewAP2928217 Rev A

13Company Confidential. Internal use only. Not to be reproduced, distributed, or excerpted.© 2008 Abbott Laboratories

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B.Amplifier. Fiber Optic Cable Connection

1.GenConnect

2.Nav Link

3.Record Connect 4.ECG

Cath Link

5.6ArrayLInk

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1.GenConnect Module The GenConnect modules

are specific to the type of RF generator being used.

The RF dispersive filters are built into the GenConnect and no longer need to be connected in line with the RF dispersive electrodes.

1.CS – 20 Polar

Confidential –

Internal use only –

not for further

distribution

Confidential –

Internal use only –

not for further

distribution

EP=wire wire wire

Gen Link Ablation Cath Connection

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ibi vs EPT

2.Ensite Navx Setup vs Ensite Navx Patch 1.The Nav Link module provides connections for the NavX patches and the System Reference.

2.NavLink will be used on all cases for the System Reference.

3.NavX Eprom is now part of the left leg patch(Erasable Programmable Read-Only Memory 可消除程式化唯讀記憶體 )

System Reference & Lt Leg Cable Connection

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Complete Connection Using Navx Link

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NavX Cable Connections Attach the NavX patches as

follows:Back of NeckRight sideLeft sideBackFront (middle of chest) slightly to left(This patch features cutouts to allow for proper ECG electrode positioning).

Left Leg (inner thigh)

Once the patches are secured, the color coded, labeled connections can be made to the NavX cable.

NavX Patches / Correct Position of Patches

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3.RecordConnect Module The different recording system will interface with EnSite Velocity

using a RecordConnect module that is specific to the recording system used in the lab.

RecordConnects are available for GE Cardiolab, Bard Stamp and Clearsign, SJM / EP Med Workmate and Siemens Sensis.

Complete Connection Using Reocord Connect

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Amplifier Record ECG Array Connections

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Choosing Correct Recording Brand/CathLink

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SJM EP-WorkMate/GE Cardiolab

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Bard ClearSign/Bard Stamp

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Siemens Sensis

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4.ECG Cable In most cases, the ECG leads will plug into the Record Connect

module. This eliminates the need for a separate ECG cable. When using the CathLink module, an ECG cable is provided to

connect to the front of the Amplifier.

4.Standard Chest Electrode Position

Confidential –

Internal use only –

not for further

distribution

2 Ways of Patient Connection

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12 lead ECG locations on Front Patch

Match theSymbols for

Easy Connections

5.6..Ensite Array Setup vs Ensite Array Catheter

D.Boston Scientific Circu Cool

D.StJude Cool Point vs Therapy Cool Path irrigated Abl Cath Hero700

2.Ensite Navx 體表電極組 3D Navigation System 1. 於 Ensite Navx 模式可執行體外定位方式建立 3 D

心腔圖 . 導引導管 (Carto 磁場 .Ensite 電位 )

2. 於 Ensite Array 及 Ensite Navx 模式可製作 Diagnostic Landmark Mapping ，並可 Local Activation Time Map 及Peak to Peak Voltage Map 隨時切換。

3. 於 Ensite Navx mode 可執行 Respiration Compensation ，使得電極導管於 3 D 心腔圖中更加穩定。

4.Lesions 和 3D Lesions 及 Geometry 可設定不同顏色5. 於 Ensite Navx mode 可同時最多顯示 12 隻導管或 128 極電

極6. 可調整 waveform 的 Time Scale 寬度7. 儲存資料時間可增加達 120 分

5.6.Ensite Array Technique : 氣球電極導管量測技術

1.Non contact mapping technique 採用非接觸型導管量測 心腔立體圖及每一瞬間心壁電位 2. Utility for Arrhythmia Analysis ;Catheter Navigation and ablation confirmation. 提供心率不整分析功能；電腦導引電燒導管到病灶位置進行電燒灼術， 並在電燒灼術完成後確認電燒灼術成功與否。 3. Ability to map unstable/non sustained arrhythmia; one beat analysis 能夠標測不穩定或非持續性心率不整；單跳心電圖即可分析病灶位置。 4. Ability to map complex arrhythmia 能夠標測複雜性之心率不整。 5. Accurate three dimensional view of the heart chamber 能夠快速繪測心腔 3D 立體圖像及細部解剖位置如 ostia.Ridge.Appendage 等

。 More than 3000 endocardial electrograms simultaneously ； Global IECG display to show early activation site in Ensite array mode. 於 Ensite Array 模式可同時瞬間 擷取 3000 點以上即時心內壁電位 圖、並能顯示 心腔心內壁電位圖 . 以利即時判斷最早電位起源部位。

5.6.Ensite Array Technique : 氣球電極導管量測技術 6.Can be ablated during sinus rhythm 可以在竇性心率下做射頻電燒灼術。 7. Post –ablation induction and recording rapidly confirming

ablation efficacy using previous geometry map. Potential leakage from a line of block can be identified.

可採用原建立之定位立體心腔圖于電燒灼術完成後，重新以電刺激器誘發並記錄心電圖後再進行分析，可以迅速評估電燒灼術成果，或辨別線形燒灼後有不完整之電位洩露位置。

8. 3D Navigational catheter display with accuracy: down to 1 mm 顯示 3D 導管形狀、彎度、接觸好壞，且導引精確度為目標區 1mm 內。 9. Channel conventional EP Channels 含 16 導傳統電生理檢查 心電圖與心腔內電極分析訊號時 . 即時訊號與重新檢視訊號可同步進行 10.Ensite Array操作模式可製作 Dynamic Substrate Mapping

Conclusions EnSite Velocity 1.EnSite Array™ Catheter — For more complex, nonsustained, polymorphic arrhythmias陣列導管 – 針對更複雜的，非持續性， 多形性心律失常病患 ex.VT VF AF Af 2.允許使用各類型導管並與各大廠產生器和記錄系統相容 . 可使用各種廠牌 的電生理診斷導管或電燒導管進行 3D 立體圖像建立及診斷定位 . 建立一個 腔室的 3D 立體圖像後 . 可於同一個圖中進行多次不同 Voltage Map 及 Activation Map 建立 3. 導管可視化和導航： 128個通道 . 可視化和導航 . 可利用任何 廠牌電生理導管進行單極或多極收集 Voltage Map 或 Activation Map 4. 於 Ensite Navx 中具有呼吸補償功能 ,讓導管於手術中不會因病人呼吸 之因素而飄移 5. 導航和可視化技術有利於創建真實的心腔幾何形狀或模型更加容易和高效 的程序，顯示激活時序和電壓數據， 以確定心律失常，引導 導管到精確的位置

Conclusions EnSite Velocity 6.EnSiteNavX 技術減少 fluoroscopy 時間，和靈活多變，促 進了多種治療策略。協助醫生創建一個心腔的 3D 模型 具有高解析之多腔 3D 立體圖像建立 , 可同時建立各腔室及血 管 3D 立體圖象。於 Ensite Navx 中 ,Fusion 軟體可進行 3D 立 體圖像及 CT.MR 影像的結合7. 可將 CT.MR 影像經製後併入 Ensite 系統和 Ensite 系統所做的 Geometry 並列，進而可進行 Geometry 和 CT.MR 影像同步翻 轉及切割； Geometry 可和 CT.MR 影像相對照後能更精確得知 心臟房室內結構。8. 於 Ensite Array 中具有 Non-Connect Mapping 功能 ,只需一個心跳便 可得到 3000 點以上的電位足以進行診斷心率不整 , 適用於診斷非持續性心律不整 .

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