心脏电生理检查和射频消融.ppt

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 procedures 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 the 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 pacemaker,an implantable cardioverter-defibrillator,or radiofrequency catheter ablation as a treatment for arrhythmia.,Radiofrequency Catheter ablation,RFCAA 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 Magnete(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 investigate 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 contraction,Carlo 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 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 1893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-cardiography,ECG Electrodes 1901,Lead I,Lead II,ECG Set,心脏电生理的历史,First Documentation of Ventricular Fibrillation In 1849:Hoffa,in Ludwigs laboratory,documented bizarre unregulated actions 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 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 Block 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 observations.,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 block,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 syndrome,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 Defibrillator,心脏电生理的历史,导管射频消融（RFCA),ELECTROPHYSIOLOGY:CARDIAC CELLS,2 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 spontaneously&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 shorten&lengthen its muscle fibers respond mechanically to an impulseExtensibility-cell to stretch,DEPOLARIZATION&REPOLARIZATION,Cardiac Action Potential,Ion 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,心肌细胞的动作电位,“3”相-55mV，慢钙通道关闭K+快速外流相当于T波最大舒张电位时快K+外流停止U波,心肌细胞的动作电位,除极的“连锁反应”（传导性）,除极的“连锁反应”（传导性）,除极的“连锁反应”（传导性）,除极的“连锁反应”（传导性）,除极的“连锁反应”（传导性）,向量的概念：强度方向,心肌的电生理特性,兴奋性传导性自律性,不应期的电生理检查,PAC without V conduction,PVC with aberrant conduction,？,R(A)S2刺激法,S1S1法：分级递增,S1S2刺激法,SEE YOU ALL NEXT THURSDAY EVENING,Goodnight!,谢 谢,