永久HIS起搏临床应用2014-9幻灯片.pptx

永久HIS起搏临床应用进展中国医学科学院阜外医院国家心血管病中心任晓庆一、希氏束二、希氏束起搏（HBP）定义DHBP(direct His bundle pacing/ pure HBP)——直接HBP/纯HBP：对于DHBP的定义各文献中概念基本一致起搏信号与QRS之间有等电位线，Vp-V间期几乎等于H-V间期起搏QRS波与自身的一致增高起搏输出可能使部份患者的QRS波变宽——带周边内膜起搏Ann Noninvasive Electrocardiol 2012;17(2):70–78J Interv Card Electrophysiol (2011) 31:255–262Journal of Cardiovascular Electrophysiology Vol. 17, No. 1, January 2006DHBP(direct His bundle pacing/ pure HBP)——直接HBPDHBP(direct His bundle pacing/ pure HBP)——直接HBP三、HIS束组织解剖 HIS束组织学：HIS束在中心纤维体由Purkinje细胞纵向排列构成，外包裹胶原纤维，缺乏正常的心肌细胞——“裸露”的HIS束是HBP电极能够精确定位的基础HIS束胶原纤维鞘HIS束正常心肌正常心肌James TN, Sherf L. Fine structure of the His bundle. Circulation 1971; 44:9–28 HIS束组织解剖HIS束RBBLBBArbeiten aus der medizinischen klinik zu leipzig 1893; 1:14–49Jena, Germany 1906; 9:114–156Kardiol Pol 2012; 70, 5: 472–476四、His 束尸体组织解剖HIS束的解剖：位于室间隔膜部上方，上与A-V node紧邻，下与左右束支相接——“裸露”的HIS束是HBP电极能够精确定位的基础Correa de Sa DD, et al. Autopsy analysis of the implantation site of a permanent selective direct his bundle pacing lead. Circ Arrhythm Electrophysiol. 2012 Feb;5(1):244-6.His 束尸体组织解剖A, The formalin-fixed tissue block containing the conduction system shows the direct His bundlepacing (DHBP) lead having been unscrewed, leaving behind a fibrous sheath where the lead tip had been actively fixed (arrow). Thelead insertion site is 9 mm above the TV leaflet.Correa de Sa DD, et al. Autopsy analysis of the implantation site of a permanent selective direct his bundle pacing lead. Circ Arrhythm Electrophysiol. 2012 Feb;5(1):244-6.His 束尸体组织解剖B, Masson trichrome (x1) staining demonstrates the proximity of the DHBP lead to the His bundle. The His bundle stains red and is indicated by the asterisk. The arrow points to the TV leaflet. The MS and scar issue are stained blue.Correa de Sa DD, et al. Autopsy analysis of the implantation site of a permanent selective direct his bundle pacing lead. Circ Arrhythm Electrophysiol. 2012 Feb;5(1):244-6.His 束尸体组织解剖C, Masson trichrome (x100). Screw puncture sites are seen surrounding the His bu