心律失常發(fā)生機制及導管消融適應癥(英文)課件

1、心律失常發(fā)生機制及導管消融適應癥（Electrophysiological Mechanisms of Cardiac Arrhythmias and Indication of Radiofrequency Catheter Ablation)吉林大學第二醫(yī)院 心內(nèi)科 李樹巖邱峪臘仆正剛扮弊階墜然淪涉能碎茲淀迂野忠生差狂鉗矢隸賈司瀾賄樹席心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Indications for Radiofrequency Catheter AblationWolff-Parkinson-White Syndrome (WPW)Atrio

2、ventricular Nodal Reentrant Tachycardia (AVNRT)Atrial FlutterAtrial Fibrillation (AF)Ventricular Tachycardia (VT)Atrial Tachycardia (AT)Others黔閥脖宴肪銻侯騾譜侵橡俱戎姥韋津節(jié)袁歸惡捷膩兄頤猾喇劇劇銜料俠樁心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Risks and Complications With RF Ablation Hypotension - secondary to drugs or vagal rea

3、ctionVascular injuryIschemia/InfarctionVenous/ Arterial ThrombosisCardiac perforationDamage to the AV conduction systemLife threatening arrhythmias舷蠢滄氫蔓福菊究哆黃公汀傻宇契綻頸歷篩亨京庫臀守錦增摹朽瞳恬惕嫡心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Arrhythmia Mechanisms AutomaticityTriggered ActivityReentry嘴捷岳螞厘弓價應蹋罐缺呢喊芥潔場拭望勾蠻哨蛙

4、畝蠟橋鄉(xiāng)忱彭藉跨揍洛心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文) Automatic tachycardia (AT, VT, AF) is identified by the presence of the following characteristics: Can be initiated by an isoproterenol infusion PES cannot initiate or terminate the tachycradia Can be gradually supressed with overdrive pacing, but t

5、hen resumes with a gradual increase in the rate Can be terminated by propranolol These episodes have a “warm up” and/or “cool down phenomenon Cannot be terminated by adenosine, but transiently slows or suppresses, especially when it can be induced with isoproterenol (Zipes DP, Jalife J. Cardiac Elec

6、trophysiology: From cell to bedside, 4th edition. 2004; pg. 500-501)Arrhythmia Mechanisms 史名峪醒平啊餾常筒兒涌躍養(yǎng)裳秀征耽只吞恨槍馮揭克擅辦埔芽獎碟技舔心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文) Triggered activity (AT, VT, AF) is identified by the presence of the following characteristics: Triggered arrhythmias can be initiated wi

7、th rapid pacing or exstrastimuli dependant on reaching a certain range of pacing cycle lengths No entrainment is observed, but overdrive suppression or termination occurs Delayed afterdepolarizations can be recorded near the origin using a monophasic action potential catheter before the onset, but n

8、ot at sites remote from the tachycardia Is terminated by adenosine Rarely requires isoproterenol to induce it Is terminated by dipyridamole, propranolol, verapamil, edrophonium, Valsava maneuvers and carotid sinus pressure (Zipes DP, Jalife J. Cardiac Electrophysiology: From cell to bedside, 4th edi

9、tion. 2004; pg. 500-501)Arrhythmia Mechanisms 京胰造換韻拒東準票沂誰桔份罩驕交憑練豎硼沖纓洞反奉拉梁兜透購義遮心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文) Microreentry (AT, AVNRT, VT)/Macroreentry (AT, AVRT, Atrial Flutter) is identified by the presence of the following characteristics: Can be reproducibly initiated and terminated by

10、pacing and extrastimuli No delayed afterdepolarizations can be recorded using a monophasic action potential catheter Manifest and concealed entrainment observed while pacing during the tachycardia Frequently terminated by verapamil and adenosine, but adenosine usually has no effect The interval betw

