心脏电生理及射频消融基础.ppt
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1、电生理相关资料Cardiac vein stenosisPTCA with 3.5 mm balloonFinal resultModified Seldinger technique for percutaneous catheter sheath introductionSequence of P Wave GenerationSinusNodeSAJunctionAtrium(P wave)Non-visible process on the EKGAV node“Slowzone”IVCLeadIISUMMARYMechanisms of SVTAtrial TachycardiaAV
2、NRTAVRTFPSPDifferential Diagnosis of NCTn nShort RPShort RPn nAVRTAVRTn nATATn nSlow-SlowSlow-SlowAVNRTAVNRTn nLong RPLong RPn nATATn nAtypicalAtypicalAVNRTAVNRTn nPJRTPJRTn nP buried in QRSP buried in QRSn nTypicalAVNRTTypicalAVNRTn nATATn nJETJETSUMMARYn nObtain a 12 lead ECG.The location of the P
3、 wave will dictate Obtain a 12 lead ECG.The location of the P wave will dictate the differential diagnosisthe differential diagnosisn nIf If hemodynamicallyhemodynamically unstable(chest pain,heart failure,unstable(chest pain,heart failure,hypotension)-CARDIOVERSIONhypotension)-CARDIOVERSIONn nIf If
4、 hemodynamicallyhemodynamically stable-AV NODAL AGENT stable-AV NODAL AGENTn nLong term therapy depends on mechanism and can be Long term therapy depends on mechanism and can be conservative,pharmacologic or invasive conservative,pharmacologic or invasive n nEP study often needed for definitive char
5、acterization of EP study often needed for definitive characterization of mechanism and can cure most mechanism and can cure most SVTsSVTs with 90%success rate with 90%success rateAVNRTAtrial flutter sawtooth or picket fenceAtrial flutter with rapid responseArrhythmias:SA BlockPQRS TArrhythmias:Atria
6、l FlutterSteps to reading ECGsn nWhat is the rate?Both atrial and ventricular if they What is the rate?Both atrial and ventricular if they are not the same.are not the same.n nIs the rhythm regular or irregular?Is the rhythm regular or irregular?n nDo the P waves all look the same?Is there a P wave
7、Do the P waves all look the same?Is there a P wave for every QRS and conversely a QRS for every P for every QRS and conversely a QRS for every P wave?wave?n nAre all the complexes within normal time limits?Are all the complexes within normal time limits?n nName the rhythm and any abnormalities.Name
8、the rhythm and any abnormalities.Raten nLook at complexes in a 6-second strip and count the complexes;that will give you a rough estimate of raten nCount the number of large boxes between two complexes and divide into 300 n nCount the number of small boxes between two complexes and divide into 1500
9、n nEstimate rate by sequence of numbers(see next slide)Bundle branch blocksLook at the QRS morphology in V1 and V6AVNRTn nAcute treatmentAcute treatment ATP or Verapamil ATP or Verapamil Cardioversion if BP Cardioversion if BP n nLong termLong term Drugs,verapamil or b-Drugs,verapamil or b-blockerbl
10、ocker EPS and RFA EPS and RFAAVRTn nWPW or concealed WPW or concealed accessory pathwayaccessory pathwayn nacute and chronic acute and chronic treatment similar to treatment similar to AVNRTAVNRTn navoid b-blocker and avoid b-blocker and verapamil in known verapamil in known WPWWPWAtrial Fluttern nM
