1、心臟電生理檢查和射頻消融治療快速心律失常-1長海醫院心內科曹 江Cardiac Electrophysiology Cellular Cardiac Electrophysiology Experimental Cardiac Electrophysiology Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology is a field within cardiology involves complicated technical pro

2、cedures to evaluate heart rhythms And provide appropriate treatment for rhythm disturbances Cardiac Electrophysiology Study EPS of the heart is a non-surgical analysis of the electrical conduction system (normal or abnormal) of the heart. involves placing cardiac electrode catheters within or near t

3、he heart to determine the characteristics of heart rhythm or arrhythmia EP studies may be helpful in: to diagnose the source of symptoms to evaluate the risk of future cardiac events to evaluate the effectiveness of medication in controlling an arrhythmia to evaluate the need for a permanent pacemak

4、er, an implantable cardioverter-defibrillator, or radiofrequency catheter ablation as a treatment for arrhythmia. Radiofrequency Catheter ablationRFCAA catheter procedure that uses electrical current to generate heat to destroy the fast irregular heartbeats心臟功能心臟功能心臟解剖心臟解剖心臟解剖心臟解剖心臟解剖心臟解剖心臟解剖心臟解剖心臟傳

5、導系統心臟傳導系統心臟傳導系統心臟傳導系統心臟X線解剖心臟X線解剖心臟X線解剖心臟X線解剖心臟電生理的歷史心臟電生理的歷史You can pick up a feather after rubbing amber with wool which were observed even in ancient Greece心臟電生理的歷史公元前300年：亞里士多德發現電鰻的“震擊”效應心臟電生理的歷史William Gilbert (1544-1603) performed important early studies of electricity and magnetism. In De Mag

6、nete (1600), he was the first to describe the earths magnetic field and to postulate the relationship between electricity and magnetism. He introduced the term electricity into scientific discourse. 心臟電生理的歷史Luigi Galvani, 1737-1798 Italian physicist and anatomist and was one of the first to investig

7、ate experimentally the phenomenon of what came to be named bioelectrogenesis. 心臟電生理的歷史1791:Galvani discovers that electrical stimulation of a frogs heart leads to muscular contractionCarlo Matteucci 心臟電生理的歷史心臟電生理的歷史British physiologist Augustus D. Waller of St Marys Medical School, London publishes

8、the first human electrocardiogram. It is recorded with a capilliary electrometer from Thomas Goswell, a technician in the laboratory. Waller AD. A demonstration on man of electromotive changes accompanying the hearts beat. J Physiol (London) 1887;8:229-234 心臟電生理的歷史心臟電生理的歷史心臟電生理的歷史心臟電生理的歷史Einthoven 1

9、893年提出了心電圖 Electrocardiogram的命名, 建立肢體導聯發現心電圖包括P, Q, R, S和 T波1903年研制成功弦線式心電圖機研究了多種心臟疾病的心電圖1924年榮獲了諾貝爾醫學獎Father of Electro-cardiographyECG Electrodes 1901Lead ILead IIECG Set心臟電生理的歷史First Documentation of Ventricular Fibrillation In 1849: Hoffa, in Ludwigs laboratory, documented bizarre unregulated ac

10、tions of the ventricles when exposed directly to strong faradic or constant currents 心臟電生理的歷史1900-1919S. Tawaras contribution to elucidation of conduction system of the mammalian heart 心臟電生理的歷史In 1929 in a small hospital in Eberswald Germany Werner Forssmann, a young surgical resident, anesthetized

11、his own elbow, inserted a catheter in his antecubital vein and, catheter dangling from his arm, proceeded to a basement x-ray room where he documented the catheters position in his right atrium ?proving that a catheter could be inserted safely into a human heart. 心臟電生理的歷史 The 1930s Bundle-Branch Blo

12、ck with Short P-R type Interval in Healthy Young People Prone to Paroxysmal Tachycardia 心臟電生理的歷史The Ventricular Vulnerable Period In 1940 Wiggers and Wegria established beyond doubt the existence of the ventricular vulnerable period by elegant experiments that confirmed previous less striking observ

13、ations. 心臟電生理的歷史Treatment of Unexpected Cardiac Arrest by External Electric Stimulation of the Heart 心臟電生理的歷史On July 16, 1958 the transvenous catheter electrode was introduced, with fluoroscopy, via the basilic vein into the right ventricular outflow tract, in a patient with fixed complete heart blo

14、ck 心臟電生理的歷史1970s 電生理檢查和治療真正起步的年代Ventricular Fibrillation: A Possible Mechanism of Sudden Death in Patients with WPW Syndrome 心臟電生理的歷史His bundle activity during the spontaneous and stimulated onset of SVT Initiation and Termination of Ventricular Tachycardia 心臟電生理的歷史Overdrive pacing in the WPW syndro

15、me Epicardial Mapping in Ventricular Tachycardia 心臟電生理的歷史1980s: 電生理檢查和治療發展的年代 Catheter Ablation of the A-V Junction by DC Energy in Man of open heart心臟電生理的歷史Catheter Induced Ablation of the A-V Junction in Man in 1981 at Moffitt Hospital 心臟電生理的歷史1990s: 心臟電生理檢查和治療走向輝煌和成熟Transvenous Implantable Defibr

16、illator 心臟電生理的歷史導管射頻消融（RFCA)ELECTROPHYSIOLOGY: CARDIAC CELLS2 Types of Cells: Electrical & Myocardial Electrical Cells impulse formation & conductionEC distributed evenly along the conduction system of the heart. They possess THREE specific properties.*Automaticity- ability to initiate an impulse sp

17、ontaneously & continuously*Excitability ability to be electrically stimulated *Conductivity-ability to transmit an impulse from one cell to another in an orderly manner * Myocardial Cells form thin muscular layer of atrial wall & the thicker wall of the ventricle.Contractility ability of cell to sho

18、rten & lengthen its muscle fibers respond mechanically to an impulseExtensibility- cell to stretchDEPOLARIZATION & REPOLARIZATIONCardiac Action PotentialIon Channel Diffusion心肌細胞的動作電位靜息電位 K平衡電位Nernst方程計算 Em=61.51og(Co/Ci)Em=61.51og(4/140) =-90毫伏“0”相 外來刺激Na+滲入細胞閾電位(-60mV)除極作用形成R波升支心肌細胞的動作電位“0”相 -55mV時，慢鈉通道開放，Ca+緩慢內流-10mV氯通道開放，Cl-內流形成R波升支心肌細胞的動作電位“1”相 快Na+通道失活Cl-快速內流-10mV氯通道失活形成R波降支心肌細胞的動作電位“2”相 Ca+內流和K+外滲抵消，形成平臺相當于ST段“1”、“2”相交界點相當于J點心肌細胞