房颤消融术后房速机制.ppt

环肺静脉电隔离后可发生局灶性房速和大折返性房速。 肺静脉电隔离后的LA-PV大折返性房速是一种新的大折返性房速，由两个传导 gaps介导，心动过速时一个作为入口、一个作为出口。 LA-PV大折返性房速和局灶性房速可用三维标测系统标测。 消融LA-PV大折返性房速入口或出口均可达到治愈的目的。 结论 * 该CD是关于起搏器的植入技术和容易遇到的问题 * Tracings show that surface ECG lead I and V1 and intracardiac recordings from a ablation catheter (Mp) inside pulmonary vein (PV) and coronary sinus (CS) during tachycardia and pacing at LA post wall. Note that activation sequence during pacing is identical to that of tachycardia and post pacing interval matches the cycle length of the tachycardia. * Tracings show that surface ECG lead I II III aVR, V1 V3 and V5 and intracardiac recordings from a ablation catheter (Mp) inside pulmonary vein (PV) Note that pacing inside PV show same P wave morphology compared to that of tachycardia and post pacing interval is almost equal to tachycardia cycle length. * RF application Intracardiac recording during tachycardia with the ablator catheter at posterior inferior region of left pulmonary vein. Ablation performed at this site leads to prolongation of cycle length and termination of tachycardia. The interval between the PV and LA potential during tachycardia prolonged gradually and finally blocked between PV and LA followed AT termination. * Note that in right panel the application at the superior anterior of left PV eliminated PV potential * The Slide shows the scheme of pacing at the entrance of PV. The pacing at both the inside and outside pulmonary vein (PV) demonstrated that an identical activation sequence of PV and left atrium (LA) and almost an equal post pacing interval to the tachycardia. (Figure 3 D, E, F). Tachycardia was terminate by single application at the site shown the earliest activation of LA. (Figure 3 H). The reentrant tachycardia of tachycardia was assumed to enter the PV at the anterior-superior site of PV and exit form PV inferior posterior site, resulting the reentrant circuit included both PV and LA and conducted through 2 conduction gaps between PV and LA. * The thr