电生理捡查课件.ppt

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1、心脏电生理检查心律失常诊治中心张澍内容电生理捡查目的电生理捡查方法及原理电生理捡查在心律失常中应用术前准备及术后护理电生理检查目的明确心律失常诊断了解心律失常机制明确心律失常起源检验药物抗心律失常效果选择射频消融适应证起搏器及ICD适应证晕厥原因捡查电生理捡查方法及原理心电图(ECG)及心内电图(EGM)记录技术心脏程序电刺激技术刺激+记录体外除颤器HardwiredpulsetimerSoftwarepulsetimer脉冲刺激器示波器计算机Preamplifiersatthetable病人记录器放大器TypicalCatheterPlacem

2、ent(H)RA前后位侧位右前斜(RAO)左前斜(LAO)导管电活动Recording1-2Recording3-4双极:激动时间4321记录纸速50-100mm/sIV1HRAHisCSCSCSRV滤波ECG(0.05-2500Hz)(30-100Hz)EGM(30-500Hz)(0.05-2500Hz)EffectoffilteringonthesignalsandinterpretationBurstRamp50HzPacing程序电刺激递增刺激扫描刺激程序早搏刺激St=StimulusR=ResponseS2S2S1S1S1S1S1S1S2

3、StRStRStRStRStRS1S1S1S1S1S1S2StR基础刺激S1早搏刺激S2,S3S1S1S1S1S2AS1S1S1S1S2AAAA400260AAAA400250V1V5HRARARVV1V5HRARARVPVVHRACSHBEAH激动顺序传导时间不应期折返RADCSPCSHBIAVFV1AAVAAVAVAVAVHAVH750PA=50AH=80HV=45HRAHisLVPRTI不同部位记录EGMHRAEGMseptumEGMCSP-waveTimingrelationshipoftheactivationofdifferentsites

4、激动顺序激动顺序IaVraVfV1HRAAVJCSpCSmCSd正常窦律房早NSRAAHVAAAPACSNAAVNBHECG最小值最小值5010055PQRSP-A:A-H:H-V:255035AHV正常传导间期正常HV间期ECG-V1HRAHisRVHV50msAHVVHV延长HRAAHAVJAVJHV=90msAHVVHV阻滞心房起搏(350ms)HRAAVJAVJSSSSSAHAHVAHVAHVA逆传不应期SSREFRACTORYREFRACTORYREFRACTORY刺激阈值引起心肌细胞兴奋的最小能量全或无概念阈值夺获不夺获心房不应期S1S1

5、S1S1S2AS1S1S1S1S2AAAA400260AAAA400250V1V5HRARARVV1V5HRARARV心室不应期260270S1S1S1S2S1S1S1S2不夺获夺获房室结特性正常情况下心房递增刺激时房室结(AH)传导时间会相应延长，房内传导及室内传导时间不变ECG-V1HR1HisRVCyclelength:450Cyclelength:360SSSSAAHVV90655020909050AHVV20AAaVfaVrV1V5HRAAVJRVIAVJS1S1S1S2300400AAAHAHHVHV激动传导心房:稳定心室:稳定AV结:随心

6、率加快传导减慢电生理捡查在心律失常中应用过缓型心律失常SSSAV阻滞室内阻滞过速型心律失常SVTVT晕厥待查选择心律失常治疗适应证病态窦房结综合征(SSS)窦律下记录窦房结恢复时间窦房传导时间窦房结电图心房窦房结房室传导阻滞体表心电图希氏束电图心房程序电刺激定位诊断定量诊断ECGMinimumvaluesMaximumvalues5010055PQRSP-A:A-H:H-V:255035AHV心室内传导阻滞体表心电图希氏束电图心房程序电刺激阻滞数量阻滞部位预后评价ECGMinimumvaluesMaximumvalues5010055PQRSP-A:A

7、-H:H-V:255035AHV心动过速大多为折返性室上性心动过速阵发性室上性心动过速窦性、房性、房室结、旁道房扑、房颤室性心动过速HPS分支折返(a)(b)(c)(d)AVNRT正路前传型AVRT旁路前传型AVRT双旁路AVRTAVNI型II型III型Wolff-Parkinson-WhiteSyndrome房室旁道—一种快传导纤维束(随心率加快不减慢)心室预激波—delta波构成折返途经慢径房室结(AV-node)快径旁道(Kentbundle)触发因素:早搏—诱发+终止隐匿性旁道房室旁道无前传良好逆传构成心动过速IaVraVfV1HRAAVJCS

8、pCSmCSdRV左侧旁路折返SVTAAAAA诱发SVTSSSSSVT200bpmIaVraV