心脏解剖生理及正常心电图PPT课件.pptVIP

* * This demonstrates the mechanisms for two forms of AV nodal reentry SVT: typical and atypical AV nodal reentry. * * This EKG demonstrates evidence for ventricular pre-excitation. There is a delta wave with a short PR-interval seen in all 12 leads of electrocardiogram. This is a right-sided accessory pathway. * * This tachycardia is an SVT with an apparent P-wave buried in the ST segment suggestive of orthodromic AV reciprocating tachycardia. * * Demonstrates the morphology of a patient’s left apical septal VT. * * There is evidence for AF with an irregular ventricular response rate and at least 2 QRS morphologies, suggestive of at least 2 accessory pathways during AF. * * The bipolar electrogram of AF is seen on the bottom of the tracing. There is evidence for rapid accessory pathway conduction, ultimately leading to ventricular fibrillation. * * This slide shows atrial flutter with 2:1 conduction. * * As the name implies, with this flutter the macroreentrant circuit is clockwise. What this means is that in the LAO projection you are observing the tricuspid ring. When activation proceeds down the lateral wall and up the septal wall, this is known as counterclockwise flutter and would like such on an electrocardiogram. Yet, when activation proceeds down the septum and up the lateral this is atypical atrial flutter. It is worthy of an ablation attempt. The atrial and ventricular rates are similar to those seen in counterclockwise flutter. A distinguishing difference is the pattern of the flutter waves. Notice that they appear more “notched” in clockwise flutter. They appear in a “sawtooth” pattern with counterclockwise flutter. Clockwise atrial flutter is another form of “isthmus dependent” atrial flutter using a right isthmus of tissue. The morphology is not shown. * * Locations of catheters to assess ablation of atrial flutter are shown. Frequently a halo catheter is inserted at the tricuspid valve region to assess activation