乳头肌和希浦氏起源室性心理失常的特点及诊断--2012杭州概要.ppt

V1右束支阻滞，左室，QRS波宽150ms，伴有切迹，V1-3极向多，高度提示乳头肌室早。 V1右束支阻滞，左室，QRS波宽150ms，伴有切迹，V1-3极向多，高度提示乳头肌室早。 后乳头肌靠下，靠左。 胸导联：V1-V3形态加宽度，基本确定乳头肌。那么II,III,AVF可以确定高低为靠下， 2009年日本YAMADA教授最早报道，对一名54岁频发室早女性，应用基于CARTO的3维超声显像技术(CARTO SOUND系统）进行标测，证实该室早来源于乳头肌。 前组乳头肌和后组乳头肌比较 相对靠左，靠上。 所以I导联多朝下，而II，III，AVF朝上。 * 垂直方向上：靠近右心室心尖部部，II,III,AVF 大S，而左右方向上是靠右，I导联比较高大的R波。 * 垂直方向上：靠上，靠近心底部，II,III,AVF 大R小s，而左右方向上是靠中间偏右，I导联不高的R波。 * 多没有心脏基础病变，病变以老年性冠心病多见。QRS波宽大，150ms。 多没有心脏基础病变，病变以老年性冠心病多见。QRS波宽大，150ms。 Carto解剖图也显示了靶点位于前乳头肌！ ICE图（腔内超声图）：较为清晰地显示左室，乳头肌结构。靶点就在前乳头肌根部！ * 这块内容大家相对熟悉！ 首先看看希浦氏系统的组成。 Figure 5.?The His–Purkinje system in the human left ventricle Modified from Tawara (2000) with permission. Structural and functional asymmetry of the His–Purkinje system. (A, C) EGFP-positive cell networks observed in the left (A) and right (C) ventricular chambers. In (A), the left ventricular free wall (LVW) was incised in the center from base to apex, then the two parts of the wall were pulled back on both sides to expose the left flank of the IVS (LF). The dotted line indicates the limits between the LF and the LVW. In (C), the whole right ventricular wall (RVW) was pulled back on the right. The dotted line indicates the limits between the right flank of the IVS (RF) and the RVW. Arrowhead indicates a fiber connecting the RF web to the RVW network. Small white circles indicate connecting fibers which have been cut. Insert shows details of the RBB (arrow) which emerged from the His bundle and intersected with the septal artery (star) and its ramifications. APM: anterior papillary muscle. Other legends are identical to those of Fig. 2. (B,D) Representative activation maps of the left (B) and right (D) BBs of Cx40EGFP/+ mice. The position of the electrode array on the septum flanks is indicated in the pictograms. Local electrograms recorded from the indicated electrodes (green and red dots) are shown, and stars indicate the specific BB signal. The large deflection represents activation of the septal myocardium. Color c