电生理及血液动力学简介完整版.pptVIP

* * * * * * * * * * * * * * * * * * * * * 术中Procedure 通过各种刺激方案可确定心律失常的类型及部位A variety of pacing protocols will reveal the arrhythmia type and its basic location Inducing the arrhythmia through pacing will help to pinpoint the arrhythmia Catheter mapping in the area of arrhythmia induction will indicate the best position for Radiofrequency (RF) catheter ablation 窦房结恢复时间Sinus Node Recovery Time: SNRT 基于超速抑制Based on Overdrive Suppression 30秒起博30 seconds pacing SNRT = Interval between pacing and recovery by sinus cSNRT = SNRT minus intrinsic heart rate 房性早搏Atrial Extra-Stimulus 典型的Typical: 8 个刺激(S1ms) 1个早搏(decreasing S2ms) AH传导间隔延长，最终阻滞脱落 interval extension, and eventual block (depicted) 寻找慢径Seeking slow pathway 心律失常Arrhythmias 室上速Supraventricular Tachycardia (SVT) AV Nodal Reentry AV Reentry Wolff-Parkinson-White Atrial Tachycardia Atrial Flutter Atrial Fibrillation 室速Ventricular Tachycardia (VT) 房室结折返性心动过速AV Nodal Reentry (AVNRT) Causes: Congenital Aging – SVT Characteristics: Reentrant Activation Around AV Node Atrial/Ventricular Activation Fast Pathway (long refractory period) Slow Pathway (short refractory period) Longer P-R interval at onset V-A activation on ECG 房室折返性AV Reentry (AVRT) Causes: Congenital Characteristics: Accessory Pathway at A-V Groove Right, Left, Posterior, or Septal Accessory Pathway WPW 综合症Syndrome Causes: Congenital Characteristics: Atrial Arrhythmia and Antegrade-Conducting Accessory Pathway Accessory Pathway at A-V Groove Right, Left, Posterior, or Septal Short P-R interval (0.12 sec) Prolonged QRS interval (0.1 sec) Slurring of the upstroke by a delta wave Accessory Pathway 房扑Atrial Flutter The Fluttering Atria produce a sawtooth-type character for the Atrial Waveform The A rate has a 4:1 ratio to the V rate The AV Node prevents all of the Atrial beats from reaching the Ventricles 房颤Atrial Fibrillation There are no identifiable P-waveforms The Ventricular response is irregular Most of the Atrial impulses are blocked by the AV node Atri