杜乃立，心律失常讲课.pptVIP

Radiofrequency catheter ablation of tachyarrhythmias Indications 1,preexcitation syndrome with paroxysmal atrial fibrillation and rapid ventricular rate（预激综合征合并阵发性心房颤动和快速心室率） 2,AVRT,AVNRT,atrial tachycardia and no structural heart disease documented VT,or cardiomyopathy due to tachycardia or hemodynamic unstable（AVRT，AVNRT，房速和无器质性心脏病证据的室速（特发性室速）呈反复发作性，或合并有心动过速性心肌病，或血流动力学不稳定者） 3,frequent attack of typical atrial flutter which ventricular rate difficult to control（发作频繁、心室率不易控制的典型房扑） Radiofrequency catheter ablation of tachyarrhythmias 4,frequent attack of atypical atrial flutter which ventricular rate difficult to control（发作频繁心室率不易控制的非典型房扑） 5,发作频繁、症状明显的心房颤动 6,inappropriate sinus tachycardia with tachycardiac cardiomyopathy（不适当窦速合并心动过速心肌病） 7,frequent attack and/or severe symptoms with drug resistant VT after myocardial infarction（发作频繁和/或症状重、药物预防发作效果差的合并器质性心脏病的室速，多作为ICD 的不成治疗） Surgical treatment of tachycardias Cardiac aneurysm operation （室壁瘤手术） CABG（冠状动脉旁路移植术） surgical sympathetic interruption（外科交感神经切断术） 谢谢 THANKS * Intraventricular block RBBB（右束支阻滞）: 1)QRS波群增宽≥0.12s 2)V1-2呈rsR型，R波粗钝，V5-6呈qRS型，S波增宽） 3)T波方向与QRS主波方向相反 Intraventricular block LBBB（左束支阻滞） 1)QRS波群延长≥0.12s 2)V5-6导联R 波顶部有切迹或粗钝 3)V5-6导联T波与主波方向相反 Intraventricular block LAFB（左前分支阻滞） 1)I,AVL:qR,II,III,AVF:r S 2)QRS电轴左偏 –45 to –90 度 3)QRS﹤ 0.12s Intraventricular block LPFB（左后分支阻滞） 1)I,AVL:r S,II,III,AVF:q R 2) QRS 电轴右偏 +90 to +120 度 3) QRS ﹤ 0.12s General consideration regarding antiarrhythmic drugs Principle 1,initial attention to the treatment of underlying heart disease and the causes ,as well as the precipitating factors（首先注意基础心脏病的治疗以及病因和诱因的纠正） 2,attention to the indications of the antiarrhythmic drugs（注意抗心律失常药物的适应症） 3,attention to the side effects of the antiarrhythmic drugs（注意抗心律失常药物的不良反应） General consideration regarding antiarrhythmic drugs Drug classification（药物分类） According to the Vaugham Williams classification Class I:block the fast sodium channel（阻断快速钠通道） Class IA:reduce Vmax and prolong action pot