室颤和心脏除颤英文课件

1、Ventricular Fibrillation and DefibrillationJian Huang, MD, PhDUniversity of Alabama at BirminghamWiggers VI stage VFWiggers CJ, Am Heart J 5:351, 1930Undulatory Stage Convulsive Stage Tremulous Stage Atonic Stage 1-2 10-20 2-4 2-5Epicardial Activation during VFHuang J. et al. Am J Physiol 2004; 286:

2、H1193Jian Huang et al. Am J Physiol 2004; 286:H1193J. Huang et al. Am J Physiol 2004; 286:H1193J. Huang et al. Am J Physiol 2004; 286:H1193Type I and Type II VFType I VFAPDR cause instabilities (steep APDR)Normal exitabilityMultiple waveletsType II VFFlat APDRLow exitabilityBroad conduction velocity

3、 (CV) restitution promotes instabilites Spatiotemporal periodicity with intermittent wavebreaksEPIEndoP1 (4, 5)P1 (3, 4)Successful Defibrillation ShockEnough strength of energy Not too lowNot too highOptimal waveform Optimal lead configurationExtinguish most of VF activation frontWithout creating an

4、 environment that promotes susceptibility to reinitiation of fibrillation 100%80%60%40%20%0% Defibrillation success0 5 10 15 20 25Energy (J)UpperCorner (E99)MeasuredThresholdCurveWidthEfficacyMarginSafetyMarginMeasuredEnergyMarginEICDGradientDefibrillation: Biphasic 4 V/cm, Monophasic 6 V/cmElectroporation: 50 to 70 V/cmConduction block: 644 V/cm (monophaic), 716 (biphasic)Block (Refractoriness)Spatial dispersionTemporal variationAPDDIAnatomyFunctionalRestitution prope