11、arcoreentrant circuit Marcoreentrant circuit in RAin RAn nterminate by terminate by cardioversion with high cardioversion with high success ratesuccess raten npoorly controlled by poorly controlled by medical therapymedical therapyn nEPS+RFAEPS+RFA“Typicalisthmusdependentatrialflutter”isduetoamacror
12、eentrantcircuitaroundthetricuspidvalveThisrhythmcanbestoppedbypacingandcuredwithablationEmbolicriskmaybelessthaninfibrillation,butsamerecommendationsapplyElectrophysiologyIISupraventricularArrhythmiasAtrialFlutterVentricularrate150bpm“Sawtooth”pwavesAtrialFlutterElectrophysiologyIISupraventricularAr
13、rhythmiasAtrioventricularNodalReentrantTachycardia(AVNodeReentryorAVNRT)MostcommoncauseofparoxysmalSVTintheyoungadultOccursoverasmallreentrantcircuitlocatedneartheAVnodeThecircuitconsistsofafastandslowpathwayconnectedbyacommontopandbottompathwayElectrophysiologyIISupraventricularArrhythmiasAVNodeRee
14、ntryTachycardiaRateof145bpm(ShortRPtachycardia)ElectrophysiologyIISupraventricularArrhythmiasRetrogradepwavesRP=60msecEctopicAtrialTachycardia(LongRPtachycardia)UncommoncauseofparoxysmalSVTintheyoungadult(0.09sPR0.09sn n预激波额面电轴右偏预激波额面电轴右偏预激波额面电轴右偏预激波额面电轴右偏(9090120120度)度)度)度)右侧房室旁路的定位标准右侧房室旁路的定位标准n n
15、V1V1导联导联导联导联QRSQRS波主波方向波主波方向波主波方向波主波方向向下(多呈向下(多呈向下(多呈向下(多呈rSrS型)型)型)型)n nV1V1导联导联导联导联P P波和波和波和波和QRSQRS波融波融波融波融合,二者间无等电位线,合,二者间无等电位线,合,二者间无等电位线,合,二者间无等电位线,PR0.07sPR0.07sn n预激波额面电轴左偏预激波额面电轴左偏预激波额面电轴左偏预激波额面电轴左偏(30306060度)度)度)度)n n右后、右侧游离壁:右后、右侧游离壁:、aVL、V5、V6导联预激波正向,导联预激波正向,、aVF导联预激波负向或正负双向。导联预激波负向或正负双向
16、。n n右前游离壁:右前游离壁:、aVF导联预激波正向或正负双向。导联预激波正向或正负双向。前间隔房室旁路的定位标准前间隔房室旁路的定位标准n nV1V1导联导联导联导联QRSQRS波主波方向波主波方向波主波方向波主波方向向下(多呈向下(多呈向下(多呈向下(多呈rSrS型)型)型)型)n nV1V1导联导联导联导联P P波和波和波和波和QRSQRS波融波融波融波融合,二者间无等电位线,合,二者间无等电位线,合,二者间无等电位线,合,二者间无等电位线,PR0.07sPR0.21wouldbeclassifiedasfirstdegreeblock.UsuallythisblockisaboveH
17、isbundleSecond degree-somePwavesarenotfollowedbyQRS.Oftenhasaregularsequence,i.e.,2:1or3:2.ThefirstnumberisthenumberofPwavespresentandthesecondisthenumberofQRSs.Whatisthis?Mobitz I(Wenckebach)thePRprogressivelylengthenswithonePwaveforeveryQRSuntilabeatisdropped.UsuallytheblockisaboveHisbundle.Thisis
18、commonincoronarypatientsandiscausedbyincreasedvagaltoneandusuallyeventuallydisappearswithnoproblemsMobitz IIthePRisconstantbutwithoccasionaldroppedbeats.ThisisamoreseriousarrhythmiabecausetheinjuryisprobablyinfastconductingtissuebelowtheHisbundlewhichisnotundervagalcontrol.ThisisunambiguouslyMobitzI
19、IItisadangerousarrhythmiabecausetheheartmaysuddenlystartbeatingveryslowlyorevenstop.Complete heart block.SincethereisnoconductiondowntheAVnodepathwayatriaandventriclesbeatregularlybutatdifferentrates.SlowventricularrateUsuallytreatedwithpacemakerMaybetemporaryorintermittent.Canbeinducedbydrugsthatca
20、useincreasedvagotoniaWPW:Normallyconductingcardiacmusclebridgesthegapbetweenatriaandventricles.TheaccessorypathwayactivatestheventriclebeforenormalactivationviatheAVnode.ThePRintervalis100b/min1.NormalPwaves2.NormalorshortenedPRinterval3.QRSandTvectorsarenormal4.STsegmentsarenormal5.RRintervalshort1
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- 心脏 生理 射频 消融 基础
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