心脏电生理及射频消融基础

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1、电生理相关资料CardiacveinstenosisPTCAwith3.5mmballoonFinalresultModifiedSeldingertechniqueforpercutaneouscathetersheathintroductionSequenceofPWaveGenerationSinusNodeSAJunctionAtrium(Pwave)Non-visibleprocessontheEKGAVnode“Slowzone”IVCLeadIISUMMARYMechanismsofSVTAtrialTachycardia

2、AVNRTAVRTFPSPDifferentialDiagnosisofNCTShortRPAVRTATSlow-SlowAVNRTLongRPATAtypicalAVNRTPJRTPburiedinQRSTypicalAVNRTATJETSUMMARYObtaina12leadECG.ThelocationofthePwavewilldictatethedifferentialdiagnosisIfhemodynamicallyunstable(chestpain,heartfailure,hypotension)-CARDIOVER

3、SIONIfhemodynamicallystable-AVNODALAGENTLongtermtherapydependsonmechanismandcanbeconservative,pharmacologicorinvasiveEPstudyoftenneededfordefinitivecharacterizationofmechanismandcancuremostSVTswith90%successrateAVNRTAtrialflutter–sawtoothorpicketfenceAtrialflutterwithrap

4、idresponseArrhythmias:SABlockPQRSTArrhythmias:AtrialFlutterStepstoreadingECGsWhatistherate?Bothatrialandventriculariftheyarenotthesame.Istherhythmregularorirregular?DothePwavesalllookthesame?IsthereaPwaveforeveryQRSandconverselyaQRSforeveryPwave?Areallthecomplexeswithinn

5、ormaltimelimits?Nametherhythmandanyabnormalities.RateLookatcomplexesina6-secondstripandcountthecomplexes;thatwillgiveyouaroughestimateofrateCountthenumberoflargeboxesbetweentwocomplexesanddivideinto300Countthenumberofsmallboxesbetweentwocomplexesanddivideinto1500Estimate

6、ratebysequenceofnumbers(seenextslide)BundlebranchblocksLookattheQRSmorphologyinV1andV6AVNRTAcutetreatmentATPorVerapamilCardioversionifBPLongtermDrugs,verapamilorb-blockerEPSandRFAAVRTWPWorconcealedaccessorypathwayacuteandchronictreatmentsimilartoAVNRTavoidb-blockerandve

7、rapamilinknownWPWAtrialFlutterMarcoreentrantcircuitinRAterminatebycardioversionwithhighsuccessratepoorlycontrolledbymedicaltherapyEPS+RFA“Typicalisthmusdependentatrialflutter”isduetoamacroreentrantcircuitaroundthetricuspidvalveThisrhythmcanbestoppedbypacingandcuredwithab

8、lationEmbolicriskmaybelessthaninfibrillation,butsamerecommendationsapplyElectrophysiologyII–Supraventri