心脏电生理检查和射频消融-1

1、心脏电生理检查和射频消融治疗快速心律失常-1长海医院心内科曹 江Cardiac Electrophysiology Cellular Cardiac Electrophysiology Experimental Cardiac Electrophysiology Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology is a field within cardiology involves complicated technical pro

2、cedures to evaluate heart rhythms And provide appropriate treatment for rhythm disturbances Cardiac Electrophysiology Study EPS of the heart is a non-surgical analysis of the electrical conduction system (normal or abnormal) of the heart. involves placing cardiac electrode catheters within or near t

3、he heart to determine the characteristics of heart rhythm or arrhythmia EP studies may be helpful in: to diagnose the source of symptoms to evaluate the risk of future cardiac events to evaluate the effectiveness of medication in controlling an arrhythmia to evaluate the need for a permanent pacemak

4、er, an implantable cardioverter-defibrillator, or radiofrequency catheter ablation as a treatment for arrhythmia. Radiofrequency Catheter ablationRFCAA catheter procedure that uses electrical current to generate heat to destroy the fast irregular heartbeats心脏功能心脏功能心脏解剖心脏解剖心脏解剖心脏解剖心脏解剖心脏解剖心脏解剖心脏解剖心脏传

5、导系统心脏传导系统心脏传导系统心脏传导系统心脏X线解剖心脏X线解剖心脏X线解剖心脏X线解剖心脏电生理的历史心脏电生理的历史You can pick up a feather after rubbing amber with wool which were observed even in ancient Greece心脏电生理的历史公元前300年：亚里士多德发现电鳗的“震击”效应心脏电生理的历史William Gilbert (1544-1603) performed important early studies of electricity and magnetism. In De Mag

6、nete (1600), he was the first to describe the earths magnetic field and to postulate the relationship between electricity and magnetism. He introduced the term electricity into scientific discourse. 心脏电生理的历史Luigi Galvani, 1737-1798 Italian physicist and anatomist and was one of the first to investig

7、ate experimentally the phenomenon of what came to be named bioelectrogenesis. 心脏电生理的历史1791:Galvani discovers that electrical stimulation of a frogs heart leads to muscular contractionCarlo Matteucci 心脏电生理的历史心脏电生理的历史British physiologist Augustus D. Waller of St Marys Medical School, London publishes

8、the first human electrocardiogram. It is recorded with a capilliary electrometer from Thomas Goswell, a technician in the laboratory. Waller AD. A demonstration on man of electromotive changes accompanying the hearts beat. J Physiol (London) 1887;8:229-234 心脏电生理的历史心脏电生理的历史心脏电生理的历史心脏电生理的历史Einthoven 1

9、893年提出了心电图 Electrocardiogram的命名, 建立肢体导联发现心电图包括P, Q, R, S和 T波1903年研制成功弦线式心电图机研究了多种心脏疾病的心电图1924年荣获了诺贝尔医学奖Father of Electro-cardiographyECG Electrodes 1901Lead ILead IIECG Set心脏电生理的历史First Documentation of Ventricular Fibrillation In 1849: Hoffa, in Ludwigs laboratory, documented bizarre unregulated ac

10、tions of the ventricles when exposed directly to strong faradic or constant currents 心脏电生理的历史1900-1919S. Tawaras contribution to elucidation of conduction system of the mammalian heart 心脏电生理的历史In 1929 in a small hospital in Eberswald Germany Werner Forssmann, a young surgical resident, anesthetized

11、his own elbow, inserted a catheter in his antecubital vein and, catheter dangling from his arm, proceeded to a basement x-ray room where he documented the catheters position in his right atrium ?proving that a catheter could be inserted safely into a human heart. 心脏电生理的历史 The 1930s Bundle-Branch Blo

12、ck with Short P-R type Interval in Healthy Young People Prone to Paroxysmal Tachycardia 心脏电生理的历史The Ventricular Vulnerable Period In 1940 Wiggers and Wegria established beyond doubt the existence of the ventricular vulnerable period by elegant experiments that confirmed previous less striking observ

13、ations. 心脏电生理的历史Treatment of Unexpected Cardiac Arrest by External Electric Stimulation of the Heart 心脏电生理的历史On July 16, 1958 the transvenous catheter electrode was introduced, with fluoroscopy, via the basilic vein into the right ventricular outflow tract, in a patient with fixed complete heart blo

14、ck 心脏电生理的历史1970s 电生理检查和治疗真正起步的年代Ventricular Fibrillation: A Possible Mechanism of Sudden Death in Patients with WPW Syndrome 心脏电生理的历史His bundle activity during the spontaneous and stimulated onset of SVT Initiation and Termination of Ventricular Tachycardia 心脏电生理的历史Overdrive pacing in the WPW syndro

15、me Epicardial Mapping in Ventricular Tachycardia 心脏电生理的历史1980s: 电生理检查和治疗发展的年代 Catheter Ablation of the A-V Junction by DC Energy in Man of open heart心脏电生理的历史Catheter Induced Ablation of the A-V Junction in Man in 1981 at Moffitt Hospital 心脏电生理的历史1990s: 心脏电生理检查和治疗走向辉煌和成熟Transvenous Implantable Defibr

16、illator 心脏电生理的历史导管射频消融（RFCA)ELECTROPHYSIOLOGY: CARDIAC CELLS2 Types of Cells: Electrical & Myocardial Electrical Cells impulse formation & conductionEC distributed evenly along the conduction system of the heart. They possess THREE specific properties.*Automaticity- ability to initiate an impulse sp

17、ontaneously & continuously*Excitability ability to be electrically stimulated *Conductivity-ability to transmit an impulse from one cell to another in an orderly manner * Myocardial Cells form thin muscular layer of atrial wall & the thicker wall of the ventricle.Contractility ability of cell to sho

18、rten & lengthen its muscle fibers respond mechanically to an impulseExtensibility- cell to stretchDEPOLARIZATION & REPOLARIZATIONCardiac Action PotentialIon Channel Diffusion心肌细胞的动作电位静息电位 K平衡电位Nernst方程计算 Em=61.51og(Co/Ci)Em=61.51og(4/140) =-90毫伏“0”相 外来刺激Na+渗入细胞阈电位(-60mV)除极作用形成R波升支心肌细胞的动作电位“0”相 -55mV时，慢钠通道开放，Ca+缓慢内流-10mV氯通道开放，Cl-内流形成R波升支心肌细胞的动作电位“1”相 快Na+通道失活Cl-快速内流-10mV氯通道失活形成R波降支心肌细胞的动作电位“2”相 Ca+内流和K+外渗抵消，形成平台相当于ST段“1”、“2”相交界点相当于J点心肌细胞