电生理检查
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至少有2个电极，用以记录心内信号和起搏
15
HRA
HIS CS
RVA
16
Standard Catheter Placement 标准的导管位置
• High Right Atrium 高右房
– A shaped quadripolar catheter (“Josephson” type) 塑 形 四 极 （ Josephson弯）
置鞘及扩张鞘
12
Seldinger Technique 静脉穿刺技术
• Sheaths are used for access 鞘管作为血管通路
• Sheath is advanced • Sheaths are rotated
旋转并推送鞘管及扩张鞘 • Position
移除扩张鞘及导丝，固定鞘管
20
Catheter Positions and their Relationship 导 管位置和相对关系
SVC
HRA
CS OS IVC
SVC
Ao MV
TV
IVC
RAO
21
LAO
Fluoroscopic Catheter Positions
HRA
CS HIS
HRA
HIS
CS
RVA
RAO
22
RVA
4
EP Lab Overview
5
Staff 人员
• Electrophysiologist (1 or more) 电生理医生（1人或以上） • EP technician (1 or more) 电生理技师（ 1人或以上） • Nurses 护士 • Clinical Support 临床技术支持
Surface ECG
25
Basic Surface ECG Components 组成 QRS
T P
26
Paper Speed 25-100 mm/sec
25mm/s
50mm/s
100mm/s
•When performing baseline measurements in EP, different paper speeds are used to enhance detail and accuracy.
28
Baseline Measurements 基线测量
• Surface ECG Measurements 体表心电图测量
– PR Interval (120-200 ms) PR间期 – QRS Duration (80-120 ms) QRS宽度 – R-R Ventricular Rate (600-1200 ms or 50-100 bpm) RR间期（心室率） – QT Interval (<440 ms) QT间期
Introduction to EP Study 电生理检查
1
Learning Objectives 目标
• To measure baseline surface and intracardiac intervals 测量体表和心内 心电图
• To understand basic pacing maneuvers in the EP lab 起搏方式及用途 • To identify refractory periods 测定不应期 • To identify the routine catheter positions for the EP Study 导管位置的常
• Right Ventricular Apex 右室 心尖
– A shaped quadripolar catheter (“Damato” type) 塑形四极 （ Damato弯形）
– Normally 10 mm spacing 通常 10mm间距
– From femoral vein 股静脉途径 – Placed on the right ventricular
13
Catheter Placement 导管放置
14
Electrode Catheters 导管
• Fixed or Deflectable 固定弯或可调弯 • Carry at least 2 electrodes for recording intracardiac signal and pacing
19
Standard Catheter Placement 标准导管位置
• HIS Bundle 希氏束
– A fixed shaped quadripolar catheter (Josephson type)塑 形固定弯四极（ Josephson弯）
– Normally 2-2-2 mm spacing 通常2-2-2 mm间距
– 60,000/HR in bpm = cycle length in ms OR
– 60,000/CL in ms = hr in bpm
• In the EP lab, both beats per minute (BPM) and “cycle length” (CL) are used to measure heart rate and conduction times. 心率和周长均常用
apex 置于右室心尖
18
Standard Catheter Placement标准的导管位置
• Coronary Sinus 冠状窦
– A fixed shaped decapolar catheter (“P” type) or steerable decapolar catheter 塑形十极（P弯）或可调弯 导管
•Typical ECG paper speed is 25 mm/sec. In EP, anywhere from 25 to 400 mm/s are typically used.
27
Heart Rate Versus Cycle Length 心率与周长
• To convert from BPM to CL (ms) or vice versa take the number you have (bpm or ms) and divide it into 60,000. Thus: 60000除以周长（ms）即为 心率（bpm）
8
Left Femoral Artery (LFA) 左股动脉 Left Femoral Vein (LFV)左股静脉
Inferior Approach 下肢途径
• Femoral Artery (RFA) 股动脉
– Palpable 可触摸到 – Left sided heart access 左心途径
– Place on the coronary sinus which is usefully situated along the mitral annulus, allowing registration of electrograms from the left atrium and ventricle 冠状窦沿二尖瓣环走 行，记录左房和左室信号
– From femoral vein 股静脉途径 – Placed on the position
straddling the tricuspid annulus in its superior portion 放置于三尖瓣环较高的位置
– At the correct location, a clear HIS bundle electrogram is seen between atrial and ventricular electrograms 在适 当位置，记录的信号可见H波
• CL is measured in milliseconds (ms). 周长单位是毫秒（ms）
– EG: A HR of 100 BPM=CL of 600 ms OR 心率100bpm＝周长600ms
– CL of 500 ms=120 bpm
心率120bpm＝周长500ms
Question: A HR of 60 BPM would equal a CL of how many ms?
