心臟電生理檢查和射頻消融-1課件

1、心臟電生理檢查和射頻消融-1長(zhǎng)海醫(yī)院(yyun)心內(nèi)科曹 江第一頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1Cardiac Electrophysiology Cellular Cardiac Electrophysiology Experimental Cardiac Electrophysiology Clinical Cardiac Electrophysiology 第二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology is a field within c

2、ardiology involves complicated technical procedures to evaluate heart rhythms And provide appropriate treatment for rhythm disturbances 第三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1Cardiac Electrophysiology Study EPS of the heart is a non-surgical analysis of the electrical conduction system (normal or abnormal) of the h

3、eart. involves placing cardiac electrode catheters within or near the heart to determine the characteristics of heart rhythm or arrhythmia 第四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1EP studies may be helpful in: to diagnose the source of symptoms to evaluate the risk of future cardiac events to evaluate the effectivene

4、ss of medication in controlling an arrhythmia to evaluate the need for a permanent pacemaker, an implantable cardioverter-defibrillator, or radiofrequency catheter ablation as a treatment for arrhythmia. 第五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1Radiofrequency Catheter ablation RFCA A catheter procedure that uses elec

5、trical current to generate heat to destroy the fast irregular heartbeats第六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1第七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)功能第八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟心臟(xnzng)功功能能第九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1第十頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十一頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十三頁(yè)，共

6、八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)解剖第十七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟傳導(dǎo)(chundo)系統(tǒng)第十八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)傳導(dǎo)系統(tǒng)第十九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟傳導(dǎo)(chundo)系統(tǒng)第二十頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)傳導(dǎo)系統(tǒng)第二十一頁(yè)，共八十頁(yè)。心臟電生理

7、檢查和射頻消融-1心臟(xnzng)X線解剖第二十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)X線解剖第二十三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)X線解剖第二十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)X線解剖第二十五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史第二十六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史You can pick up a feather after rubbing amber with wool which were observed even in

8、ancient Greece第二十七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史公元前300年：亞里士多德發(fā)現(xiàn)電鰻(din mn)的“震擊”效應(yīng)第二十八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史William Gilbert (1544-1603) performed important early studies of electricity and magnetism. In De Magnete (1600), he was the first to describe the earths magnetic field and t

9、o postulate the relationship between electricity and magnetism. He introduced the term electricity into scientific discourse. 第二十九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史Luigi Galvani, 1737-1798 Italian physicist and anatomist and was one of the first to investigate experimentally the phenomenon of what

10、 came to be named bioelectrogenesis. 第三十頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史1791:Galvani discovers that electrical stimulation of a frogs heart leads to muscular contractionCarlo Matteucci 第三十一頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史第三十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史British physiologist Augustus D

11、. Waller of St Marys Medical School, London publishes the first human electrocardiogram. It is recorded with a capilliary electrometer from Thomas Goswell, a technician in the laboratory. Waller AD. A demonstration on man of electromotive changes accompanying the hearts beat. J Physiol (London) 1887

12、;8:229-234 第三十三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史第三十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史第三十五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史第三十六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史 Einthoven 1893年提出了心電圖 Electrocardiogram的命名, 建立肢體導(dǎo)聯(lián) 發(fā)現(xiàn)(fxin)心電圖包括P, Q, R, S和 T波 1903年研制成功弦線式心電圖機(jī) 研究(ynji)了多種心臟疾病的心電圖 1924年榮獲了諾貝爾醫(yī)

13、學(xué)獎(jiǎng)Father of Electro-cardiography第三十七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1ECG Electrodes 1901Lead ILead IIECG Set第三十八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史 First Documentation of Ventricular Fibrillation In 1849: Hoffa, in Ludwigs laboratory, documented bizarre unregulated actions of the ventricles when exposed direct

14、ly to strong faradic or constant currents 第三十九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史 1900-1919 S. Tawaras contribution to elucidation of conduction system of the mammalian heart 第四十頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史In 1929 in a small hospital in Eberswald Germany Werner Forssmann, a young surgical r

15、esident, anesthetized his own elbow, inserted a catheter in his antecubital vein and, catheter dangling from his arm, proceeded to a basement x-ray room where he documented the catheters position in his right atrium ?proving that a catheter could be inserted safely into a human heart. 第四十一頁(yè)，共八十頁(yè)。心臟電

