医药-心脏电生理跟射频消融基础.ppt

电生理相关资料 Differential Diagnosis of NCT Short RP AVRT AT Slow-Slow AVNRT Long RP AT Atypical AVNRT PJRT SUMMARY Obtain a 12 lead ECG. The location of the P wave will dictate the differential diagnosis If hemodynamically unstable (chest pain, heart failure, hypotension)- CARDIOVERSION If hemodynamically stable -AV NODAL AGENT Long term therapy depends on mechanism and can be conservative, pharmacologic or invasive EP study often needed for definitive characterization of mechanism and can cure most SVTs with 90% success rate AVNRT Atrial flutter – sawtooth or picket fence Atrial flutter with rapid response Arrhythmias: SA Block Arrhythmias: Atrial Flutter 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. Rate Look at complexes in a 6-second strip and count the complexes; that will give you a rough estimate of rate 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) AVNRT Acute treatment ATP or Verapamil Cardioversion if BP ? Long term Drugs, verapamil or b-blocker EPS and RFA AVRT WPW or concealed accessory pathway acute and chronic treatment similar to AVNRT avoid b-blocker and verapamil in known WPW Atrial Flutter Marcoreentrant circuit in RA terminate by cardioversion with high success rate poorly controlled by medical therapy EPS + RFA AVNRT Heart Disease Arrhythmias = abnormal heart rhythms. Bradycardia = slower Tachycardia = faster (exercise!) Flutter: extremely rapid Fibrillation: Contractions of different groups of myocardial cells at different times. Ventricular fibrillation is life-threatening. Train your eyes T