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1、电生理相关资料,Cardiac vein stenosis,PTCA with 3.5 mm balloon,Final result,Modified Seldinger technique for percutaneous catheter sheath introduction,Sequence of P Wave Generation,Sinus Node,SA Junction,Atrium,(P wave),Non-visible process on the EKG,SUMMARY Mechanisms of SVT,Atrial Tachycardia,AVNRT,AVRT,F
2、P,SP,Differential Diagnosis of NCT,Short RP AVRT AT Slow-Slow AVNRT,Long RP AT Atypical AVNRT PJRT,P buried in QRS Typical AVNRT AT JET,SUMMARY,Obtain a 12 lead ECG. The location of the P wave will dictate the differential diagnosis If hemodynamically unstable (chest pain, heart failure, hypotension
3、)- CARDIOVERSION If hemodynamically stable -AV NODAL AGENT Long term therapy depends on mechanism and can be conservative, pharmacologic or invasive EP study often needed for definitive characterization of mechanism and can cure most SVTs with 90% success rate,AVNRT,Atrial flutter sawtooth or picket
4、 fence,Atrial flutter with rapid response,Arrhythmias: SA Block,P,QRS T,Arrhythmias: Atrial Flutter,Steps to reading ECGs,What is the rate? Both atrial and ventricular if they are not the same. Is the rhythm regular or irregular? Do the P waves all look the same? Is there a P wave for every QRS and
5、conversely a QRS for every P wave? Are all the complexes within normal time limits? Name the rhythm and any abnormalities.,Rate,Look at complexes in a 6-second strip and count the complexes; that will give you a rough estimate of rate Count the number of large boxes between two complexes and divide
6、into 300 Count the number of small boxes between two complexes and divide into 1500 Estimate rate by sequence of numbers (see next slide),Bundle branch blocksLook at the QRS morphology in V1 and V6,AVNRT,Acute treatmentATP or VerapamilCardioversion if BP Long termDrugs, verapamil or b-blockerEPS and
7、 RFA,AVRT,WPW or concealed accessory pathway acute and chronic treatment similar to AVNRT avoid b-blocker and verapamil in known WPW,Atrial Flutter,Marcoreentrant circuit in RA terminate by cardioversion with high success rate poorly controlled by medical therapy EPS + RFA,“Typical isthmus dependent
8、 atrial flutter” is due to a macro reentrant circuit around the tricuspid valve,This rhythm can be stopped by pacing and cured with ablationEmbolic risk may be less than in fibrillation, but same recommendations apply,Electrophysiology II Supraventricular Arrhythmias,Atrial Flutter,Ventricular rate
9、150 bpm,“Saw tooth” p waves,Atrial Flutter,Electrophysiology II Supraventricular Arrhythmias,Atrioventricular Nodal Reentrant Tachycardia (AV Node Reentry or AVNRT),Most common cause of paroxysmal SVT in the young adult Occurs over a small reentrant circuit located near the AV nodeThe circuit consis
10、ts of a fast and slow pathway connected by a common top and bottom pathway,Electrophysiology II Supraventricular Arrhythmias,AV Node Reentry Tachycardia,Rate of 145 bpm,(Short RP tachycardia),Electrophysiology II Supraventricular Arrhythmias,RP = 60 msec,Ectopic Atrial Tachycardia (Long RP tachycard
11、ia),Uncommon cause of paroxysmal SVT in the young adult ( 5%) Occurs in a small region of either the right or left atrium,Electrophysiology II Supraventricular Arrhythmias,Frequently due to an automatic mechanism making it difficult to reproduce in EP Lab,Rate = 160 bpm,RP = 220 msec,Atrial tachycar
12、dia,(Long RP tachycardia),Electrophysiology II Supraventricular Arrhythmias,Wolff-Parkinson-White Syndrome,Relatively common cause of paroxysmal SVT in children and young adultsDue to an “extra” muscular bridge that connects the atrium and ventricle and allows the ventricle to be “excited” before th
13、e signal passing through the AV Node,Electrophysiology II Supraventricular Arrhythmias,Accessory Pathway Mediated Tachycardias (AV Reentry),95% of infants,95% of adults,AVNRT,Manolis, Ann IM, 1994,AVRT (WPW),Heart Disease,Arrhythmias = abnormal heart rhythms. Bradycardia = slower Tachycardia = faste
14、r (exercise!) Flutter: extremely rapid Fibrillation: Contractions of different groups of myocardial cells at different times. Ventricular fibrillation is life-threatening.,Train your eyes,Train your eyes for Rate: Check the computer Train your eyes for Rhythm: Check the rhythm strip Check I, II, avF
15、 Train your eyes for Axis: Check I, II Train your eyes for Intervals: PR: check II QT: check the computer QRS: check I, V1,Train your eyes,Train your eyes for LVH: Look atin order avL V3 V1 V5,V6 Check your cheat sheet Read the computer Train your eyes for MI: Look at all T waves Look at all ST segm
16、ents Check for Q waves Check for R waves in V1-2,Arrhythmias,Ventricular fibrillationrapid, uncoordinated depolarization of ventricles,Tachycardiarapid heartbeat,Atrial flutterrapid rate of atrial depolarization,15-71,Brugada Algorithm,Supraventricular Tachycardia,Wavy baseline,Sinoatrial (SA) node,Internodal and interatrial tracts,Atrioventricular (AV) node,Bundle of His,Bundle branches,Purkinje fibers,Electrocardiography,Figure 18.16,
