詹贤章_拖带与在临床心律失常的应用.pptVIP

消融线验证双向阻滞 CS34起搏： 1.起搏至ABL传导时间 达到120ms 2.ABL的激动顺序由近端传向远端 消融线验证双向阻滞 ABL起搏： 1.起搏至CS12传导时间达到144ms 2.CS上的传导顺序由近端传向远端 局灶性房速，靠近房速起源点，PPI小 LA顶部 CS近、远端 右房峡部 外科迷宫术后房速 心外膜激动、基质标测 电压图：折返位于低电压区域 激动图：最早、最晚激动位于左室外侧壁 拖带标测 问题 PPI很接近TCL，说明刺激拖带在折返环上吗？一定是隐匿性拖带吗？ 隐匿性拖带时PPI一定接近TCL吗？ 显性拖带时,PPI一定大于TCL30ms吗？ 关键峡部拖带，一定是隐匿性拖带吗？ 如何判断某部位拖带是否成功？ 关键峡部拖带，为什么不产生融合波？ 谢谢大家！ 感谢您的观看！ * * * In this patient with a previous Rastelli repair for transposition of the great artery, a halo catheter was deployed around the TA (TA 1 through 20). Electrodes 1,2 were situated at approximately 7 oclock on the TA and electrodes 19,20 at approximately 12 oclock on the TA when that structure is viewed as a clockface in the left anterior oblique prosection. A, Entrainment with manifest fusion from 2 oclock on the TA. Note that there are subtle yet definite differences between the entrained P wave (P Ent) and the spontaneous tachycardia P wave (P Spont). TA electrodes 1 through 8 are all captured orthodromically (O) through the tachycardia circuit. On these recording bipoles, the electrogram morphology is identical during entrainment and spontaneous tachycardia. TA electrodes 11 through 20 all exhibit a different electrogram morphology during entrainment due to antidromic capture. TA 9,10 displays some similarity to the spontaneous P wave, although not identical, and may represent the site of collision between the orthodromic and antidromic wave fronts (F). Note that the first beat after the last stimulus (denoted by asterisk) is entrained at the pacing rate but displays no endocardial fusion. Note also that at this pacing site the PPI is within 2 ms of the TCL, suggesting that this site is within the tachycardia circuit. However in the presence of manifest fusion this represents an outer loop site. B, Pacing from 6 oclock on the TA produced entrainment with concealed fusion. P Ent and P Spont are identical in morphology. All of the electrodes on the halo catheter are captured orthodromically with morphology similar t