D2_电生理手术适应症及过程.pptVIP

产生折返性心动过速的前提条件 a 慢的旁道 b 一个传导中断 (由于心肌细胞的恢复期) c 存在一个早搏 局灶性心房早搏 机理 : 起源于心房传导组织 在心动周期中较早的出现 局灶性心房早搏 机理 : 起源于心房内固定位置 心率 : 心房 – 110 - 200/分钟 P 波 : 形状依赖于起源点在心房的位置 QRS 复杂 : 通常正常，有时会发生房室结处中断 Mechanism : Arise from an ectopic focus in the atrium Rate : Atrial – 110 - 200/min P wave : P wave morphology depends on the site of the ectopic focus QRS complex : usually normal * * 电生理培训（二） 电生理手术 适应症及过程 心律不齐 类型 心动过缓 心动过速 心动过缓 不能产生电刺激响应 不能传导电信号 窦房结阻滞 病窦 房室传导阻滞 (I 度, II 度e 传导阻滞和 III 度完全传导阻滞) 束支传导阻滞 心动过速 异常自律 病窦综合症 特发性房速 右室流出道室速 特发性室速 折返机制 房颤 典型房扑 预激综合症 隐性房室折返旁道 房室结折返心动过速 缺血性室速 折返机制 - slow pathway - short refractory period - normal pathway - long refractory period extrastimulus Scenario 1 心率不齐 - 不正常的自率性搏动 心率不齐 -不正常的自率性搏动 心率不齐 -不正常的自率性搏动 - slow pathway - short refractory period - normal pathway - long refractory period extrastimulus Re-entry activation Scenario 2 - slow pathway - short refractory period - normal pathway - long refractory period extrastimulus Scenario 3 Premature Atrial Contraction Mechanism : Originates in the atrial conducting tissues Occurs early in the cardiac cycle VT – ECG Characteristics QRS complexes Wide and bizarre Ventricular rate 100 - 200 bpm P wave usually absent or obscured by the QRS complexes ? AV Dissociation Ectopic Atrial Tachycardia 心率不齐 - 折返 房颤 机理 : 早搏引发心房激动，在同一时间心房不同位置同时发生，使得心房的活动变的混乱。 Atrial Fibrillation Mechanism : It is influenced by the functional and anatomic structure of the right and left atrium. Related to a trigger extrastimulus which activates the atrium, that have existing conduction defects, and this results in chaotic activity in the atria. Atrial Rate : rapid, usually 400-600/min Characterised by no discrete P waves, except ‘fibrillating waves’ that gives rise to irregular, chaotic ECG baseline. Atrial Fibrillation-ECG Characteristics 心率不齐 - 折返 Typical Atrial Flutter Mechanism Propagation of impulses in a circular pathway usually around the tricuspid annulus - clockw