CARTO临床应用-幻灯片.ppt

文档介绍：CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLYCarto 3 临床应用CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY?Carto 3平台可用于各类心律失常的标测 1. AVNRT 2. AVRT 3. 房扑 4. 房速 5. 房颤 6. VTCARTO 3 临床应用CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLYCARTO在旁道中的应用CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY右侧疑难旁道?右侧旁路的心房的插入点可能远离三尖瓣环。?使用CARTO系统可以准确地找到和消融这些不常见旁路Courtesy of Anzhen HospitalCARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY?标测房室交界/瓣环区域?标出旁道位置?记忆功能:当消融过程中导管移位或消融后旁道恢复,可轻松回到旁道部位?优势:较少爆光(儿童),减少消融次数右侧常见旁道Courtesy of Runrun Shao HospitalCARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY左侧旁道(逆行途径)Courtesy of Ningbo First Hospital?导管精确显示,直指靶点?体位互补,减少手术时间?较少爆光(儿童,孕妇),减少消融次数AVCARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY?将逆传A波最早的CS电极高亮,显示靶点?穿间隔,导管操作更方便,减少手术时间左侧旁道(穿房间隔) Courtesy of Dr. Calò at Casilino Hospital, Rome. CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY旁道(心室起搏下标测)-参数设置?机制: 大折返(但当作局灶标测)?关键部位: 二尖瓣环,三尖瓣环?标测方式: 心室起搏时,稳定模式下逐点激动标测或FAM+激动标测逆传A波?参考通道: 体表QRS波或起搏钉?标测通道:标注逆传A波MAP1-2电位的起始, 同时利用单极M1来验证?兴趣窗: 从起搏钉后10ms至QRS波后方(需包含所有逆传A波)?Point Viewer窗口的排列: 体表导联,多个CS通道,MAP 1-2, MAP 3-4和M1通道CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY旁道(心室起搏下标测)-手术流程?穿刺股静脉和锁骨下静脉,分别放置右心室电极、高右房电极、6极His束导管和冠状窦电极。?常规电生理检查,诱发心动过速,鉴别诊断明确为AVRT。?心室起搏时,利用NaviStar 4mm导管(右侧旁路)或Thermocool导管(左侧旁路)沿三尖瓣或二尖瓣环逐点激动标测或FAM同时激动标测逆传A波。?标测方法类似于局灶性房速,沿瓣环“热点追踪”最早逆传A波。?在最早逆传A波处,结合单极电位,放电消融,及时标记消融点。?消融后,心室起搏下,室房分离或室房沿房室结逆传,则手术成功。CARTO 3 TRAINING COURSEFOR PHYSICIAN TRAINING ONLY显性旁道(心房起搏下标测)-参数设置?机制: 大折返(但当作局灶标测)?关键部位: 二尖瓣环,三尖瓣环?标测方式: 心房起搏时,稳定模式下逐点激动标测或FAM+逐点激动标测最早V波?参考通道: 体表QRS波或起搏钉?标测通道:标注前传V波MAP1-2电位的起始, 同时利用单极M1来验证?兴趣窗: 从起搏钉后10ms至QRS波结束。?Point Viewer窗口的排列: 体表导联,多个CS通道,MAP 1-2, MAP 3-4和M1通道