16、生理檢查和射頻消融-1心臟電生理(shngl)的歷史 The 1930s Bundle-Branch Block with Short P-R type Interval in Healthy Young People Prone to Paroxysmal Tachycardia 第四十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史 The Ventricular Vulnerable Period In 1940 Wiggers and Wegria established beyond doubt the existence of the ventricula

17、r vulnerable period by elegant experiments that confirmed previous less striking observations. 第四十三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史Treatment of Unexpected Cardiac Arrest by External Electric Stimulation of the Heart 第四十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史On July 16, 1958 the transvenous cathete

18、r electrode was introduced, with fluoroscopy, via the basilic vein into the right ventricular outflow tract, in a patient with fixed complete heart block 第四十五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史1970s 電生理檢查和治療真正電生理檢查和治療真正(zhnzhng)起步的年代起步的年代Ventricular Fibrillation: A Possible Mechanism of Sudden Deat

19、h in Patients with WPW Syndrome 第四十六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史His bundle activity during the spontaneous and stimulated onset of SVT Initiation and Termination of Ventricular Tachycardia 第四十七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史Overdrive pacing in the WPW syndrome Epicardial Mapping in Vent

20、ricular Tachycardia 第四十八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史1980s: 電生理電生理(shngl)檢查和治檢查和治療發(fā)展的年代療發(fā)展的年代 Catheter Ablation of the A-V Junction by DC Energy in Man of open heart第四十九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟(xnzng)電生理的歷史Catheter Induced Ablation of the A-V Junction in Man in 1981 at Moffitt Hospital 第五十頁(yè)，共八

21、十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史1990s: 心臟電生理檢查和治療走向輝煌心臟電生理檢查和治療走向輝煌(huhung)和成熟和成熟Transvenous Implantable Defibrillator 第五十一頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心臟電生理(shngl)的歷史 導(dǎo)管導(dǎo)管(dogun)(dogun)射頻消融射頻消融（RFCA)RFCA)第五十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1ELECTROPHYSIOLOGY: CARDIAC CELLS2 Types of Cells: Electrical & Myocardial

22、Electrical Cells impulse formation & conductionEC distributed evenly along the conduction system of the heart. They possess THREE specific properties.*Automaticity- ability to initiate an impulse spontaneously & continuously*Excitability ability to be electrically stimulated *Conductivity-ab

23、ility to transmit an impulse from one cell to another in an orderly manner * Myocardial Cells form thin muscular layer of atrial wall & the thicker wall of the ventricle.Contractility ability of cell to shorten & lengthen its muscle fibers respond mechanically to an impulseExtensibility- cel

24、l to stretch第五十三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1DEPOLARIZATION & REPOLARIZATIONCardiac Action Potential第五十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1第五十五頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1Ion Channel Diffusion第五十六頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1心肌細(xì)胞的動(dòng)作電位 靜息(jn x)電位 K平衡電位 Nernst方程計(jì)算 Em=61.51og(Co/Ci) Em=61.51og(4/140) =-90毫伏第五十七頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1 “0

25、”相 外來(lái)刺激 Na+滲入(shnr)細(xì)胞 閾電位(-60mV) 除極作用 形成R波升支心肌細(xì)胞的動(dòng)作電位第五十八頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1 “0”相 -55mV時(shí)，慢鈉通道開(kāi)放(kifng)，Ca+緩慢內(nèi)流 -10mV氯通道開(kāi)放，Cl-內(nèi)流 形成R波升支心肌細(xì)胞的動(dòng)作電位第五十九頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1 “1”相 快Na+通道失活 Cl-快速(kui s)內(nèi)流 -10mV氯通道失活 形成R波降支心肌細(xì)胞的動(dòng)作電位第六十頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1 “2”相 Ca+內(nèi)流和K+外滲抵消(dxio)，形成平臺(tái) 相當(dāng)于ST段 “1”、“2”相交界點(diǎn)相當(dāng)于J點(diǎn)心肌細(xì)胞的動(dòng)作電位第六十一頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1 “3”相 -55mV，慢鈣通道關(guān)閉 K+快速(kui s)外流 相當(dāng)于T波 最大舒張電位時(shí)快K+外流停止 U波心肌細(xì)胞的動(dòng)作電位第六十二頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1除極的“連鎖反應(yīng)(linsufnyng)”（傳導(dǎo)性）第六十三頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1除極的“連鎖反應(yīng)(linsufnyng)”（傳導(dǎo)性）第六十四頁(yè)，共八十頁(yè)。心臟電生理檢查和射頻消融-1除