醫(yī)藥衛(wèi)生]室上性心動(dòng)過速(已修改)
2025-01-16 08:12 本頁面
【正文】 一、適應(yīng)證 房性心律失常 1)房顫和房撲復(fù)律時(shí)首選（ I， A） 2)直流電復(fù)律強(qiáng)化藥物治療（ IIa） 3)圍外科手術(shù)期的房顫復(fù)律（ IIa） 4)房顫 +WPW（無血流動(dòng)力學(xué)異常）（ I， C） 伊布利特的臨床應(yīng)用 二、禁忌證 1. 急性心肌梗死或不穩(wěn)定心絞痛 2. 嚴(yán)重充血性心力衰竭 3. 心室率 ＜ 55次 /分 4. 二度、三度房室阻滯 5. 低鉀血癥 6. 有尖端扭轉(zhuǎn)型室速發(fā)作史 7. QTc≥440ms 8. 嚴(yán)重肝腎功能損害 伊布利特的臨床應(yīng)用 AVRT: WPW: Initiation of AVRT ? Supraventricular tachycardia – can be initiated by a closely coupled premature atrial plex (PAC) – blocks in the accessory pathway – but conducts through the AV node – retrograde conduction via accessory pathway – inverted P wave produced by retrograde conduction visible in the inferior ECG leads AVRT: WPW: 12Lead ECG ? The P wave produced by retrograde conduction during AV reentry tachycardia is inverted in the inferior ECG leads, since atrial depolarization begins in the lower right atrium and proceeds superiorly and leftward. Rapid retrograde conduction over the accessory pathway results in a short RP interval, usually less than onehalf of the RR interval. AVRT: Catheter Ablation Of Accessory Pathway ? Radio frequency ablation of the accessory pathway is often indicated in patients with WPW who are at risk of sudden death due to atrial fibrillation with a rapid ventricular response via the bypass tract. ? Note the disappearance of the preexcitation delta wave in the QRS with catheter ablation. AVRT: Catheter Ablation Of Accessory Pathway ? Radio frequency ablation of the accessory pathway is often indicated in patients with WPW who are at risk of sudden death due to atrial fibrillation with a rapid ventricular response via the bypass tract. ? Note the disappearance of the preexcitation delta wave in the QRS with catheter ablation. ?AVRT ? 典型旁道了房室結(jié)為連接心房和心室肌的通道。 ? 旁道的分類是基于沿著二尖瓣和三尖瓣的部位不同而定。 ? 旁道通常顯示為快的、非遞減傳導(dǎo)，約 8%旁道可顯示遞減的前向或逆向傳導(dǎo)。 ? 當(dāng)同時(shí)有預(yù)激圖形和快速心律失常時(shí)，則可診斷為預(yù)激。 ? 以房室結(jié)的傳導(dǎo)方向分為前向和逆向 AVRT。 ? 預(yù)激伴房顫是一種潛在危及患者生命的心律失常，約 1/3預(yù)激患者合并房顫。 ? 預(yù)激患者的猝死和危險(xiǎn)分層 在 3~10年的隨診中，預(yù)激患者的心性猝死發(fā)生率為 %~%，心臟驟停為預(yù)激首發(fā)癥狀的并不多見；然而，在預(yù)激中約有一半猝死為首發(fā)表現(xiàn)，預(yù)激并房顫的患者發(fā)生心性猝死是由于過快的心室率，雖然預(yù)激患者猝死的年發(fā)生率并不高，但應(yīng)積極建議射頻消融治療。 ? AVRT急性期治療： ? 對寬 QRS波心動(dòng)過速患者的特殊處理：對逆向心動(dòng)過速患者，藥物治療是針對旁道或房室結(jié)，因?yàn)檫@兩條途徑都是心動(dòng)過速折返的組成部分。 ? 腺苷的應(yīng)用應(yīng)當(dāng)慎重，因?yàn)樗苷T發(fā)房顫伴快速心室率。 ? 依布利特、普魯卡因胺或氟卡尼能夠減慢旁道傳導(dǎo)，常被選中。 臨床狀況 治療建議 推薦類別 證據(jù)水平 顯性預(yù)激 ABC 心動(dòng)過速有癥狀 導(dǎo)管消融 Ⅰ B 心動(dòng)過速能耐受 氟卡尼、普羅帕酮 Ⅱa C 索他洛爾、胺碘酮 β受體阻滯劑 Ⅱa C 維拉帕米、地爾硫卓、地主辛 Ⅲ C 房顫快的房室 傳導(dǎo)、AVRT
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