流出道室早及室速的导管消融.ppt

Figure 1. A, Determination of the precordial MDI. The earliest time to maximum deflection (TMD) in any of the precordial leads (in this example, lead V3) is measured and divided by total QRS duration (QRSd). See text for details. B, Distribution of precordial MDI values in various subgroups of patients with idiopathic VT. There is excellent discrimination between ILVT arising remote from the ASOV and other subgroups with a cut point of 0.55. The maximum deflection index (MDI), were calculated for each tracing. The MDI was calculated as follows. The QRS duration was measured as the interval between the earliest rapid deflection of the ventricular complex in any of the 12 simultaneous leads to the latest offset in any lead. Time to maximum deflection was measured from the onset of the QRS complex to the maximum deflection in each precordial lead; the maximum deflection was defined as the largest amplitude deflection either above or below the isoelectric line. The time to maximum deflection was divided by the QRS duration to obtain the MDI. The MDI was calculated for each precordial lead separately and as the shortest of any precordial lead (precordial MDI; Figure 1A). 重点突出在： 1.局部的解剖结构（组织学、影像学、重要毗邻结构，可以 找一点冠脉造影显示窦部的片子） 2.心电图特征（典型、不典型）及心电图定位 3.标测及消融路径（窦律时及靶点电位特点） 4.如何规避风险？（操作因素、消融条件、避免传导系统 及冠脉血管的损伤） 5.最后可以总结自己的一组病例、或典型病例 导管射频消融术之流出道室早及室速的导管射频消融治疗 导管射频消融术之流出道室早及室速的导管射频消融治疗 多在青少年起病 可无明显症状、或明显症状、偶有晕厥 心脏超声检查多正常 机制自律性、或触发活动、或折返 预后相对良好 射频消融特发性流出道室性心动过速－心电图特征 RVOT 导管射频消融特发性流出道室性心动过速－心电图特征 I II III AVR AVL AVF V1 V2 V3 V4 V5 V6 LVOT I II III AVR AVL AVF V1 V2 V3 V4 V5 V6 导管射频消融特发性流出道室性心动过速－心电图特征 LVOT 导管射频消融特发性流出道室性心动过速－心电图特征 RVOT RVOT 起源定位 间隔 前游离壁 室性心律失常射频消融治疗－难易程度的预测Catheter ablation of premature ventricular contractions 15 cases 室性心律失常射频消融治疗－难易程度的预测Catheter ablation of premature ventricular contractions 用于左右流出道的鉴别 Daniels DV, et al. Circulation. 2006, 113:1659 12/138 CASES MDI≥0.55 用于非主动脉根部起源的鉴别 MDI≥0.55, 敏感性100％，特异性98.7％ 9/12经CGV或心包穿刺 消融成功，2例外科直视 消融成功 10 CASE