医学教程 常见心律失常的诊断和处理课件.ppt

心电轴极度右偏-几乎肯定为VT左室特发性室速要点好发于青壮年心脏大体结构正常患者多不伴频发室早WCT时QRS波时限常小于140ms，呈RBBB型，Ⅱ、Ⅲ、aVF导联QRS主波方向向下，aVR导联主波向上，电轴极度左偏抗心律失常药物效果欠佳，70％对维拉帕米敏感发生机制可能为折返（与左后分支或左前有关）射频消融效果佳消融标测多用激动标测（局部P电位）THANKYOUSUCCESS**可编辑***1903年，荷兰Leiden大学EinthovenW教授发明的弦线式心电图机*Wolff-Parkinson-Whitesyndrome:PreexcitationWolff-Parkinson-WhitesyndromeisaformofanomalousAVconductionorventricularpre-excitation.Ventricularpre-excitationissaidtoexistwhenconductionofasupraventricularimpulsesoccursviaanaccessorypathwaywhichbypassestheAVnode.Conductionthroughtheaccessorypathwayallowsprematureactivationoftheventricularmyocardium,whichisevidencedbytheshortPRintervalandtheinitialslurringornotchingoftheQRS(thedeltawave).ECGrequirementsfordiagnosisofWPWsyndrome ? ShortP-Rinterval(120ms) ? NormalPwavevector(toexcludejunctionalrhythm) ? Presenceofadeltawave,slurringornotchingofthefirstportion oftheQRScomplex ? QRSdurationgreaterthan100msNotethatinthisexample,right-sidedpre-excitationisfollowedbynormalactivationviatheleftbundlebranch,producingafusioncomplex.[?2003BlaufussMultimedia.Allrightsreserved.]*AVRT:WPWsyndrome:Preexcitation12-LeadECGECGrequirementsfordiagnosisofWPWsyndrome ? ShortP-Rinterval(120ms) ? NormalPwavevector(toexcludejunctionalrhythm) ? Presenceofadeltawave,slurringornotchingofthefirstportion oftheQRScomplex ? QRSdurationgreaterthan100msNotethatinthisexample,right-sidedpre-excitationisfollowedbynormalactivationviatheleftbundlebranch,producingafusioncomplex.[?2003BlaufussMultimedia.Allrightsreserved.]*Wolff-Parkinson-Whitesyndrome:InitiationofAVRTAnepisodeofsupraventriculartachycardiacanbeinitiatedbyacloselycoupledprematureatrialcomplex(PAC)whichblocksintheaccessorypathway,butconductsthroughtheAVnode.Therapidlycon