心律失常的心电图诊断及处理要点.ppt

折返是发生快速心律失常的最常见的机理。形成折返激动的条件是： ① 心脏的两个或多个部位的电生理的不均一性(即传导性或不应性的差异),这些部位互相连接,形成一个潜在的闭合环； ② 在环形通路的基础上一条通道内发生单向阻滞； ③ 可传导通道的传导减慢,使最初阻滞的通道有时间恢复其兴奋性； ④ 最初阻滞的通道的再兴奋，从而可完成一次折返激动。冲动经过这个环反复循环，引起持续性加速心律失常。折返心律失常能由早搏发动和终止，也能由快速刺激终止（称为超速抑制）。这些特点有助于区别折返性心律失常和触发活动引起的心律失常 For reentry to occur, the following events must take place: A premature impulse occurs in the reentrant circuit at a time when Pathway A (with the short refractory period) is ready to accept the impulse, and Pathway B (with the long refractory period) is still repolarizing from the previous depolarization. The impulse slowly travels through Pathway A and reaches Pathway B just as Pathway B completes it repolarization and is no longer refractory, which means it is ready to accept a stimulus. The impulse travels through Pathway B in a retrograde direction and reenters Pathway A. The impulse is conducted antegrade through Pathway A, and the circuit continues. Reentry does not display a “warm up” or “cool down” period. Atrial fibrillation can also result from the rapid discharge of impulses from one or many ectopic (non-sinus) sites in the atria. The ectopic cells (called foci) depolarize independently of the sinus node and disrupt the normal sinus rhythm. Multifocal firing takes place at multiple atrial ectopic sites. The cells produce many depolarization waves that activate different areas of the atrial myocardium at different times. AF occurs because the myocardial cells do not contract and relax rhythmically, in normal synchronization with the sinus node. *Note: Because a mechanism of AF may be Mulifocal Firing, some would argue that AF is a disorder of Impulse Formation (abnormal automaticity), rather than Impulse Conduction (multiple wavelets of reentry). Some argue still that while ectopic or mulifocal firing may begin AF, it is reentry that sustains it. For purposes of laying out rhythm disorders in this presentation, AF has been identified as a disorder of Impulse Conduction due to how it is