起源于心外膜心律失常识别和消融

1、起源于心外膜心律失常识别和消融起源于心外膜心律失常包括哪些？心外膜旁路起源于心外膜的室速Tricuspid Annulus LAO Projection Mitral AnnulusLA Connections RA ConnectionsLV ConnectionLV ConnectionIdeal Ablation SiteEpicardial Posteroseptal and Left Posterior Accessory Pathways: Connections Between the CS Myocardial Coat and the Atria and Left Ventr

2、iclePosteriorCoronary Vein Middle Cardiac Vein Ideal Ablation siteMCVVentricularConnection Mitral Annulus Tricuspid AnnulusCS Myocardial CoatEpicardial Posteroseptal and Left Posterior Accessory PathwaysLAORAORAACSMCVPVLVMapHBABHBLVMapCSRAAMCV1.2cmPVCCSRAAHBMCVRVABRAAHBMCVRV2.0cmLAORAOCSCEpicardial

3、Accessory Pathways171 Patients99911115 (9%)318120 (70%)36 (21%)327DiverticulaNarrow NeckWide NeckSeptal to MCV(5/27) Lateral to MCV(22/27)CSCSCSCSMCVDDDDMCVCSMCVSCV Enlargement of SCV, MCV and CS15/171 (9%) Pts Bulbous Enlargement of MCV or CS (3 Patients) Fosiform Enlargement of SCV or MCV (12 pts

4、)LAOAtrial Diastole Atrial systoleCSMCVPV PosteriorDescending Coronary Artery Right Coronary ArteryFig 2Tricuspid Annulus Mitral AnnulusLA Connection RA Connection Ideal Ablation site Middle Cardiac VeinLocation of the Distal Right Coronary Artery Relative to Ideal Ablation SitePosteriorCoronary Vei

5、n Ideal Ablation siteCS Angiography (LAO)RCA Angiography (LAO)LCA Angiography (RAO) CSDAblationAblationA. Before AblationB. After Ablation 左前斜位行选择性冠状动脉造影，该处未见相邻冠状动脉，心外膜旁路起源于心外膜的室速心外膜室速的心电图特征Pseudo delta wave34msIntrinsicoid deflection time85msRS complex duration121msecQRS198msCirculation 109:1842-18

6、47,2004.心外膜室速与基础心脏病特发性室性心动过速伴缺血性心脏病伴扩张性心肌病心外膜室速的心内电图特征心内膜标测不到最早激动心内膜的最早激动分布范围较广心内膜起搏标测不理想心内膜处消融不成功心外膜消融冠状窦心外膜其他(主动脉,心内膜等)心外膜室速的消融方法后室间静脉内标测电极心内膜消融电极心外膜标测电极处隐匿拖带经冠状静脉系统标测指导心内膜消融Heart 79:59-63,1998心外膜消融的激动标测JICE 2004,10:281-288心外膜室速的拖带标测PACE 1999.22:128-130心外膜消融冠状窦心外膜其他(主动脉,心内膜等)心外膜室速的消融方法经剑下穿刺心包内标测消融 心外膜拖带标测JCE 16:449-452,2005经剑下心外穿刺消融的注