起源于心外膜心律失常的识别与消融演示文稿.pptVIP

起源于心外膜心律失常的识别与消融 中国医科大学盛京医院 孙英贤 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 CS RAA HB MCV RV A B RAA HB MCV RV 2.0cm LAO RAO CS C Epicardial Accessory Pathways 171 Patients 9 99 1 11 15 (9%) 3 18 120 (70%) 36 (21%) 3 27 Diverticula Narrow Neck Wide Neck Septal to MCV(5/27) Lateral to MCV(22/27) CS CS CS CS MCV D D D D MCV CS MCV SCV Enlargement of SCV, MCV and CS 15/171 (9%) Pts Bulbous Enlargement of MCV or CS (3 Patients) Fosiform Enlargement of SCV or MCV (12 pts ) LAO Atrial Diastole Atrial systole CS MCV PV Posterior Descending Coronary Artery Right Coronary Artery Fig 2 Tricuspid Annulus Mitral Annulus LA Connection RA Connection Ideal Ablation site Middle Cardiac Vein Location of the Distal Right Coronary Artery Relative to Ideal Ablation Site Posterior Coronary Vein Ideal Ablation site CS Angiography (LAO) RCA Angiography (LAO) LCA Angiography (RAO) CS D Ablation Ablation A. Before Ablation B. After Ablation 左前斜位 行选择性冠状动脉造影，该处未见相邻冠状动脉， 心外膜旁路 起源于心外膜的室速 心外膜室速的心电图特征 Pseudo delta wave34ms Intrinsicoid deflection time85ms RS complex duration121msec QRS198ms Circulation 109:1842-1847,2004. 心外膜室速与基础心脏病 特发性室性心动过速 伴缺血性心脏病 伴扩张性心肌病 心外膜室速的心内电图特征 心内膜标测不到最早激动 心内膜的最早激动分布范围较广 心内膜起搏标测不理想 心内膜处消融不成功