心律失常文件材料教学稿件.pptVIP

Mechanism Responsible for AVNRT Pre-excitation syndrome Abnormal connection between the atrium and the ventricle Pre-excitation syndrome ECG Features Short PR interval Slurred upstroke of QRS complexes (the delta wave) broad QRS complexes Secondary ST-T abnormalities (reflecting modified ventricular repolarization secondary to abnormal depolariozation 11111 Mechanism Responsible for AVRT Pre-excitation Syndrome (WPW) Paroxysmal SVT:  Treatment Vagal maneuvers: Valsalva maneuver or carotid sinus massage First choice of drugs: adenosine 6-12 mg iv, or verapamil 5 mg iv Preferred choice of drugs: propafenone 70 mg iv; cedilanid 0.4-0.6 mg iv Synchronized DC cardioversion (shock delivery that is timed within the QRS complex Radiofrequency catheter ablation Radiofrequency Catheter Ablation Radiofrequency Catheter Ablation Premature Beats Atrial AV junctional Ventricular Clinical considerations ECG features Management strategies Normal AP Conduction in Ventricles Initiation site Normal conduction VPB conduction Ventricular Premature Beats Ventricular Premature Beats Ventricular Premature Beats Atrial Premature Beats Atrial Premature Beats Ventricular Tachycardia ECG: ≥3 VPBs in succession at a rate of 100-250 bpm; suggesting VT: ventricular captures, fusion complexes Clinical: coronary heart disease, AMI; dilated cardiomyopathy; signifying myocardial damage Treatment: drugs (lidocaine, amiodarone) DC cardioversion (synchronized) Ventricular Tachycardia ECG: ≥3 VPBs in succession at a rate of 100-250 bpm; Non-sustained VT (＜ 30 sec), sustained VT suggesting VT: ventricular captures, fusion complexes Ventricular Tachycardia A wide QRS tachycardia is VT until proven otherwise. Features suggesting VT include: evidence of AV dissociation independent P waves (shown by arrows here) capture or fusion beats