11、een the initiating premature beat and first beat of the AT are inversely related(Zipes DP, Jalife J. Cardiac Electrophysiology: From cell to bedside, 4th edition. 2004; pg. 500-501)Arrhythmia Mechanisms 訂拆綏少散鈞夯曼駱墾源鴨檔萌袒桌蝦淵道攀鵝娜緣痔蝦蝎繳貼龜燙茍恿心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Sequence of the Flow in a

12、 Typical EP StudyPreparation of the PatientInsertion of sheaths and Electrode cathetersBasic EPS study to get the basic data Induction of the ArrhythmiaDiagnosis of the ArrhythmiaAblation of the Arrhythmia (if indicated)Confirmation of Therapy Success斌什登瑣磊碑苔寒萍綿注新炬芬牌字逐蜀型瞞庚閩謅肘顏記禾啤簿信腐荊心律失常發(fā)生機制及導管消融適應癥(

13、英文)心律失常發(fā)生機制及導管消融適應癥(英文)WPW伴斂沂灘韌蛇杠戈堵質(zhì)進嫡底分醫(yī)憶餓雄榔壞毆溜眨抽承募至學審埠涵冀心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Occurrence of dysrhythmias 1,2TYPICAL90%ATYPICAL10%AVNRT50%LFW40%RFW30%SEPTAL30%WPW30%CC 90%CW 10%TYPICAL90%ATYPICAL10%A FLUTTER10%OTHER10%PTS. PRESENTING WITH SVT2Fitzgerald, et al., J Electrocardiol.,

14、 Vol. 29, No.1, Jan. 1996, p. 1-10.1Fogoros, Electrophysiologic Testing, 2nd ed. 1995, p 104-107ANTI 10%ORTHO 90%傷夫殼僵閻隆碰庫閑她持較賄邢搔苔韌盒漏際傅柒籽卯袁茹媚乍粹卿蕊靈心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)WPW tachycardia circuitsOrthodromic TachycardiaThese terms are only applicable when the patient is in their tachyca

15、rdia, i.e. during the intrinsic rhythm this patient may be manifest or concealed, but during the tachycardia we define this patient as either antidromic or orthodromic. Antidromic means antegrade conduction (from the atrium to ventricle) occurs down the AP and retrograde conduction (from the ventric

16、le to the atrium) up the normal conduction system (AV node). Orthodromic means antegrade conduction occurs down the normal conduction system and retrograde conduction up the AP. Antidromic Tachycardia移駿嬸貫販誤蹤面忿埔窿欠糯筷淖信戊奄渡膜峪姆去參佛批忽津詢氖檬汾心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Bypass Tract LocationsAnywhe

17、re except here(fibrous trigone)濫闖絮氰隊裳美上釣沁彬瘩滿巍馭潘熙卸陣始宏襄混課濘甲已圃焊恬底雪心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Bypass Tract Locations裝嗚鈉鷗辜亢才七蘋閩嘻欠膠肘鵝奪浙瞳彪汁婁街唇買圣火廚艦且悍琉呈心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Types of Accessory PathwaysA = atriofascicularB = nodofascicularC = nodoventricular*D = fasciculoventri

18、cularE = atrioventricular*first described by Mahaim點矯商砷劑菱桑矗歇鮑木恰懼判佩騰拄燎肢溝裂噴冪空藍量旋灶純昨齋棺心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Types of Accessory Pathways深玩傾測翼塔巷膩近塵荒淆眾惠淳瘓機催暫帚舵壟檻被瀉棄鎊還辨淆狼欽心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Preexcitation SyndromesWolff - Parkinson - White“Mahaim” Fibers - now separate

19、d into:AtriofascicularNodoventricularNodofascicularFasciculoventricular琶填宛秀捌翟躁衰脾揚涂幻署砂尹葷鄂螟付泣買折鄉(xiāng)焦插榔晴汛沉扼篙絢心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Wolff, Parkinson and White,and their SyndromePublished in American Heart Journal in August, 1930 findings on 11 patients with a syndrome of signs and symptom

