医学教材 瓣环起源的室性心律失常的心电图特征b.ppt

概述瓣环起源的心律失常有相似的解剖学基础发病机制相似介入治疗消融非常好，不认识则很易失败一、解剖结构（二）解剖结构与影像学的关系（四）心律失常的机制机制不清，推测有以下机制：微折返触发机制自律性增高二、心电图特征（二）起源于肺动脉的室速起源于主肺动脉的室早（三）起源于His区的室速（7）（五）三尖瓣环室早（六）二尖瓣环室早 OrugantiSaiSatish,Kuan-HungYeh,Ming-ShienWen,Chun-ChiehWang ，etal.Europace2005;7:348-352.Focalrightventriculartachycardiaoriginatingfromthesubtricuspidseptum。 Figure1TwelveleadECGrecorded(speed25mm/s)duringelectrophysiologicalstudyshowingventriculartachycardiaofleftbundleblockmorphologywithleftaxisdeviation. Figure2(A)Earliestendocardialactivationrecordedbytheablationcatheteratthesuccessfulablationsiteinthesubtricuspidseptumoftherightventricle.(B)Atrial(A)andventricular(V)electrogramsrecordedbytheablationcatheterattherightventricularseptumaftersuccessfulradiofrequencyablationoftheventriculartachycardiafocus. Figure3Fluoroscopicimagesobtainedintherightanterioroblique(A)andleftanterioroblique(B)projections(30)showingthesuccessfulablationsite.Thedistalelectrodesoftheablationcatheter(arrow)arepositionedatthesubtricuspidseptumoftherightventricle. Figure1.A:12-leadECGoftwotypesofventricularprematurecontractionsinpatient1.His-VPCoriginatedneartheHis-bundle,andRVOT-VPCoriginatedfromananteroseptalsiteoftherightventricularoutflowtract(RVOT).NotethattheRwaveamplitudeinleadIIIforHis-VPCwassmallerthanthatforRVOT-VPC,althoughtheRwaveamplitudeinleadIIwasalmostthesame.Furthermore,inleadIII,ashorterQRSdurationwasobservedforHis-VPCascomparedtoRVOT-VPC.InadditiontothetallmonophasicRwavemorphologypresentinleadI,aneventallerRwaveamplitudewasobservedinleadsV4-V6forHis-VPC. Figure3.A:12-leadECGofrepetitivemonomorphicnonsustainedVTinpatient2.ThefeaturesoftheclinicalVTexhibitedamonophasictallRwaveinleadI,relativelynarrowQRScomplexintheinf