电生理-心脏生理解剖结构和传导路径.ppt

1、7/6/2018,Slide 1,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,Electrophysiology电生理知识,Training培训,7/6/2018,Slide 2,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,培训内容,The anatomy of the heart 心脏解剖结构The electrical c

2、onduction system 电传导途径The EP procedure 电生理手术过程The EP catheter 电生理导管简介The Biosense Webster product portfolio BW产品综述,7/6/2018,Slide 3,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,电生理培训（一）,心脏解剖结构、电传导路径导管定位,7/6/2018,Slide 4,Biosense Webster EP Training 2003 P

3、art Anatomy, Conduction System, and Catheter Positions,A n a t o m y o ft h e H e a r t,A r r h y t h m i a s, 位置, 大小,心脏,7/6/2018,Slide 5,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,左室,冠状窦,右室,左房,右房,左下肺静脉,左上肺静脉,左上肺静脉,左下肺静脉,左室上腔静脉,主动脉弓,下腔静脉,7/6/2018,Slide

4、6,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,7/6/2018,Slide 7,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,卵圆窝,房间隔,主动脉,界嵴,7/6/2018,Slide 8,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, an

5、d Catheter Positions,三尖瓣,肺动脉,室间隔,7/6/2018,Slide 9,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,二尖瓣,7/6/2018,Slide 10,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,循环系统,7/6/2018,Slide 11,Biosense Webster EP Train

6、ing 2003 Part Anatomy, Conduction System, and Catheter Positions,Right coronary artery 右冠posterior descending artery 后降支Left coronary artery 左冠LAD 前降支Circumflex and its marginal 回旋支,CORONARY CIRCULATION冠状动脉循环系统,ARTERIAL SUPPLY 动脉血供,7/6/2018,Slide 12,Biosense Webster EP Training 2003 Part Anatomy, Co

7、nduction System, and Catheter Positions,右冠,左冠,回旋支,左心耳,前降支,7/6/2018,Slide 13,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,7/6/2018,Slide 14,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,7/6/2018,Slide 15,Biosense

8、 Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,心脏解剖结构,三尖瓣环,7/6/2018,Slide 16,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,心脏传导系统,希氏束,蒲氏纤维,窦房节,房室节,7/6/2018,Slide 17,Biosense Webster EP Training 2003 Part Anatomy, Conducti

9、on System, and Catheter Positions,AV,心脏的电传导系统,CS,7/6/2018,Slide 18,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,A n a t o m y o ft h e H e a r t,A r r h y t h m i a s,BIOSENSE WEBSTER TRAINING,7/6/2018,Slide 19,Biosense Webster EP Training 2003 Part Anato

10、my, Conduction System, and Catheter Positions,心肌细胞的电活动周期,7/6/2018,Slide 20,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,体表心电图,P,Q,R,S,T,Simplified ECG,7/6/2018,Slide 21,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positi

11、ons,A n a t o m y o ft h e H e a r t,A r r h y t h m i a s,BWT Apr02,7/6/2018,Slide 22,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,P wave - Atrial Depolarisation QRSPR intervalST segment T wave,T,7/6/2018,Slide 23,Biosen

12、se Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,7/6/2018,Slide 24,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,P,P wave - Atrial DepolarisationQRS - Ve

13、ntricular DepolarisationPR intervalST segmentT wave,T,7/6/2018,Slide 25,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,7/6/2018,Slide 26,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positi

14、ons,BIOSENSE WEBSTER PRODUCT TRAINING,P,Q,P wave - Atrial DepolarisationQRS - Ventricular Depolarisation PR interval - time taken for the impulse to be conducted from the SA node to just before ventricular depolarizationST segmentT wave,T,7/6/2018,Slide 27,Biosense Webster EP Training 2003 Part Anat

15、omy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,7/6/2018,Slide 28,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,P,P wave - Atrial DepolarisationQRS - Ventricular Depolarisation PR interval

16、- time taken for the impulse to be conducted from the SA node to the PurkinjieST segment - Beginning of Ventricular RepolarisationT wave,T,7/6/2018,Slide 29,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,P,P wave - Atrial D

17、epolarisationQRS - Ventricular Depolarisation PR interval - time taken for the impulse to be conducted from the SA node to the PurkinjieST segment - Beginning of Ventricular RepolarisationT wave - Ventricular Repolarisation (Recovery),T,7/6/2018,Slide 30,Biosense Webster EP Training 2003 Part Anatom

18、y, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,Repolarization or Recovery,7/6/2018,Slide 31,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,心电传导路径,如何测量这些时间距离 (PA, AH, HV)?靠近相应这些位置获得其心内心电信号，并同其他部位的信号相比较。,7/6/2018,Slide 32,Biose

19、nse Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,如何到达这些传导位置?,利用电生理标测导管:最早激动位置: 窦房结 HRA希氏束电位： 希氏束 HBE最晚电位： 心室心尖 RVA左房电位/左室电位 冠状窦 CS,7/6/2018,Slide 33,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,常规电生理标测过程,RAO,LAO,PA,右室心尖

20、电极,冠状窦电极,希氏束电极,高位右房电极,7/6/2018,Slide 34,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,X光透视图（右前斜位）,RAO,7/6/2018,Slide 35,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,LAO,X光透视图（左前斜位）,7/6/2018,Slide 36,Biosense Web

21、ster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,典型心内心电图记录,Surface ECG,HRA,HBE,CS,RVA,7/6/2018,Slide 37,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,BIOSENSE WEBSTER PRODUCT TRAINING,导管放置,7/6/2018,Slide 38,Biosense Webster EP

22、Training 2003 Part Anatomy, Conduction System, and Catheter Positions,“A”波“H”波“V”波,BIOSENSE WEBSTER PRODUCT TRAINING,7/6/2018,Slide 39,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,体表 心电图高位右房希氏束冠状窦心尖,BIOSENSE WEBSTER PRODUCT TRAINING,7/6/2018,Slide 40,Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions,电生理检查 前传从高位右房起搏 逆传从右室心尖起搏,心内心电图前传测试,BIOSENSE WEBSTER PRODUCT TRAINING,