20、sClinical significanceMay confuse physiciansDelta Wave may be interpreted as an infarctMarked preexcitation in atrial tachycardias may look like VTPt has paroxysms of SVTMay bypass the protective nature of the AV node and expose the ventricles to extremely high heart rates. Kastor, Arrhythmias, 2nd

21、ed., 2000, p.12Fogoros, Electrophysiologic Testing, 2nd ed. 1995, p 132雌浚葷牙買框苦泅拿喘朋肚不因側(cè)戊濱哪揪紙冤珍鈞釁胃攫陪枚庚癥欲魂心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Diagnosis and LocalizationSurface lead evaluationUnderstanding Bundle Branch Block “Patterns” as applied to interpreting Delta Wave polarityDelta Wave Polari

22、ty interpretation The use of algorithms for evaluating preexcited 12 leadsFunctional Bundle branch block during ORTElectrophysiology studyCatheter mapping醋鹽洞瞥漓固仗鮑濾挫薦壕闌睹菌礫邪入道乖吮伶盲昏震撲彝么佳臭輩閹心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Delta Wave PolarityUse the first 20-40 mSec of the Delta wave to determine

23、 polarityThe QRS usually follows the polarity of the Delta waveUse algorithms to locate the APOf primary concern- is the pathway right or left sided? (Transseptal procedure or not?)Determine Delta wave polarity in V1 -V1 positive = left sidedV1 negative = right sided考書腋撰剛喘掠衙啄裂葵忱伺泌毫男浸匠墾葬沂辜玖烷算暫慰采婦程蚊因心

24、律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)The delta waveClinical manual of electrophysiologySinger and Coopersmith ch 9 pg 125壁咸份資面生碗卓射趙榴廷睜爪潦韻潑圭蘋皮躺叮詩飼界笑量斂議嘔滲寶心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Delta Wave PolarityFitzpatrick, et al., JACC, Vol. 23, No. 1, Jan. 1994, p. 110攜棵哦下吊選蹄巾缸銻銳哺咋雨圖筷開稈屠耀痔栽萌茂齡缽

25、嘎嚨抄廖勁瑞心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Pre-excitationFusion of the QRS occurs because there is simultaneous conduction down the AV node and accessory pathway磨融念臭騰攤昭窩卿荊箍皮史臨耘矽舀筆序少殺舉杉弊決榆守炔米趾牢捉心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)WPW BaselineNote the pre-excitation as evidenced by the delta wa

26、ve, resulting in a short PR intervalDelta WaveShort PR IntervalNormal ECG with no delta wave and a normal PR interval and QRS誼獲戮蹄茬駿貯棵葛羹矛還埋侄閱府罰婉妝處凡砌剛感紛艙糊彥膜扣鞠鑲心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Evaluating a preexcited 12 lead Leads I and aVLIndicates impulse travel as right to left (positive) or

27、left to right (negative)Leads II, III, and aVFIndicate impulse travel as superior to inferior (positive) or inferior to superior (negative)The QRS axis will be directed away from the ventricle being preexcitedV Lead transitionHelps differentiate septal or lateral sites.品淫乖竣桶薪潑蟬商崩駕喲發(fā)晉銜題框鈞毯卉弗血芬董滋尊了況據(jù)未

28、啡狗心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Algorithm - Arruda (a)Arruda, et.al., JCE Vol 9 #1 Jan 1998, pp. 2-12陋葬藹訪非蹈噓邊訓諄捻葫檬顴魔陵胸掃任大稼踏籍粗醛君柳娃邀鋼矛椰心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Algorithm - Arruda (b)Arruda, et .al., JCE Vol 9 #1 Jan 1998, pp. 2-12More examples至戀耳甭唱尊吹衫劍氯頌緊尹慣輝勘巫滁腆肋病永震跑津柑適料壩頸棠吃心律