– Normally 5 mm spacing 通常 5mm间距
– From femoral vein 股静脉 途径 – Placed on the lateral wall,
near SVC/right atrial junction 置于侧壁、上腔和右房交界处
17
Standard Catheter Placement 标准的导管位置
• Femoral vein is medial 股静脉位于其内侧
Femoral Artery 股 动脉
Femoral Vein 股 静脉
11
Seldinger Technique 静脉穿刺技术
• Needle is inserted 进针 • Steady venous blood flow 静脉血回流 • Wire is inserted 进导丝 • Needle is removed 退针 • Dilator used to widen access
6
Access Sites 手术入路
7
Access Location入路位置
Internal Jugular (IJ) 颈内静脉 Subclavian Vein 锁骨下静脉
Subclavian Vein 锁骨下静脉
Brachial Vein 肱静脉
Right Femoral Artery (RFA) 右股动脉 Right Femoral Vein (RFV)右股静脉
29
Surface ECG Measurements 体表心电图测量
P QRS T
P QRS T
P QRS
• PR Interval: beginning of P wave to start of QRS
PR间期：P波起始到QRS波起始 • Normal: 120-200 ms
– Normally 2-5-2-5-2 mm spacing 通 常2-5-2 mm间距
– From subclavian vein/ internal jugular vein to SVC (fixed shape catheter) or from femoral vein (steerable catheter) 颈内或锁骨下 静脉途径（固定弯）或股静脉途径 （可调弯）
• Subclavian Vein 锁骨下静脉
Internal Jugular Vein 颈内静脉
Subclavian Vein 锁骨下静脉
10
Seldinger Technique 静脉穿刺技术
• Most common technique 最常用
• Locate femoral artery 先找到股动脉
规位置以及导管类型
2
Indications for Intracardiac EPS 心内电生理检查的适应症
• Indication 适应症
Approx Frequency 比例
– Cardiac Arrest 心脏骤停
30%
– Unexplained Recurrent Syncope 晕厥
25%
• Femoral Vein (RFV) 股静脉
– Medial 动脉内侧 – Right sided heart access 右心途径
Femoral Artery 股动脉 Femoral Vein 股静脉
9
Superior Approach 上肢途径
• Internal Jugular Vein (IJ) 颈内静脉
– Recurrent sustained/nonsustained VT 室速 25%
– Symptomatic SVT
有症状的室上速
18%
– Bradycardia 心动过缓
2%
• numbers and indications may vary by lab 各导管室可能略有差异
3
Electrophysiology Laboratory 电生理实验室
LAO
REVIEW : Catheter Positions 导管位置
Aaaa
CS is from femoralter Positions
Aaaa
HRA
HIS CS
RVA
HRA
RVA
HIS
CS
CS is from femoral vein
24
Basic EP Measurements 基础电生理测量：体表心电图
15
HRA
HIS CS
RVA
16
Standard Catheter Placement 标准的导管位置
• High Right Atrium 高右房
– A shaped quadripolar catheter (“Josephson” type) 塑 形 四 极 （ Josephson弯）
置鞘及扩张鞘
12
Seldinger Technique 静脉穿刺技术
• Sheaths are used for access 鞘管作为血管通路
• Sheath is advanced • Sheaths are rotated
旋转并推送鞘管及扩张鞘 • Position
移除扩张鞘及导丝，固定鞘管
20
Catheter Positions and their Relationship 导 管位置和相对关系
SVC
HRA
CS OS IVC
SVC
Ao MV
TV
IVC
RAO
21
LAO
Fluoroscopic Catheter Positions
HRA
CS HIS
HRA
HIS
CS
RVA
RAO
22
RVA
4
EP Lab Overview
5
Staff 人员
• Electrophysiologist (1 or more) 电生理医生（1人或以上） • EP technician (1 or more) 电生理技师（ 1人或以上） • Nurses 护士 • Clinical Support 临床技术支持
Surface ECG
25
Basic Surface ECG Components 组成 QRS
T P
26
Paper Speed 25-100 mm/sec
25mm/s
50mm/s
100mm/s
•When performing baseline measurements in EP, different paper speeds are used to enhance detail and accuracy.
28
Baseline Measurements 基线测量
• Surface ECG Measurements 体表心电图测量
– PR Interval (120-200 ms) PR间期 – QRS Duration (80-120 ms) QRS宽度 – R-R Ventricular Rate (600-1200 ms or 50-100 bpm) RR间期（心室率） – QT Interval (<440 ms) QT间期
Introduction to EP Study 电生理检查
1
Learning Objectives 目标
• To measure baseline surface and intracardiac intervals 测量体表和心内 心电图
• To understand basic pacing maneuvers in the EP lab 起搏方式及用途 • To identify refractory periods 测定不应期 • To identify the routine catheter positions for the EP Study 导管位置的常
• Right Ventricular Apex 右室 心尖
– A shaped quadripolar catheter (“Damato” type) 塑形四极 （ Damato弯形）
– Normally 10 mm spacing 通常 10mm间距
– From femoral vein 股静脉途径 – Placed on the right ventricular
13
Catheter Placement 导管放置
14
Electrode Catheters 导管
• Fixed or Deflectable 固定弯或可调弯 • Carry at least 2 electrodes for recording intracardiac signal and pacing
19
Standard Catheter Placement 标准导管位置
• HIS Bundle 希氏束
– A fixed shaped quadripolar catheter (Josephson type)塑 形固定弯四极（ Josephson弯）
– Normally 2-2-2 mm spacing 通常2-2-2 mm间距
– 60,000/HR in bpm = cycle length in ms OR
– 60,000/CL in ms = hr in bpm
• In the EP lab, both beats per minute (BPM) and “cycle length” (CL) are used to measure heart rate and conduction times. 心率和周长均常用
apex 置于右室心尖
18
Standard Catheter Placement标准的导管位置
• Coronary Sinus 冠状窦
– A fixed shaped decapolar catheter (“P” type) or steerable decapolar catheter 塑形十极（P弯）或可调弯 导管
•Typical ECG paper speed is 25 mm/sec. In EP, anywhere from 25 to 400 mm/s are typically used.
