起源于心外膜心律失常的識別與消融

起源于心外膜心律失常

的識別與消融中國醫(yī)科大學盛京醫(yī)院孫英賢整理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行選擇性冠狀動脈造影，該處未見相鄰冠狀動脈，整理ppt心外膜旁路起源于心外膜的室速整理ppt心外膜室速的心電圖特征Pseudodeltawave>34msIntrinsicoiddeflectiontime>85msRScomplexduration>121msecQRS>198msCirculation109:1842-1847,2004.整理ppt心外膜室速與基礎(chǔ)心臟病特發(fā)性室性心動過速伴缺血性心臟病伴擴張性心肌病整理ppt心外膜室速的心內(nèi)電圖特征心內(nèi)膜標測不到最早激動心內(nèi)膜的最早激動分布范圍較廣心內(nèi)膜起搏標測不理想心內(nèi)膜處消融不成功整理ppt心外膜消融冠狀竇心外膜其他(主動脈,心內(nèi)膜等)整理ppt心外膜室速的消融方法后室間靜脈內(nèi)標測電極心內(nèi)膜消融電極心外膜標測電極處隱匿拖帶經(jīng)冠狀靜脈系統(tǒng)標測指導心內(nèi)膜消融Heart79:59-63,1998整理ppt心外膜消融的激動標測JICE2004,10:281-288整理ppt心外膜室速的拖帶標測PACE1999.22:128-130整理ppt心外膜消融冠狀竇心外膜其他(主動脈,心內(nèi)膜等)整理ppt心外膜室速的消融方法經(jīng)劍下穿刺心包內(nèi)標測消融

心外膜拖帶標測JCE16:449-452,2005整理ppt經(jīng)劍下心外穿刺消融的注意事項避免冠狀動脈操作:常規(guī)行冠脈造影心外膜脂肪墊影響消融效果:應用灌注消融術(shù)后合并心包炎:對癥抗炎鎮(zhèn)痛合并膈神經(jīng)損傷:消融前高能量起搏整理ppt整理ppt整理ppt心外膜