课件：心内电生理检查.ppt

THANK YOU SUCCESS * * 可编辑 Fluoroscopy is used to guide catheters into position. ? The most common vascular access sites are the right or left femoral (leg) veins. The catheter is advanced through the inferior vena cava (IVC) into the right atrium (RA). It may be inserted into the coronary sinus (CS) or advanced across the tricuspid valve into the RV. Multiple catheters may be inserted into the same femoral vein. ? For more complicated EP studies, catheters are inserted from the upper extremities via the internal or external jugular, subclavian (near collarbone), or brachial (arm) veins. The median basilic vein is occasionally used. The catheter is advanced through the superior vena cava (SVC) into the RA, right ventricle (RV), His bundle area, or CS. A transseptal approach is used to cross the interatrial septum and access the left atrium (Figure B). The catheter is introduced into the RA and advanced to the LA by puncturing the interatrial septum. ? The femoral artery is used only if access to the left ventricle (LV) is required. The catheter is advanced through the aorta and then in a retrograde fashion across the aortic valve into the LV. It may be advanced across the mitral valve into the LA. EP catheters are usually placed percutaneously using a modified Seldinger technique - a needle-stick technique that does not require a cutdown. The high right atrial (HRA) catheter is placed in the lateral wall of the high right atrium, near the junction of the SVC and as close to the SA node as possible. ? The HRA catheter is positioned away from the ventricles, so it senses atrial activity only. The HRA EGM is somewhat aligned with the surface P-wave since both represent atrial depolarization. The His bundle (HIS) catheter is placed across the posterior aspect of the tricuspid valve, as close to the His bundle as possible. It straddles the major structures of the AV conduction system. ? The HIS catheter electrodes sense electrical signals in the low right atriu