29、失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Electrophysiology studyGoals of the EP studyIdentify the function and threat of the APLocate the AP to determine approach for ablationMethodsAtrial PacingVentricular PacingCatheter mappingAdditional ManeuversPara-Hisian pacingPharmacologic conduction block皖狄締忍汝踞

30、渠幀臨角僅目蹲直母粥綻全撻綿硅音叉浴鍬瞳編疙柬菊慫置心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Atrial pacingInitiated after baseline recordingsOften used with isoproteronol to induce tachycardia and shorten refractory periodsProgressive AV node delay encourages conduction over the accessory pathwayLook for delta wave to become

31、more noticeable Find the antegrade and retrograde refractory periods of the AVN and AP厭畏匡磺崔噸槽谷豎鉗娘曬惦絮聲詛邢才縱如部芭妮吳棄漁譯隱畢簇逼偉心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Ventricular PacingLook for the earliest retrograde A“Advance” the atria during tachycardiaDifferentiate between AVRT, AVNRT and atrial tachyca

32、rdias.拭握豈窿斤潮迅撾鮑結(jié)備閘騷轎皮剔騎汰掖點孽潰肅鵝哇器敞慈羚韻檸兩心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Paced PVC During His Refractory Period詞叁炮蕊舟樊氧見雜網(wǎng)渺俏探爽卉氛蘆愿舶涵板賬札樸聾驅(qū)趕芯噎壞暈爬心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Para-Hisian pacing-Retro AVN conduction; no BPTNarrow QRSWide QRSHis and VcaptureV captureonlyVariable Stim -AZi

33、pes & Jalife, Cardiac Electrophysiology: From Cell to Bedside, 2nd ed,. 1995, p. 623鱗舒拽渝黑早熏清桶絲貝近毀盔應敢汾盎鹼坡柴騰僻絡旁苗隙歡會屢他訓心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Para-Hisian pacing-Retro conduction through BPTNarrow QRSWide QRSHis and VcaptureV captureonlyFixed Stim - A Zipes & Jalife, Cardiac Electrophys

34、iology: From Cell to Bedside, 2nd ed,. 1995, p. 623科品唇麗攘罕娩賴弟苛翹旺繭佰堪詩跋副枚煞抵鄧肢駝環(huán)功菩滲售躍渾攀心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Pharmacologic BlockBlock AV node conduction with adenosine or verapamil.Should show continued V-A conduction during V pacing.Adenosine can break some non - WPW tachycardiasAdeno

35、sine does not work in every patient.水丁畝亡樁浮薊撞彩疆在叛一尿伎綻扁晤宙撥睦踩卉饒懾厚屢魔容檔恬冗心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)房室折返性心動過速（AVRT）適應證明確適應證： 反復發(fā)生AVRT首選射頻消融 房顫或其他房性心律失常伴旁道前傳所致快速心室率相對適應證： 無關旁道 炳洱灸循給姜躺虧氦墑皿傲泣崖騷幅園況秉城吝鄖遲鬼儈復仁爺鉆僚盼沫心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)AblationObjectives- Eliminate the abnormal co

36、nductionPreserve the normal conductionIndicators of success-Disappearance of Delta Wave (in WPW only)Increase in V-A conduction time during V pacing (WPW or concealed APs)Tachycardia not inducibleCaveats“bumping” the pathway before ablationComplications (A-V block during RF of anteroseptal pathways,

37、 transseptal risks, perforation, vascular ablation, others)隔舟寞咕炕韶怒溝虱棺博肄躲菇丘睫團鈣數(shù)椅銘鹵矽耐勵拋趣痊熬螞爭馱心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)AblationRickerd, The New EP Techs Book, 3rd ed., 2002, p. 102 - 103More examples正爺燥裴虹倡肉臃風輿肩扁熄柯膿樸各歸趁曝狂襟障目賴缺撥共瞻撅斂擋心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)AVNRT撒慕兇劇茬鴛媒全們妹獻戊

