avrt房室折返型心动过速

房室折返型心动过速

AVRT学习目标定义“旁道”解释旁道的机制描述WPW的心电图特征描述旁道的标测与消融讲述在旁道电生理检查导管的选择讲述如何验证旁道消融是否成功房室折返型心动过速的简介AVRT介绍另一种折返类型，阵发型室上速,

(占室上速35-40%,占总人口的0.1-0.3%)心电图窦性心电图中Discrete

P波能够诊断部分病例症状心悸,头昏眼花,忧心男性患者更多，与女性患者比例是,更多是年轻时候发病适当的早搏房室折返型心动过速的机制房室折返型心动过速!AVNRALARVAPLV房室折返型心动过速的机制心室与心房之间有两条通路:房室结(正常)旁道(异常)旁道心房与心室除正常传导系统外心内膜组织有额外的肌束房室交接处发育异常，可以出现在瓣环任意一点没有递减传导,比房室结传导速度更快Kent

Bundle,

Bypass

Tract两种类型旁道显性/WPW可以顺向传导（心房到心

室），也可以逆向传导（心室到心房）异常的心电图基线预激程度不同伴房颤高危险性隐匿性只有逆向传导（心室到心房）正常的心电图基线没有预激房颤不会并发WPW:

Wolff-Parkinson-White

Preexcitation

Syndrome旁道部位旁道能够出现在任何位置，二尖瓣，三尖瓣环的后壁和侧壁.右侧游离壁左侧游离壁后间隔前间隔窦率下显性旁道（WPW）心电图–PR间期<120

ms–正常P波向量后面出现delta波(预激)–QRS波持续>100

msWPW综合征:12-导联心电图预激这个病例,左侧预激后伴随着一个正常的激动，通过右束支，产生融合波房室折返型心动过速:WPW:心动过速的发生一个房性早搏能触发 旁道阻滞后仍可以通过房室结传导通过旁道逆向传导 逆向传导形成在下壁导联可见倒置P波房室折返型心动过速机制AccessorypathwayAAVNVHAP©

Biosense

Webster,

Inc.2008房室折返型心动过速:12-导联心电图WPW:房颤伴预激发作快速心室率Patients

with

WPW

are

at

risk

of

sudden

cardiac

death

due

to

atrialarrhythmias,

such

as

atrial

flutter

and

atrial

fibrillation

that

conduct

rapidlyover

the

accessory

pathway,

and

elicit

extremely

rapid

ventricular

rates.

Asthis

continuous

tracing

shows,

it

can

degrade

into

ventricular

fibrillation.WPW:房颤伴预激发作快速心室率WPW患者伴有房扑，房颤有非常高的心脏猝死几率，因为通过旁道快速心房激动传导到心室激动，形成快速的心室率房室折返型心动过速的诊断房室折返型心动过速的诊断心电图窦律(WPW)房室折返型心动过速发作旁道的诊断心室-心房逆向传导:没有递减传导,His束不早房室折返型心动过速诱发AVRT诊断窦律下心电图短PR间期<0.12s正常P波向量(排除交界心律)Delta波宽QRS>

100msI

+

andAVF

-AVFII,III,+旁道定位Thefirst

25

ms

of

the

manifest(Pre-excited)

QRScomplexAVRT诊断:心动过速下心电图The

P

wave

produced

by

retrograde

conduction

during

AV

reentrytachycardia

is

inverted

in

the

inferior

ECG

leads,

since

atrialdepolarization

begins

in

the

lower

rightatrium

andproceedssuperiorly

and

leftward. Rapid

retrograde

conduction

over

theaccessory

pathway

results

in

a

short

R-P

interval,

usually

less

thanone-half

of

the

R-R

interval.AVRT诊断:窦率&心室起搏窦率心室起搏AVRT诱发AVRT诊断:发作时AVRT:房波或者心室起搏终止房室折返型心动过速的治疗AVRT的治疗房室折返型心动过速治疗可以使用Beta受体阻滞剂或者Ca离子拮抗剂(5药物治疗可以导致疲劳和心动过缓另一个选择是射频导管消融治疗(>90%有效率)–治疗后不需要其他长期治疗AVRT导管消融旁道射频消融旁道针对患者显 性预激患者，伴有突然死 亡的风险射频消融后预激delta波 消失.AVRT导管消融治疗左侧旁道逆向导管消融RAO右侧旁道导管消融AVRT旁道定位Precise

location

of

the

accessory

pathway

is

determined

by

therovecatheter. Retrograde

conduction

over

the

AP

is

seen

as

a

small

spikebetween

theV

and

A

waves. These

"Kent

potentials"

are

so

namedbecause

ofthe

original

denomination

ofaccessory

pathways

as"Kentbundles,"

after

the

investigator

Stanley

Kent,

who

first

proposed

theexistence

of

accessory

AV

connections.AVRT导管消融Radio

frequency

ablation

of

the

accessory

pathway

is

oftenindicated

in

patients

with

WPW

who

are

at

risk

ofsuddendeath

due

to

atrial

fibrillation

with

a

rapid

ventricularresponse

via

the

bypass

tract.Note

the

disappearance

of

the

preexcitation

delta

wave

inthe

QRS

with

catheter

ablation.Pre-Post

V-AConduction房室折返型心动过速:导管消融AVRT导管消融CARTOENSITE

NAVXAVRT导管消融HRA:HIS:CS:RVA:Ablation

Catheter:Others房室折返型心动过速消融验证AVRT