2022年医学专题-心脏电生理检查和射频消融-1

心脏电生理(shēnglǐ)检查和射频消融治疗快速心律失常-1长海医院(yīyuàn)心内科曹江第一页，共八十页。CardiacElectrophysiology

CellularCardiacElectrophysiologyExperimentalCardiacElectrophysiologyClinicalCardiacElectrophysiology第二页，共八十页。ClinicalCardiacElectrophysiology

ClinicalCardiacElectrophysiologyisafieldwithincardiologyinvolvescomplicatedtechnicalprocedurestoevaluateheartrhythmsAndprovideappropriatetreatmentforrhythmdisturbances第三页，共八十页。CardiacElectrophysiologyStudy

EPSoftheheartisanon-surgicalanalysisoftheelectricalconductionsystem(normalorabnormal)oftheheart.involvesplacingcardiacelectrodecatheterswithinornearthehearttodeterminethecharacteristicsofheartrhythmorarrhythmia

第四页，共八十页。EPstudiesmaybehelpfulin:todiagnosethesourceofsymptomstoevaluatetheriskoffuturecardiaceventstoevaluatetheeffectivenessofmedicationincontrollinganarrhythmiatoevaluatetheneedforapermanentpacemaker,animplantablecardioverter-defibrillator,orradiofrequencycatheterablationasatreatmentforarrhythmia.第五页，共八十页。RadiofrequencyCatheterablationRFCAAcatheterprocedurethatuseselectricalcurrenttogenerateheattodestroythefastirregularheartbeats第六页，共八十页。第七页，共八十页。心脏(xīnzàng)功能第八页，共八十页。心脏(xīnzàng)功能第九页，共八十页。心脏(xīnzàng)解剖第十页，共八十页。心脏(xīnzàng)解剖第十一页，共八十页。心脏(xīnzàng)解剖第十二页，共八十页。心脏(xīnzàng)解剖第十三页，共八十页。心脏(xīnzàng)解剖第十四页，共八十页。心脏(xīnzàng)解剖第十五页，共八十页。心脏(xīnzàng)解剖第十六页，共八十页。心脏(xīnzàng)解剖第十七页，共八十页。心脏传导(chuándǎo)系统第十八页，共八十页。心脏(xīnzàng)传导系统第十九页，共八十页。心脏传导(chuándǎo)系统第二十页，共八十页。心脏(xīnzàng)传导系统第二十一页，共八十页。心脏(xīnzàng)X线解剖第二十二页，共八十页。心脏(xīnzàng)X线解剖第二十三页，共八十页。心脏(xīnzàng)X线解剖第二十四页，共八十页。心脏(xīnzàng)X线解剖第二十五页，共八十页。心脏电生理(shēnglǐ)的历史第二十六页，共八十页。心脏电生理(shēnglǐ)的历史YoucanpickupafeatherafterrubbingamberwithwoolwhichwereobservedeveninancientGreece第二十七页，共八十页。心脏电生理(shēnglǐ)的历史公元前300年：亚里士多德发现电鳗(diànmán)的“震击”效应第二十八页，共八十页。心脏电生理(shēnglǐ)的历史WilliamGilbert(1544-1603)

performedimportantearlystudiesofelectricityandmagnetism.InDeMagnete(1600),hewasthefirsttodescribetheearth'smagneticfieldandtopostulatetherelationshipbetweenelectricityandmagnetism.Heintroducedthetermelectricityintoscientificdiscourse.第二十九页，共八十页。心脏电生理(shēnglǐ)的历史LuigiGalvani,1737-1798Italianphysicistandanatomistandwasoneofthefirsttoinvestigateexperimentallythephenomenonofwhatcametobenamed"bioelectrogenesis".

第三十页，共八十页。心脏(xīnzàng)电生理的历史1791:Galvanidiscoversthatelectricalstimulationofafrog'sheartleadstomuscularcontractionCarloMatteucci

第三十一页，共八十页。心脏(xīnzàng)电生理的历史第三十二页，共八十页。心脏电生理(shēnglǐ)的历史BritishphysiologistAugustusD.WallerofStMary'sMedicalSchool,Londonpublishesthefirsthumanelectrocardiogram.ItisrecordedwithacapilliaryelectrometerfromThomasGoswell,atechnicianinthelaboratory.WallerAD.Ademonstrationonmanofelectromotivechangesaccompanyingtheheart'sbeat.JPhysiol(London)1887;8:229-234

第三十三页，共八十页。心脏(xīnzàng)电生理的历史第三十四页，共八十页。心脏电生理(shēnglǐ)的历史第三十五页，共八十页。心脏(xīnzàng)电生理的历史第三十六页，共八十页。心脏(xīnzàng)电生理的历史Einthoven1893年提出了心电图‘Electrocardiogram’的命名,建立肢体导联发现(fāxiàn)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(yánjiū)了多种心脏疾病的心电图1924年荣获了诺贝尔医学奖FatherofElectro-cardiography第三十七页，共八十页。ECGElectrodes1901LeadILeadIIECGSet第三十八页，共八十页。心脏电生理(shēnglǐ)的历史FirstDocumentationofVentricularFibrillation

