1、Electrophysiology電生理知識Training培訓(xùn)9/23/20221Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions培訓(xùn)內(nèi)容The anatomy of the heart 心臟解剖結(jié)構(gòu)The electrical conduction system 電傳導(dǎo)途徑The EP procedure 電生理手術(shù)過程The EP catheter 電生理導(dǎo)管簡介The Biosense Webster product portfolio BW產(chǎn)品綜述9/23

2、/20222Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions電生理培訓(xùn)（一）心臟解剖結(jié)構(gòu)、電傳導(dǎo)路徑導(dǎo)管定位9/23/20223Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsA n a t o m y o ft h e H e a r tA r r h y t h m i a s 位置 大小 心臟9/23/20224Biosense W

3、ebster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions左室冠狀竇右室左房右房左下肺靜脈左上肺靜脈左上肺靜脈左下肺靜脈左室上腔靜脈主動脈弓下腔靜脈9/23/20225Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions卵圓窩房間隔主動脈界嵴9/23/20227Biosense Webster EP Training 2003 Part Anatomy, Conducti

4、on System, and Catheter Positions三尖瓣肺動脈室間隔9/23/20228Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions循環(huán)系統(tǒng)9/23/202210Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsRight coronary artery 右冠posterior descending artery 后降支

5、Left coronary artery 左冠LAD 前降支Circumflex and its marginal 回旋支CORONARY CIRCULATION冠狀動脈循環(huán)系統(tǒng)ARTERIAL SUPPLY 動脈血供9/23/202211Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions右冠左冠回旋支左心耳前降支9/23/202212Biosense Webster EP Training 2003 Part Anatomy, Conduction System,

6、and Catheter Positions9/23/202214Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions心臟解剖結(jié)構(gòu)右房右室左房左室冠狀竇右室心尖心尖高位右房升主動脈右室流出道上腔靜脈下腔靜脈三尖瓣環(huán)9/23/202215Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsAV心臟的電傳導(dǎo)系統(tǒng)CSSA 纖維瓣環(huán)RVLVRALATVM

7、V9/23/202217Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsA n a t o m y o ft h e H e a r tA r r h y t h m i a sBIOSENSE WEBSTER TRAINING9/23/202218Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions心肌細(xì)胞的電活動周期9/23/202219

8、Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions體表心電圖PQRSTSimplified ECG9/23/202220Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsA n a t o m y o ft h e H e a r tA r r h y t h m i a sBWT Apr029/23/202221Biosense Webst

9、er EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsP wave - Atrial Depolarisation QRSPR intervalST segment T wavePR Interval QRSST SegmentPT9/23/202222Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsPP wave - Atrial DepolarisationQRS -

10、 Ventricular DepolarisationPR intervalST segmentT wavePR Interval QRSST SegmentT9/23/202224Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions9/23/202225Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions9/23/202227Biosense

11、Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsPP wave - Atrial DepolarisationQRS - Ventricular Depolarisation PR interval - time taken for the impulse to be conducted from the SA node to the PurkinjieST segment - Beginning of Ventricular RepolarisationT wavePR Inter

12、val QRSST SegmentT9/23/202228Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsPP wave - Atrial DepolarisationQRS - Ventricular Depolarisation PR interval - time taken for the impulse to be conducted from the SA node to the PurkinjieST segment - Beginning of Ve

13、ntricular RepolarisationT wave - Ventricular Repolarisation (Recovery)PR Interval QRSST SegmentT9/23/202229Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsRepolarization or Recovery9/23/202230Biosense Webster EP Training 2003 Part Anatomy, Conduction System,

14、and Catheter Positions心電傳導(dǎo)路徑如何測量這些時間距離 (PA, AH, HV)?靠近相應(yīng)這些位置獲得其心內(nèi)心電信號，并同其他部位的信號相比較。Standard values希氏束房室節(jié)竇房節(jié) ECG9/23/202231Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions如何到達(dá)這些傳導(dǎo)位置?利用電生理標(biāo)測導(dǎo)管:最早激動位置: 竇房結(jié) HRA希氏束電位： 希氏束 HBE最晚電位： 心室心尖 RVA左房電位/左室電位 冠狀竇 CS9/23/2022

15、32Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions常規(guī)電生理標(biāo)測過程RAOLAOPA右室心尖電極冠狀竇電極希氏束電極高位右房電極9/23/202233Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter PositionsX光透視圖（右前斜位）RAO9/23/202234Biosense Webster EP Training 2003 Part Anatom

16、y, Conduction System, and Catheter PositionsLAOX光透視圖（左前斜位）9/23/202235Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions典型心內(nèi)心電圖記錄Surface ECGHRAHBECSRVA9/23/202236Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions 導(dǎo)管放置9/23/202237Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter Positions“A”波“H”波“V”波9/23/202238Biosense Webster EP Training 2003 Part Anatomy, Conduction System, and Catheter