心脏电生理和射频消融基础课件
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Cardiac vein stenosis
2/23/2021
PTCA with 3.5 mm balloon
心脏电生理和射频消融基础
Final result
1
Modified Seldinger technique for percutaneous catheter sheath introduction
2/23/2021
心脏电生理和射频消融基础
12
Arrhythmias: SA Block
P QRS T
2/23/2021
心脏电生理和射频消融基础
13
Arrhythmias: Atrial Flutter
2/23/2021
心脏电生理和射频消融基础
14
Steps to reading ECGs
What is the rate? Both atrial and ventricular if they are not the same.
Is the rhythm regular or irregular? Do the P waves all look the same? Is there a P wave
for every QRS and conversely a QRS for every P wave? Are all the complexes within normal time limits? Name the rhythm and any abnormalities.
2/23/2021
心脏电生理和射频消融基础
2
2/23/2021
心脏电生理和射频消融基础
3
Sequence of P Wave Generation
Sinus Node
SA Junction
Atrium (P wave)
Non-visible process on the EKG
2/23/2021
Short RP
AVRT AT Slow-Slow
AVNRT
Long RP
AT Atypical
AVNRT PJRT
P buried in QRSБайду номын сангаас
Typical AVNRT AT JET
2/23/2021
心脏电生理和射频消融基础
7
SUMMARY
Obtain a 12 lead ECG. The location of the P wave will dictate the differential diagnosis
2/23/2021
心脏电生理和射频消融基础
8
AVNRT
2/23/2021
心脏电生理和射频消融基础
9
2/23/2021
心脏电生理和射频消融基础
10
Atrial flutter – sawtooth or picket fence
2/23/2021
心脏电生理和射频消融基础
11
Atrial flutter with rapid response
Count the number of large boxes between two complexes and divide into 300
Count the number of small boxes between two complexes and divide into 1500
Estimate rate by sequence of numbers (see next slide)
avoid b-blocker and verapamil in known WPW
心脏电生理和射频消融基础
21
Atrial Flutter
Marcoreentrant circuit in RA
terminate by cardioversion with high success rate
心脏电生理和射频消融基础
4
AV node
“Slow zone”
IVC
Lead II
2/23/2021
心脏电生理和射频消融基础
5
SUMMARY
Mechanisms of SVT
SP
FP
Atrial Tachycardia AVNRT
AVRT
2/23/2021
心脏电生理和射频消融基础
6
Differential Diagnosis of NCT
Long term Drugs, verapamil or bblocker EPS and RFA
2/23/2021
心脏电生理和射频消融基础
20
AVRT
2/23/2021
WPW or concealed accessory pathway
acute and chronic treatment similar to AVNRT
conservative, pharmacologic or invasive EP study often needed for definitive characterization of
mechanism and can cure most SVTs with 90% success rate
If hemodynamically unstable (chest pain, heart failure, hypotension)- CARDIOVERSION
If hemodynamically stable -AV NODAL AGENT Long term therapy depends on mechanism and can be
2/23/2021
心脏电生理和射频消融基础
18
Bundle branch blocks
Look at the QRS morphology in V1 and V6
2/23/2021
心脏电生理和射频消融基础
19
AVNRT
Acute treatment ATP or Verapamil Cardioversion if BP
2/23/2021
心脏电生理和射频消融基础
15
2/23/2021
心脏电生理和射频消融基础
16
2/23/2021
心脏电生理和射频消融基础
17
Rate
Look at complexes in a 6-second strip and count the complexes; that will give you a rough estimate of rate
2/23/2021
PTCA with 3.5 mm balloon
心脏电生理和射频消融基础
Final result
1
Modified Seldinger technique for percutaneous catheter sheath introduction
2/23/2021
心脏电生理和射频消融基础
12
Arrhythmias: SA Block
P QRS T
2/23/2021
心脏电生理和射频消融基础
13
Arrhythmias: Atrial Flutter
2/23/2021
心脏电生理和射频消融基础
14
Steps to reading ECGs
What is the rate? Both atrial and ventricular if they are not the same.
Is the rhythm regular or irregular? Do the P waves all look the same? Is there a P wave
for every QRS and conversely a QRS for every P wave? Are all the complexes within normal time limits? Name the rhythm and any abnormalities.
2/23/2021
心脏电生理和射频消融基础
2
2/23/2021
心脏电生理和射频消融基础
3
Sequence of P Wave Generation
Sinus Node
SA Junction
Atrium (P wave)
Non-visible process on the EKG
2/23/2021
Short RP
AVRT AT Slow-Slow
AVNRT
Long RP
AT Atypical
AVNRT PJRT
P buried in QRSБайду номын сангаас
Typical AVNRT AT JET
2/23/2021
心脏电生理和射频消融基础
7
SUMMARY
Obtain a 12 lead ECG. The location of the P wave will dictate the differential diagnosis
2/23/2021
心脏电生理和射频消融基础
8
AVNRT
2/23/2021
心脏电生理和射频消融基础
9
2/23/2021
心脏电生理和射频消融基础
10
Atrial flutter – sawtooth or picket fence
2/23/2021
心脏电生理和射频消融基础
11
Atrial flutter with rapid response
Count the number of large boxes between two complexes and divide into 300
Count the number of small boxes between two complexes and divide into 1500
Estimate rate by sequence of numbers (see next slide)
avoid b-blocker and verapamil in known WPW
心脏电生理和射频消融基础
21
Atrial Flutter
Marcoreentrant circuit in RA
terminate by cardioversion with high success rate
心脏电生理和射频消融基础
4
AV node
“Slow zone”
IVC
Lead II
2/23/2021
心脏电生理和射频消融基础
5
SUMMARY
Mechanisms of SVT
SP
FP
Atrial Tachycardia AVNRT
AVRT
2/23/2021
心脏电生理和射频消融基础
6
Differential Diagnosis of NCT
Long term Drugs, verapamil or bblocker EPS and RFA
2/23/2021
心脏电生理和射频消融基础
20
AVRT
2/23/2021
WPW or concealed accessory pathway
acute and chronic treatment similar to AVNRT
conservative, pharmacologic or invasive EP study often needed for definitive characterization of
mechanism and can cure most SVTs with 90% success rate
If hemodynamically unstable (chest pain, heart failure, hypotension)- CARDIOVERSION
If hemodynamically stable -AV NODAL AGENT Long term therapy depends on mechanism and can be
2/23/2021
心脏电生理和射频消融基础
18
Bundle branch blocks
Look at the QRS morphology in V1 and V6
2/23/2021
心脏电生理和射频消融基础
19
AVNRT
Acute treatment ATP or Verapamil Cardioversion if BP
2/23/2021
心脏电生理和射频消融基础
15
2/23/2021
心脏电生理和射频消融基础
16
2/23/2021
心脏电生理和射频消融基础
17
Rate
Look at complexes in a 6-second strip and count the complexes; that will give you a rough estimate of rate