心脏电生理和射频消融基础.ppt

Premature ventricular contraction (PVC) 1. Arises from ectopic focus in ventricles 2. Early QRS not preceded by a P wave (see fig 4) 3. Will have an unusual QRS shape a) odd vector b) prolonged QRS duration 4. A compensatory pause Multifocal PVCs. Two separate foci are originating PVC’s Irritable ventricle IF all PVC are identical it is from one ectopic site (Unifocal). Premature atrial contraction (PAC) 1. Arises from an ectopic focus in the atria. 2. Will have an identifiable P wave but the shape of the P wave may be altered 3. May have a normal QRS 4. May have a compensatory pause The QRS may be altered if some of the ventricle is still in its refractory period. The compensatory pause is lacking because the SA node was reset. The rhythm has been shifted. Atrial fibrillation 1. Irregularly irregular 2. No P waves The AV node keeps the ventricular rate low May be treated with drugs to depress AV conduction and slow the ventricular rhythm: Beta blockers, calcium channel blockers Common: will occur in about 1/3 of the population Not a serious arrhythmia unless in WPW Electrical reentry can cause fibrillations and tachycardias. Ventricular tachycardia (Fig 9) 1. Regularly occurring rhythm originating from a regular ventricular ectopic focus. 2. QRS morphology is usually like a PVC Because the cardiac output is very low it usually produces myocardial ischemia and often progresses to ventricular fibrillation Ventricular fibrillation (VF) 1. Thought to be a reentrant excitation of the ventricles; premature impulse may arise during vulnerable period 2. Irregular baseline with no identifiable waves 3. No cardiac output. Usually the cause of sudden death 4. May be the result of ischemia, lightning strike, electrocution, chest trauma, or drugs 5. Requires CPR and electrical difibrillation. Patients do not spontaneously recover. Extended phase two cause long QT syndrome. 右侧房室旁路的定位标准 V1导联QRS波主波方向向下（多呈rS型） V1导联P波和QRS波融合，二者间无等电位线，PR0.07s 预激波额面电轴左偏（－30－－60度）