起源于心外膜心律失常識別和消融

1、起源于心外膜心律失常識別和消融起源于心外膜心律失常包括哪些？心外膜旁路起源于心外膜的室速Tricuspid Annulus LAO Projection Mitral AnnulusLA Connections RA ConnectionsLV ConnectionLV ConnectionIdeal Ablation SiteEpicardial Posteroseptal and Left Posterior Accessory Pathways: Connections Between the CS Myocardial Coat and the Atria and Left Ventr

2、iclePosteriorCoronary Vein Middle Cardiac Vein Ideal Ablation siteMCVVentricularConnection Mitral Annulus Tricuspid AnnulusCS Myocardial CoatEpicardial Posteroseptal and Left Posterior Accessory PathwaysLAORAORAACSMCVPVLVMapHBABHBLVMapCSRAAMCV1.2cmPVCCSRAAHBMCVRVABRAAHBMCVRV2.0cmLAORAOCSCEpicardial

3、Accessory Pathways171 Patients99911115 (9%)318120 (70%)36 (21%)327DiverticulaNarrow NeckWide NeckSeptal to MCV(5/27) Lateral to MCV(22/27)CSCSCSCSMCVDDDDMCVCSMCVSCV Enlargement of SCV, MCV and CS15/171 (9%) Pts Bulbous Enlargement of MCV or CS (3 Patients) Fosiform Enlargement of SCV or MCV (12 pts

4、)LAOAtrial Diastole Atrial systoleCSMCVPV PosteriorDescending Coronary Artery Right Coronary ArteryFig 2Tricuspid Annulus Mitral AnnulusLA Connection RA Connection Ideal Ablation site Middle Cardiac VeinLocation of the Distal Right Coronary Artery Relative to Ideal Ablation SitePosteriorCoronary Vei

5、n Ideal Ablation siteCS Angiography (LAO)RCA Angiography (LAO)LCA Angiography (RAO) CSDAblationAblationA. Before AblationB. After Ablation 左前斜位行選擇性冠狀動脈造影，該處未見相鄰冠狀動脈，心外膜旁路起源于心外膜的室速心外膜室速的心電圖特征Pseudo delta wave34msIntrinsicoid deflection time85msRS complex duration121msecQRS198msCirculation 109:1842-18

6、47,2004.心外膜室速與基礎(chǔ)心臟病特發(fā)性室性心動過速伴缺血性心臟病伴擴(kuò)張性心肌病心外膜室速的心內(nèi)電圖特征心內(nèi)膜標(biāo)測不到最早激動心內(nèi)膜的最早激動分布范圍較廣心內(nèi)膜起搏標(biāo)測不理想心內(nèi)膜處消融不成功心外膜消融冠狀竇心外膜其他(主動脈,心內(nèi)膜等)心外膜室速的消融方法后室間靜脈內(nèi)標(biāo)測電極心內(nèi)膜消融電極心外膜標(biāo)測電極處隱匿拖帶經(jīng)冠狀靜脈系統(tǒng)標(biāo)測指導(dǎo)心內(nèi)膜消融Heart 79:59-63,1998心外膜消融的激動標(biāo)測JICE 2004,10:281-288心外膜室速的拖帶標(biāo)測PACE 1999.22:128-130心外膜消融冠狀竇心外膜其他(主動脈,心內(nèi)膜等)心外膜室速的消融方法經(jīng)劍下穿刺心包內(nèi)標(biāo)測消融 心外膜拖帶標(biāo)測JCE 16:449-452,2005經(jīng)劍下心外穿刺消融的注