3—拖带标测
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•PPI=TCL±30ms（b maybe PPI>TCL±30ms in bystander)ystander •bystander
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
putative ablation sites including the critical isthmus within the reentrant circuit. • Very helpful in analysing Marcro-Reentry tachycardia
AFL,VT,AVRT
• EGM-QRS: measure from the local potential to the onset of QRS from the mapping catheter
• TCL: Tachycardia Cycle Length
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
5
Introduction to Entrainment
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
•
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
Introduction to Entrainment
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
3
Introduction to Entrainment
• Entrainment was first Described by Dr. WALDO in 1970s during the study of AFL post surgery
• Used to distinguish reentrant arrhythmias from automatic and triggered ones. • After reentry has been confirmed, entrainment permits the electrophysiologist to defEntrainment
• Concealed Entrainment •The P/QRS morphology in 12-lead ECG, conduction sequence of atrium/ventricle during entrainment is same as during tachycardia • •Pacing site is at/close to the slow conduction area
11
Macro Re-entry Arrhythmia Circuit
P/QRS
Exit Center Proximal
Outer Loops Inner Loop
Bystander sites
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
8
Introduction to Entrainment
• PPI(Post Pacing Interval): measure from the last pacing spike to first local potential from the pacing channel
• Stim-QRS: measure from the last pacing spike to the onset of first QRS complex
QRS
Electrode Cath FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION.
15
Entrainment- pacing at outerloop
* QRS
400
450
450
Pacing at OUTER LOOP: -Entrainment with fusion -Short S-QRS -PPI = VT
QRS
Electrode Cath FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION.
2
Why study entrainment?
Basic tools in EP. Proficient doctors like using it A helpful tool in complex cases Help to understand the mechanism of EP Provide us a good tool to discuss with master EP doctors
13
Introduction to Entrainment
• Manifest Entrainment •The P/QRS morphology in 12-lead ECG, conduction sequence of atrium/ventricle during entrainment is different from that during Tachycardia (Fusion ECG) • •Pacing site is not close to the slow conduction area •PPI>TCL±30ms（ PPI=TCL±30ms in outer loops)
12
Introduction to Entrainment
•PPI
P/QRS
•TCL •Stim-QRS
•Egm-QRS
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
7
Introduction to Entrainment
I II III aVR aVL aVF V1
V6 Abl
PPI
TCL FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
10
Introduction to Entrainment
• What is PPI? • What is TCL? • What is PPI – TCL?
•
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
1
课程目标
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
6
Introduction to Entrainment
• S1-S1 pacing during Tachycardia at a faster rate(20-30ms less in cycle length) than the intrinsic tachycardia, the rate of the pacing chamber become as fast as the pacing rate, and is consequently captured within the circle.
• The tachycardia doesn’t terminate when pacing is discontinued, the rate of tachycardia return to the previous one
Entrainment!
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
9
Introduction to Entrainment
I
II
III
•PPI
aVR
•TCL
aVL
•Stim-QRS
aVF
V1
•Egm-QRS
V6 Abl
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
Pending FDA clearance. Not available for sale or commercial use in any market.
17
Entrainment- Pacing at Exit
400
QRS
*
450
450
Pacing at EXIT: -Concealed entrainment -Short S-QRS -Post Pacing Interval = VT
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
putative ablation sites including the critical isthmus within the reentrant circuit. • Very helpful in analysing Marcro-Reentry tachycardia
AFL,VT,AVRT
• EGM-QRS: measure from the local potential to the onset of QRS from the mapping catheter
• TCL: Tachycardia Cycle Length
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
5
Introduction to Entrainment
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
•
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
Introduction to Entrainment
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
3
Introduction to Entrainment
• Entrainment was first Described by Dr. WALDO in 1970s during the study of AFL post surgery
• Used to distinguish reentrant arrhythmias from automatic and triggered ones. • After reentry has been confirmed, entrainment permits the electrophysiologist to defEntrainment
• Concealed Entrainment •The P/QRS morphology in 12-lead ECG, conduction sequence of atrium/ventricle during entrainment is same as during tachycardia • •Pacing site is at/close to the slow conduction area
11
Macro Re-entry Arrhythmia Circuit
P/QRS
Exit Center Proximal
Outer Loops Inner Loop
Bystander sites
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
8
Introduction to Entrainment
• PPI(Post Pacing Interval): measure from the last pacing spike to first local potential from the pacing channel
• Stim-QRS: measure from the last pacing spike to the onset of first QRS complex
QRS
Electrode Cath FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION.
15
Entrainment- pacing at outerloop
* QRS
400
450
450
Pacing at OUTER LOOP: -Entrainment with fusion -Short S-QRS -PPI = VT
QRS
Electrode Cath FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION.
2
Why study entrainment?
Basic tools in EP. Proficient doctors like using it A helpful tool in complex cases Help to understand the mechanism of EP Provide us a good tool to discuss with master EP doctors
13
Introduction to Entrainment
• Manifest Entrainment •The P/QRS morphology in 12-lead ECG, conduction sequence of atrium/ventricle during entrainment is different from that during Tachycardia (Fusion ECG) • •Pacing site is not close to the slow conduction area •PPI>TCL±30ms（ PPI=TCL±30ms in outer loops)
12
Introduction to Entrainment
•PPI
P/QRS
•TCL •Stim-QRS
•Egm-QRS
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
7
Introduction to Entrainment
I II III aVR aVL aVF V1
V6 Abl
PPI
TCL FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
10
Introduction to Entrainment
• What is PPI? • What is TCL? • What is PPI – TCL?
•
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
1
课程目标
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
6
Introduction to Entrainment
• S1-S1 pacing during Tachycardia at a faster rate(20-30ms less in cycle length) than the intrinsic tachycardia, the rate of the pacing chamber become as fast as the pacing rate, and is consequently captured within the circle.
• The tachycardia doesn’t terminate when pacing is discontinued, the rate of tachycardia return to the previous one
Entrainment!
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
9
Introduction to Entrainment
I
II
III
•PPI
aVR
•TCL
aVL
•Stim-QRS
aVF
V1
•Egm-QRS
V6 Abl
FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMERS OR FOR DISTRIBUTION. Pending FDA clearance. Not available for sale or commercial use in any market.
Pending FDA clearance. Not available for sale or commercial use in any market.
17
Entrainment- Pacing at Exit
400
QRS
*
450
450
Pacing at EXIT: -Concealed entrainment -Short S-QRS -Post Pacing Interval = VT