房室折返性心动过速(AVRT)-基础知识介绍-孙洪昌-20190305

1FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.房室折返型心动过速AVRT2FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.房室折返型心动过速的简介3FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.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DiscreteP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4FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.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!5FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.AVNRAAPLARVLV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)6FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.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7FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.•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•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WPW:Wolff-Parkinson-WhitePreexcitationSyndrome两种类型旁道显性WPW隐匿性8FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.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（三维帮助大）•左侧游离壁（最常见）•后间隔•前间隔9FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.窦律下显性旁道（WPW）•心电图PR间期120ms正常P波向量后面出现delta波(预激)QRS波持续100ms10FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.WPW综合征:12-导联心电图预激11FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.房室折返型心动过速: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12FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.房室折返型心动过速机制AccessorypathwayAAVNVHAP©BiosenseWebster,Inc.200813FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.房室折返型心动过速:12-导联心电图14FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.WPW:房颤伴预激发作快速心室率15FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.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16FORINTERNALUSEONLY.NOTFORUSEWITHANYCUSTOMERSORFORDISTRIBUTION.PendingFDAclearance.Notavailableforsaleorcommercialuseinanymarket.ThankYou