培训__幻灯片.pptVIP

RVA导管 起博Pace: 远端Distal 1,2 逆传测试Retrograde Conduction Testing 记录Record: 近端Prox 3,4 心室激动Ventricular Activation CS 导管 记录Record: CS 7,8 CS 5,6 起博Pace: 标测左侧旁路Mapping of Left Side Pathways 激动顺序Sequence of Activation 基线传导记录Baseline Conduction Recordings 12 Lead HRA, HIS, RV 起博HRA (前传Antegrade Conduction) 窦房结恢复Sinus Node Recovery 递增心房刺激Incremental Atrial Pacing (Wenkebach) 房性期前刺激Atrial Extra-Stimulus 起博RVA (逆传Retrograde Conduction) 递增心室刺激Incremental Ventricular Pacing 室性期前刺激Ventricular Extra-Stimulus EP Protocol方案 术中Procedure 在记录基线测量后，采用在8个刺激后增加房性早搏或室性早搏的方法检测心律失常的性质及部位After Baseline Measurements are taken and recorded, Pacing is Done for 8 beats, then PVC’s or PAC’s are added. 房性早搏通常用于研究源于心房的心律失常PAC’s are used for study of Arrhythmias originating from the Atria 室性早搏通常用于研究源于心室的心律失常PVC’s are used for study of Arrhythmias originating from the Ventricles 术中Procedure 通过各种刺激方案可确定心律失常的类型及部位A variety of pacing protocols will reveal the arrhythmia type and its basic location Inducing the arrhythmia through pacing will help to pinpoint the arrhythmia Catheter mapping in the area of arrhythmia induction will indicate the best position for Radiofrequency (RF) catheter ablation 窦房结恢复时间Sinus Node Recovery Time: SNRT 基于超速抑制Based on Overdrive Suppression 30秒起博30 seconds pacing SNRT = Interval between pacing and recovery by sinus cSNRT = SNRT minus intrinsic heart rate 房性早搏Atrial Extra-Stimulus 典型的Typical: 8 个刺激(S1ms) 1个早搏(decreasing S2ms) AH传导间隔延长，最终阻滞脱落 interval extension, and eventual block (depicted) 寻找慢径Seeking slow pathway 心律失常Arrhythmias 室上速Supraventricular Tachycardia (SVT) AV Nodal Reentry AV Reentry Wolff-Parkinson-White Atrial Tachycardia Atrial Flutter Atrial Fibrillation 室速Ventricular Tachycardia (VT) 房室结折返性心动过速AV Nodal Reentry (AVNRT) Causes: Congenital Aging – SVT Characteristics: Reentrant Activation Around AV Node Atrial/Ventricular Activation Fast Pathway (long refractory period) Slow Pathway (short refractory period) Longer P-R interval at onset V-A activation on ECG