D1-心脏生理解剖结构和传导路径

4/8/2020Slide1BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsElectrophysiology电生理知识Training培训4/8/2020Slide2BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions培训内容•Theanatomyoftheheart心脏解剖结构•Theelectricalconductionsystem电传导途径•TheEPprocedure电生理手术过程•TheEPcatheter电生理导管简介•TheBiosenseWebsterproductportfolioBW产品综述4/8/2020Slide3BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions电生理培训（一）心脏解剖结构、电传导路径导管定位4/8/2020Slide4BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsAnatomyoftheHeartArrhythmias位置大小心脏4/8/2020Slide5BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions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4/8/2020Slide6BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide7BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions卵圆窝房间隔主动脉界嵴4/8/2020Slide8BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions三尖瓣肺动脉室间隔4/8/2020Slide9BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions二尖瓣4/8/2020Slide10BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions循环系统4/8/2020Slide11BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsRightcoronaryartery右冠posteriordescendingartery后降支Leftcoronaryartery左冠LAD前降支Circumflexanditsmarginal回旋支CORONARYCIRCULATION冠状动脉循环系统ARTERIALSUPPLY动脉血供4/8/2020Slide12BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions右冠左冠回旋支左心耳前降支4/8/2020Slide13BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide14BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide15BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions心脏解剖结构右房右室左房左室冠状窦右室心尖心尖高位右房升主动脉右室流出道上腔静脉下腔静脉三尖瓣环4/8/2020Slide16BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions心脏传导系统希氏束蒲氏纤维窦房节房室节4/8/2020Slide17BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsAV心脏的电传导系统CSSA纤维瓣环RVLVRALATVMV4/8/2020Slide18BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsAnatomyoftheHeartArrhythmias4/8/2020Slide19BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions心肌细胞的电活动周期4/8/2020Slide20BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions体表心电图PQRSTSimplifiedECG4/8/2020Slide21BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsAnatomyoftheHeartArrhythmiasBWTApr’024/8/2020Slide22BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsPwave-AtrialDepolarisationQRSPRintervalSTsegmentTwavePRIntervalQRSSTSegmentPT4/8/2020Slide23BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide24BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsPPwave-AtrialDepolarisationQRS-VentricularDepolarisationPRintervalSTsegmentTwavePRIntervalQRSSTSegmentT4/8/2020Slide25BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide26BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsPQPRIntervalRSSTSegmentPwave-AtrialDepolarisationQRS-VentricularDepolarisationPRinterval-timetakenfortheimpulsetobeconductedfromtheSAnodetojustbeforeventriculardepolarizationSTsegmentTwaveT4/8/2020Slide27BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions4/8/2020Slide28BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsPPwave-AtrialDepolarisationQRS-VentricularDepolarisationPRinterval-timetakenfortheimpulsetobeconductedfromtheSAnodetothePurkinjieSTsegment-BeginningofVentricularRepolarisationTwavePRIntervalQRSSTSegmentT4/8/2020Slide29BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsPPwave-AtrialDepolarisationQRS-VentricularDepolarisationPRinterval-timetakenfortheimpulsetobeconductedfromtheSAnodetothePurkinjieSTsegment-BeginningofVentricularRepolarisationTwave-VentricularRepolarisation(Recovery)PRIntervalQRSSTSegmentT4/8/2020Slide30BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsRepolarizationorRecovery4/8/2020Slide31BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions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。Standardvalues希氏束房室节窦房节ECG4/8/2020Slide32BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions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CS4/8/2020Slide33BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositions常规电生理标测过程RAOLAOPA右室心尖电极冠状窦电极希氏束电极高位右房电极4/8/2020Slide34BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsX光透视图（右前斜位）RAO4/8/2020Slide35BiosenseWebsterEPTraining2003PartAnatomy,ConductionSystem,andCatheterPositionsLAOX光透