27
Heart Rate Versus Cycle Length 心率与周长
• To convert from BPM to CL (ms) or vice versa take the number you have (bpm or ms) and divide it into 60,000. Thus: 60000除以周长（ms）即为 心率（bpm）
8
Left Femoral Artery (LFA) 左股动脉 Left Femoral Vein (LFV)左股静脉
Inferior Approach 下肢途径
• Femoral Artery (RFA) 股动脉
– Palpable 可触摸到 – Left sided heart access 左心途径
– Place on the coronary sinus which is usefully situated along the mitral annulus, allowing registration of electrograms from the left atrium and ventricle 冠状窦沿二尖瓣环走 行，记录左房和左室信号
– From femoral vein 股静脉途径 – Placed on the position
straddling the tricuspid annulus in its superior portion 放置于三尖瓣环较高的位置
– At the correct location, a clear HIS bundle electrogram is seen between atrial and ventricular electrograms 在适 当位置，记录的信号可见H波
• CL is measured in milliseconds (ms). 周长单位是毫秒（ms）
– EG: A HR of 100 BPM=CL of 600 ms OR 心率100bpm＝周长600ms
– CL of 500 ms=120 bpm
心率120bpm＝周长500ms
Question: A HR of 60 BPM would equal a CL of how many ms?
– Normally 5 mm spacing 通常 5mm间距
– From femoral vein 股静脉 途径 – Placed on the lateral wall,
near SVC/right atrial junction 置于侧壁、上腔和右房交界处
17
Standard Catheter Placement 标准的导管位置
• Femoral vein is medial 股静脉位于其内侧
Femoral Artery 股 动脉
Femoral Vein 股 静脉
11
Seldinger Technique 静脉穿刺技术
• Needle is inserted 进针 • Steady venous blood flow 静脉血回流 • Wire is inserted 进导丝 • Needle is removed 退针 • Dilator used to widen access
6
Access Sites 手术入路
7
Access Location入路位置
Internal Jugular (IJ) 颈内静脉 Subclavian Vein 锁骨下静脉
Subclavian Vein 锁骨下静脉
Brachial Vein 肱静脉
Right Femoral Artery (RFA) 右股动脉 Right Femoral Vein (RFV)右股静脉
29
Surface ECG Measurements 体表心电图测量
P QRS T
P QRS T
P QRS
• PR Interval: beginning of P wave to start of QRS
PR间期：P波起始到QRS波起始 • Normal: 120-200 ms
– Normally 2-5-2-5-2 mm spacing 通 常2-5-2 mm间距
– From subclavian vein/ internal jugular vein to SVC (fixed shape catheter) or from femoral vein (steerable catheter) 颈内或锁骨下 静脉途径（固定弯）或股静脉途径 （可调弯）
• Subclavian Vein 锁骨下静脉
Internal Jugular Vein 颈内静脉
Subclavian Vein 锁骨下静脉
10
Seldinger Technique 静脉穿刺技术
• Most common technique 最常用
• Locate femoral artery 先找到股动脉
规位置以及导管类型
2
Indications for Intracardiac EPS 心内电生理检查的适应症
• Indication 适应症
Approx Frequency 比例
– Cardiac Arrest 心脏骤停
30%
– Unexplained Recurrent Syncope 晕厥
25%
• Femoral Vein (RFV) 股静脉
– Medial 动脉内侧 – Right sided heart access 右心途径
Femoral Artery 股动脉 Femoral Vein 股静脉
9
Superior Approach 上肢途径
• Internal Jugular Vein (IJ) 颈内静脉
– Recurrent sustained/nonsustained VT 室速 25%
– Symptomatic SVT
有症状的室上速
18%
– Bradycardia 心动过缓
2%
• numbers and indications may vary by lab 各导管室可能略有差异
3
Electrophysiology Laboratory 电生理实验室
LAO
REVIEW : Catheter Positions 导管位置
Aaaa
CS is from femoralter Positions
Aaaa
HRA
HIS CS
RVA
HRA
RVA
HIS
CS
CS is from femoral vein
24
Basic EP Measurements 基础电生理测量：体表心电图