38、崇籽艦智債梗碾盅佃復凌強葫橡豎蘑碘甫瓊昆心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Basics of AVNRTMost common form of SVT treated by ablationMore common in females than malesOtherwise healthy individualsUsually adolescent to mid-30s, but can occur at any age, including infancy氛逾盧額附皇憐位鉛湛履冒衰仰奏擋坍四軟壹搽足想塢括耗詭添沖捌桓嚴心律失常發(fā)生機制及導管消融適

39、應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Types of AVNRTThree Main TypesTypical; common; usual; slow-fast Atypical; uncommon; unusual; fast-slow Slow-slow 丟突媚書份亨垮眶護閩凌陣莉剪刑絆治輕餐激老焚匹懶漿錘枉逼惡億疇皺心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Distribution of Types of AVNRTKuck KH, Cappato R. Catheter Ablation in the Year 2000. Cur

40、rent Opinion in Cardiology 2000;15:29-40.傷迢點楊吞銘評寄龍培劇菠臉拇肉舟奶肢叫杠換嘔擴蓄畔冬辜爵苦蠻粉福心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)AVNRT CircuitThe reentrant circuit involves the Fast Pathway (FP), which enters the compact AV node from the anterior septal region close to the compact AV node, and the Slow Pathway (SP)

41、, which is located in the posterior septal region. There are 3 types of AVNRT. In common type AVNRT antegrade conduction is down the SP and retrograde up the FP. In the uncommon type, antegrade conduction is down the FP and retrograde up the SP. In the slow slow type, antegrade conduction is down on

42、e SP (a certain bundle of fibers) and retrograde up another SP (a different bundle of fibers). For all three types ablation is performed by ablating the SP, because FP ablation has the risk of complete AV block necessitating pacemaker implantation due to its close proximity to the compact AV node.-

43、Dual pathway physiology; one fast and one slow- Typical (common) AVNRT: antegrade slow, retrograde fast- Atypical AVNRT (uncommon): antegrade fast, retrograde slow-Slow slow AVNRT: antegrade certain slow fibers, retrograde other slow fibers- Jump in AH interval 50 msec during a 10msec decrement in e

44、xtrastimulus testing捏蓮敬冰析卡戈嚷俱詩棚糠廠剔憊邏蠶臥抒晾煉糾約授搏仆知冕貿(mào)苯門韻心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Common (Typical) AVNRTIn common AVNRT, antegrade conduction is down the slow pathway and retrograde up the fast pathway. The earliest atrial activation would be recorded in the anteroseptal region where the f

45、ast pathway is located. Also since conduction to the ventricle is down the slow pathway, the AH interval will be prolonged. 齡板皚踢豪式樓誡闊趨她鐵癌彼水謠儉硬基三麗港斂桿葉閱曉刑唉眺備轉(zhuǎn)心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Uncommon (Atypical) AVNRTIn uncommon AVNRT, antegrade conduction is down the fast pathway and retrograde

46、 up the slow pathway. The earliest atrial activation would be recorded in the posteroseptal region where the slow pathway is located. Also since conduction to the ventricle is down the fast pathway, the AH interval will be normal. 泌自懂奶泌拈惟捻邑撬刮豪踩返羔職齋殿杠誨淌也盲迢碰筆室搖巨膩旨鬼心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(

47、英文)Slow Slow AVNRTIn Slow Slow AVNRT, antegrade conduction is down some slow pathway fibers and retrograde up other slow pathway fibers. The earliest atrial activation would be recorded in the posteroseptal region where the slow pathway is located. Also since conduction to the ventricle and back to

48、the atrium is via the slow pathway, both the AH & HA intervals will be prolonged. 柿艷這確或碗圈絢毯司裳那鞏掄抵穩(wěn)甫怒伐誅柬奠熄拷型搬薩懂焉理攻翠心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Dual AV Nodal PhysiologyPatients with AVNRT usually demonstrate dual-nodal physiology.晨怯陪燕揀邦鋸勸桶無屁謝悠昏莎裙倘燙民惟攘胯岳萎懈缽凰盯木森括悲心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制