In1849:Hoffa,inLudwig'slaboratory,documentedbizarreunregulatedactionsoftheventricleswhenexposeddirectlytostrongfaradicorconstantcurrents第三十九页，共八十页。心脏电生理(shēnglǐ)的历史1900-1919S.Tawara’scontributiontoelucidationofconductionsystemofthemammalianheart

第四十页，共八十页。心脏(xīnzàng)电生理的历史In1929inasmallhospitalinEberswaldGermanyWernerForssmann,ayoungsurgicalresident,anesthetizedhisownelbow,insertedacatheterinhisantecubitalveinand,catheterdanglingfromhisarm,proceededtoabasementx-rayroomwherehedocumentedthecatheter'spositioninhisrightatrium?provingthatacathetercouldbeinsertedsafelyintoahumanheart.第四十一页，共八十页。心脏电生理(shēnglǐ)的历史

The1930s

Bundle-BranchBlockwithShortP-RtypeIntervalinHealthyYoungPeoplePronetoParoxysmalTachycardia

第四十二页，共八十页。心脏(xīnzàng)电生理的历史TheVentricularVulnerablePeriod

In1940WiggersandWegriaestablishedbeyonddoubttheexistenceoftheventricularvulnerableperiodbyelegantexperimentsthatconfirmedpreviouslessstrikingobservations.第四十三页，共八十页。心脏电生理(shēnglǐ)的历史TreatmentofUnexpectedCardiacArrestbyExternalElectricStimulationoftheHeart

第四十四页，共八十页。心脏电生理(shēnglǐ)的历史OnJuly16,1958thetransvenouscatheterelectrodewasintroduced,withfluoroscopy,viathebasilicveinintotherightventricularoutflowtract,inapatientwithfixedcompleteheartblock第四十五页，共八十页。心脏电生理(shēnglǐ)的历史1970s电生理检查和治疗真正(zhēnzhèng)起步的年代VentricularFibrillation:APossibleMechanismofSuddenDeathinPatientswithWPWSyndrome

第四十六页，共八十页。心脏(xīnzàng)电生理的历史HisbundleactivityduringthespontaneousandstimulatedonsetofSVTInitiationandTerminationofVentricularTachycardia第四十七页，共八十页。心脏(xīnzàng)电生理的历史OverdrivepacingintheWPWsyndromeEpicardialMappinginVentricularTachycardia第四十八页，共八十页。心脏(xīnzàng)电生理的历史1980s:电生理(shēnglǐ)检查和治疗发展的年代CatheterAblationoftheA-VJunctionbyDCEnergyinManofopenheart第四十九页，共八十页。心脏(xīnzàng)电生理的历史CatheterInducedAblationoftheA-VJunctioninManin1981atMoffittHospital第五十页，共八十页。心脏电生理(shēnglǐ)的历史1990s:心脏电生理检查和治疗走向辉煌(huīhuáng)和成熟TransvenousImplantableDefibrillator第五十一页，共八十页。心脏电生理(shēnglǐ)的历史导管(dǎoguǎn)射频消融（RFCA)第五十二页，共八十页。ELECTROPHYSIOLOGY:CARDIACCELLS2TypesofCells:Electrical&MyocardialElectricalCells

impulseformation&conductionECdistributedevenlyalongtheconductionsystemoftheheart.TheypossessTHREEspecificproperties.*Automaticity-

abilitytoinitiateanimpulsespontaneously&continuously*Excitability–

abilitytobeelectricallystimulated

*Conductivity-abilitytotransmitanimpulsefromonecelltoanotherinanorderlymanner*MyocardialCells

formthinmuscularlayerofatrialwall&thethickerwalloftheventricle.Contractility–abilityofcelltoshorten&lengthenitsmusclefibers[respondmechanicallytoanimpulse]Extensibility-celltostretch第五十三页，共八十页。DEPOLARIZATION&REPOLARIZATIONCardiacActionPotential第五十四页，共八十页。第五十五页，共八十页。IonChannelDiffusion第五十六页，共八十页。心肌细胞的动作电位静息(jìnɡxī)电位K＋平衡电位Nernst方程计算Em=61.5×1og(Co/Ci)Em=61.5×1og(4/140)=-90毫伏第五十七页，共八十页。“0”相外来刺激Na+渗入(shènrù)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第五十八页，共八十页。“0”相-55mV时，慢钠通道开放(kāifàng)，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第五十九页，共八十页。“1”相快Na+通道失活Cl-快速(kuàisù)内流-10mV氯通道失活形成R波降支心肌细胞的动作电位第六十页，共八十页。“2”相Ca++内流和K+外渗抵消(dǐxiāo)，形成平台相当于ST段“1”、“2”相交界点相当于J点心肌细胞的动作电位第六十一页，共八十页。“3”相-55mV，慢钙通道关闭K+快速(kuàisù)外流相当于T波最大舒张电位时快K+外流停止U波心肌细胞的动作电