室性心律失常EP综述(英文版)课件.ppt
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- 心律失常 EP 综述 英文 课件
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1、An Electrophysiologic OverviewVentricular TachyarrhythmiasModule Objectives Ventricular Tachyarrhythmias Identify the mechanisms for ventricular tachycardias Differentiate types of ventricular tachycardias using ECG and intracardiac electrogram recordings Discuss treatment options for ventricular ta
2、chycardiasAfter completion of this module,the participant should be able to:Module Outline Ventricular TachyarrhythmiasDescriptionCharacteristicsMechanismsSustained vs.nonsustainedPremature ventricular contractionsModule Outline Ventricular TachyarrhythmiasClassificationMonomorphicIdiopathicDescript
3、ionECG recognitionTreatment ablationBundle branchDescriptionECG recognitionTreatment ablationModule Outline Ventricular TachyarrhythmiasClassifications-continuedVentricular flutterECG recognitionVentricular fibrillationECG recognitionPolymorphicTorsades de pointesDescriptionECG recognitionTreatmentS
4、ummaryVentricular Tachycardia(VT)Originates in the ventricles Can be life threatening Most patients have significant heart diseaseCoronary artery diseaseA previous myocardial infarctionCardiomyopathyMechanisms of VT Reentrant Reentry circuit(fast and slow pathway)is confined to the ventricles and/or
5、 bundle branches Automatic Automatic focus occurs within the ventricles Triggered activityEarly afterdepolarizations(phase 3)Delayed afterdepolarizations(phase 4)Reentrant Reentrant ventricular arrhythmiasPremature ventricular complexesIdiopathic left ventricular tachycardiaBundle branch reentryVent
6、ricular tachycardia and fibrillation when associated with chronic heart disease:Previous myocardial infarctionCardiomyopathyAutomatic Automatic ventricular arrhythmiasPremature ventricular complexesIschemic ventricular tachycardiaVentricular tachycardia and fibrillation when associated with acute me
7、dical conditions:Acute myocardial infarction or ischemiaElectrolyte and acid-base disturbances,hypoxemiaIncreased sympathetic toneAutomaticityAbnormal Acceleration of Phase 4Fogoros:Electrophysiologic Testing.3rd ed.Blackwell Scientific 1999;16.Triggered Triggered activity ventricular arrhythmiasPau
8、se-dependent triggered activityEarly afterdepolarization(phase 3)Polymorphic ventricular tachycardiaCatechol-dependent triggered activityLate afterdepolarizations(phase 4)Idiopathic right ventricular tachycardiaTriggeredFogoros:Electrophysiologic Testing.3rd ed.Blackwell Scientific 1999;158.Sustaine
9、d vs.Nonsustained Sustained VTEpisodes last at least 30 secondsCommonly seen in adults with prior:Myocardial infarctionChronic coronary artery diseaseDilated cardiomyopathy Non-sustained VTEpisodes last at least 6 beats but 30 secondsPremature Ventricular Contraction PVCEctopic beat in the ventricle
10、 that can occur singly or in clustersCaused by electrical irritability Factors influencing electrical irritabilityIschemiaElectrolyte imbalancesDrug intoxicationClassification Ventricular TachycardiaMonomorphicIdiopathic VT Bundle branch reentry tachycardiaVentricular flutterVentricular fibrillation
11、PolymorphicTorsades de pointes(TdP)Monomorphic VTsMonomorphic VT Heart rate:100 bpm or greater Rhythm:Regular MechanismReentryAbnormal automaticityTriggered activity RecognitionBroad QRSStable and uniform beat-to-beat appearanceECG RecognitionECG used with permission of Dr.Brian Olshansky.Intracardi
12、ac Recording of VTEGM used with permission of Texas Cardiac Arrhythmia,P.A.Idiopathic Right Ventricular Tachycardia Right ventricular idiopathic VTFocus originates within the right ventricular outflow tractVentricular function is usually normalUsually LBBB,inferior axis Treatment options:Pharmacolog
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