Presentatie B.G.F. Springorum, Elektrofysiologie inleiding

Anatomie van
het hart
Gericht op
Positie van het hart

Right Lateral view
Infero posterior view

Anterior View
Posterior View
Cardiac Anatomy
SVC
SA node
Terminal
Crest
LV
RA
Fossa
AV node
Coronary
Sinus
IVC
RV
Anatomy
Cardiac conduction system
A Practical Guide to ECG Interpretation
Ken Grauer, M.D. Ch 7 Pg. 98
Right Atrium
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Atrium
SA Node
region

The SA node is generally located in the high RA, posterior to the crista
terminalis.
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Atrium
AV Node
region

The Atrio-Ventricular (AV) node is the only normal electrical
connection between the upper and lower chambers of the heart.
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Atrium
Fossa Ovalis

The fossa ovalis is a thin layer of tissue that forms shortly after birth that
can provide access to the left atrium using special instruments.
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Atrium
Coronary Sinus
Ostium

The coronary sinus ostium (cs os) provides access to the base of the left
atrium and ventricle without requiring an arterial puncture.
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Atrium&Triangle of Koch
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Right Ventricle
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
Left Heart
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
LAO




LAO projection
Aortic valve
Mitral valve
Tricuspid valve
SVC
Klepvlak
RA
RV
IVC
Anterior
TV
Klepvlak
MV
CS
Posterior
Klepvlak
Prevalentie
SVT’s
Boezemfibriller 0.7-18% (55-85+
en
jaar)
Boezemflutter
0.05%-0.6% (<50
- 80+ jaar)
AVNRT
0.2%
AVRT
0.1-0.3%
Uiteindelijke diagnose
bij regulaire SVT
verwezen voor ablatie
AVNRT
50%
AVRT
40%
AT
10%
Success Rates for RF Ablations
Type of Arrhythmia
WPW or SVT (concealed bypass tract)
Success Rate (%)
85-95
AV Node Reentry
95+
Atrial Fibrillation
95+
Typical Atrial Flutter
80-90
Atrial Tachycardia
70-80
Ventricular Tachycardia
(Normal Heart)
90
95
Ventricular Tachycardia
(Structural Heart Disease)
60
Adapted from Gallik DM. Radio-frequency
Catheter Ablation for the Treatment of Cardiac
Arrhythmias. Cardiology Special Edition. 1997;59-61.
28
RF Ablation Complications
Complication
Death
Prevalence (%)
0.1
Non-fatal complications:
Tamponade
0.5
AV block
0.5
Pericarditis
0.1
Femoral artery complications:
Thrombolic occlusion
0.2
Hematoma
0.2
AV fistula
0.1
ACC/AHA Circ. 1995;92:673-691.
Morady F. N Engl J Med. 1999;340:534-544.
29
A - Flutter
Atrium fibrillatie
Structure and Mechanisms of AF
Transseptale punktie
AO
Esophagus
AVNRT
Substraat bij common type
Dual AV nodal pathways:
Up p e r c o m m o n
p a th w a y
Fast pathway:
Slow pathway:
trage geleiding
S lo w
p a th w a y
Fa st
p a th w a y
snelle geleiding
traag herstel
snel herstel
Lo w e r c o m m o n
p a th w a y
Trigger:
bijv. boezemextrasystole:
Anatomy of the Human
Atrioventricular Node
51
Right Atrium&Triangle of Koch
Netter, F. Clinical Symposia. Novartis Pharmaceuticals Corporation, Summit, NJ, 1997.
AVRT
Bedankt voor de aandacht

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