内科学心律失常(8年制).ppt

* * Management of AVB First or second degree type I AVB Aim for etiology and symptoms, follow up AV conduction changing Second degree type Ⅱ AVB Aim for etiology and symptoms, close investigation of clinical manifestation Patients with symptomatic bradyarrhythmia should receive a permanent pacemaker Management of AVB Third degree AVB There is evidence that pacing can improve prognosis in these patient no matter symptomatic or asymptomatic, in acute stage, temporary pacemaker, chronic permanent Bundle branch block(BBB) Right BBB(complete, incomplete) Left BBB (complete, incomplete) Left anterior fascicular block RBBB plus Left anterior fascicular block Intraventricular block(nonspecific intraventricular conduction defect) Left posterior fascicular block Right bundle branch block Features of ECG Duration of QRS complex 0.12s VAT(ventricle activity time) at right precordial leads 0.07s QRS complex in lead V1 is in pattern of rSR`，in V5 with a blunt, prolonged and shallow S wave, with secondary ST-T changing QRS complex measured is 0.12s is recognized as incomplete RBBB Left t bundle branch block Features of ECG Duration of QRS complex 0.12s VAT(ventricle activity time) at left precordial leads 0.07s QRS complex in lead V1 is in pattern of rS，in V5 is a high, blunt, widen R wave, with secondary ST-T changing QRS complex measured is 0.12s is recognized as incomplete LBBB Clinical significance of BBB BBB per se have no significant effect on hemadynamics BBB may not deteriorate at long term follow-up in patients who have no underlying heart diseases New BBB in AMI or myocarditis signifies clinical deterioration Clinical significance of BBB Most of bilateral BBB will develop complete heart block No particular treatment unless there is indication of pacing Management of arrhythmias Medication Non medication Catheter based Ablation(electric, radiofrequecy, cryoablation, Chemo-ablation, laser) Programmed electric stimulation Management of arrhythmias Non medication pace