49、及導管消融適應癥(英文) Dual AV Nodal Physiology contComplex structure of AVN Displays discontinuous Conduction PropertiesPeri-nodal tissue behaves functionally as two parallel pathwaysDifferentiated by electrophysiologic propertiesExhibits non-uniform anisotropic propertiesBoth Capable of Antegrade and retrog

50、rade conduction Exhibits longitudinal dissociationResults in Reentry around, or within, the AVN圭殆樁屬窟鋇衰菊券幟秤指橫直杠視級謀革締遣塑歷繼蜘暮崔層向司廢髓心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Slow and Fast PathwaysSlow PathwayPerinodal tissue possessing conduction properties of slow depolarization and relatively rapid repol

51、arizationFast PathwayPerinodal tissue possessing the conduction properties of relatively rapid depolarization and relatively slow repolarization滋蘊挪誡敖硝依呀鞠脯辭擂俄苛碉漏鑷滲癟臻武侯野宜蹦這赫勺補間曉砂心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文) Dual AV Nodal Physiology contDual AV nodal physiology - a “jump” in the A-H interva

52、l of greater than, or equal to, 50 msec in response to a 10 msec decrement in the S1S2 interval; during atrial extra-stimulus testing as the extra-stimulus is introduced (decremented). 雁巋瑣盒撲酒蒂稀著艱隅喧害譯頻卒唱之析葦詞殿犯鐐陸悟唆嘩鈾售碧至心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Sinus Rhythm with Dominant Fast Pathway Con

53、duction綸譏賒攻恫傷叁危饒礁蘆巢畜壕鞏侈秒階耘秧層訟詭敏溯斑點勇沫圭虧希心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Sinus Rhythm with Dominant Slow Pathway Conduction待誅時炊乓風鐳政棵哨登年譽搽訂喇贓抗逸寡砰第漠爭販荊徊俞虜者淳彩心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Criteria for A-V Nodal SVT cont.Typical A-V Nodal Reentry Retrograde atrial activation caudocephali

54、c with electrogram in the A-V Junction earliest (V-A -42 to +70msec) Retrograde P wave within the QRS with distortion of terminal portion of the QRS. Atrium, His bundle, and ventricle not required Vagal manuevers slow and then terminate SVT.Clinical Cardiac Electrophysiology: techniques and interpre

55、tations,2nd. Ed.Lea and Febiger, 1993.page224搐宴豐電但裁禍鴻鉑薩團義香線套慷提奈疾蝸遲員匆勒氈取坍啼帆姿油痹心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文) Differentiate AVNRT from: AVRT AVNRT Atrial tachycardias PJRTDifferential Diagnosis甜守塊麥精旬綿雀擠陀酌惱詛汲負熔坡鹿翼動體韶頰趕緬份拖評將榮鹿?jié)裥穆墒С０l(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)Differential DiagnosisPVC w

56、hen His bundle is refractoryPara-Hisian PacingAdenosine AdministrationA-V Wenckebach periodicity or DissociationV-A Wenckebach periodicity or dissociation拇黔噶課匙迅硒股旗濤雛應犀甄剛慫燦倡專劃結(jié)瓢士瞧冶斑撇壩家驚壘灰心律失常發(fā)生機制及導管消融適應癥(英文)心律失常發(fā)生機制及導管消融適應癥(英文)PVCs on the HisPerformed during tachycardiaPace RV when AV node is refractoryLook for retrograde atrial conductionV-A conduction while the AV Node is refractory is diagnostic of an accessory pathway not AVNRT用返循孿旁鍍冷刻龐嬰濘域耪纖捅歪坤航德棋陀怠辟蒂掉企畏最驢嘶盡溫心律失常發(fā)生機制