起源于心外膜心律失常的识别与消融

起源于心外膜心律失常

的识别与消融中国医科大学盛京医院孙英贤整理ppt起源于心外膜心律失常包括哪些？整理ppt心外膜旁路起源于心外膜的室速整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理pptTricuspidAnnulus

LAOProjection

MitralAnnulusLAConnections

RAConnectionsLVConnectionLVConnectionIdealAblationSiteEpicardialPosteroseptalandLeftPosteriorAccessoryPathways:ConnectionsBetweentheCSMyocardialCoatandtheAtriaandLeftVentriclePosteriorCoronaryVein

MiddleCardiacVein

IdealAblationsite整理pptMCVVentricularConnection

MitralAnnulusTricuspidAnnulusCSMyocardialCoatEpicardialPosteroseptalandLeftPosteriorAccessoryPathways整理pptLAORAORAACSMCVPVLVMapHBABHBLVMapCSRAAMCV1.2cmPVC整理pptCSRAAHBMCVRVABRAAHBMCVRV2.0cmLAORAOCSC整理pptEpicardialAccessoryPathways171Patients99911115(9%)318120(70%)36(21%)327整理pptDiverticulaNarrowNeckWideNeckSeptaltoMCV(5/27)

LateraltoMCV(22/27)CSCSCSCSMCVDDDD整理pptMCVCSMCVSCV

EnlargementofSCV,MCVandCS15/171(9%)Pts

BulbousEnlargementofMCVorCS(3Patients)

FosiformEnlargementofSCVorMCV(12pts)整理pptLAOAtrialDiastoleAtrialsystoleCSMCVPV整理ppt

PosteriorDescendingCoronaryArtery

RightCoronaryArteryFig2TricuspidAnnulus

MitralAnnulusLAConnection

RAConnection

IdealAblationsite

MiddleCardiacVeinLocationoftheDistalRightCoronaryArteryRelativetoIdealAblationSitePosteriorCoronaryVein

IdealAblationsite整理pptCSAngiography(LAO)RCAAngiography(LAO)LCAAngiography(RAO)CSDAblationAblation整理pptA.BeforeAblationB.AfterAblation整理ppt整理ppt左前斜位整理ppt整理ppt行选择性冠状动脉造影，该处未见相邻冠状动脉，整理ppt心外膜旁路起源于心外膜的室速整理ppt心外膜室速的心电图特征Pseudodeltawave>34msIntrinsicoiddeflectiontime>85msRScomplexduration>121msecQRS>198msCirculation109:1842-1847,2004.整理ppt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整理ppt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整理ppt心外膜消融冠状窦心外膜其他(主动脉,心内膜等)整理ppt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Heart79:59-63,1998整理ppt心外膜消融的激动标测JICE2004,10:281-288整理ppt心外膜室速的拖带标测PACE1999.22:128-130整理ppt心外膜消融冠状窦心外膜其他(主动脉,心内膜等)整理ppt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JCE16:449-452,2005整理ppt经剑下心外穿刺消融的注意事项避免冠状动脉操作:常规行冠脉造影心外膜脂肪垫影响消融效果:应用灌注消融术后合并心包炎:对症抗炎镇痛合并膈神经损伤:消融前高能量起搏整理ppt整理ppt整理ppt心外膜