內(nèi)科學(xué)英文課件：Cardiac Arrhythmia

CardiacArrhythmiaCardiacArrhythmiaWhatisCardiacArrthythmia?DefinitionMechanismsClassificationWhatisCardiacArrthythmia?DeWhatisCardiacArrthythmia?Cardiacarrhythmiaisanabnormalityintheheart'srhythm,orheartbeatpattern.Theheartbeatcanbetooslow,toofast,haveextrabeats,skipabeat,orotherwisebeatirregularly.WhatisCardiacArrthythmia?CDefinitionofArrhythmiaTheOrigin,Rate,Rhythm,ConductvelocityandsequenceofheartactivationareabnormalDefinitionofArrhythmia內(nèi)科學(xué)英文課件：CardiacArrhythmiaMechanismsDisordersofimpulseFormationSinusnodearrest,prematurebeats,automaticrhythmsFORAbnormalitiesofimpulseconductionRe-entryTriggeredactivitySino-atrialexitblock,atrioventricularblock,establishingreentrycircuitprematurebeats,paroxysmalsupraventriculartachycardias,atrialflutterVentriculartachycardiaintheprolongedQTsyndromeandinsomeofdigitalistoxicityMostarrhythmiascanbeclassifiedasMechanismsDisordersofimpulseMechanismsDisordersofimpulseFormationAlteredautomaticityisthemechanismforsinusnodearrest,manyprematurebeats,andautomaticrhythmsaswellasinitiatingfactorinreentryarrhythmias.FORAbnormalitiesofimpulseconductionRe-entryTriggeredactivityMostarrhythmiascanbeclassifiedasMechanismsDisordersofimpulseClassification

Brady-arrhythmia:slowheartrates(lessthan60beatsperminute)Tachy-arrhythmia:

fastheartrates(morethan100beatsperminute)ClassificationBrady-arrhythmiDiagnosisClinicalmanifestationsHistory

Symptoms:canbelethal(suddencardiacdeath)symptomatic(chestdistress,palpitations,dizziness,fatigue,nearsyncope,syncopeandshock）asymptomaticSigns:slow,fastandirregularheartbeatsorpulses.DiagnosisClinicalmanifeClinicalmanifestationsStableSVTisgenerallywelltoleratedinpatientswithoutunderlyingheartdiseasebutmayleadtomyocardialischemiaorcongestiveheartfailureinpatientswithcoronarydisease,valvularabnormalities,andsystolicordiastolicmyocardialdysfunction.ClinicalmanifestationsStableClinicalmanifestationsVT,ifprolonged(lastingmorethan10-30seconds),oftenresultsinhemodynamiccompromiseandismorelikelytodeteriorateintoventricularfibrillation.ClinicalmanifestationsVT,ifClinicalmanifestationsWhetherslowheartratesproducessymptomsatrestoronexertiondependsuponwhethercerebralperfusioncanbemaintained,whichisgenerallyafunctionofwhetherthepatientisuprightorsupineandwhetherleftventricularfunctionisadequatetomaintainstrokevolume.ClinicalmanifestationsWhetheClinicalmanifestationsIftheheartrateabruptlyslow,aswiththeonsetofcompleteheartblockorsinusarrest,syncopeorconvulsionsmayresult.ClinicalmanifestationsIftheTechniquesforevaluatingrhythmdisturbancesElectrocardiographicmonitoringElectrophysiologictestingAutonomictesting(tilt-tabletesting)TechniquesforevaluatingrhytRoutineECGTheidealwayofestablishingacausalrelationshipbetweenasymptomandarhythmdisturbanceistodemonstratethepresenceoftherhythmduringthesymptom.Unfortunately,thisisnotalwayseasybecausesymptomsareusuallysporadic.RoutineECGTheidealwayofesContinuousECGmonitorPatientswithabortedsuddendeathandrecentorrecurrentsyncopeareoftenmonitoredinthehospital.ContinuousECGmonitorPatientsHolterWhenepisodesareinfrequent,useofaneventrecorderispreferableto24-hourcontinuousmonitoring.HolterWhenepisodesareinfreqHolterDevelopmentHolterDevelopmentHolterDevelopmentHolterDevelopmentArrhythmia

captureArrhythmiacaptureTelephoneECGtransmissionsystemTelephoneECGtransmissionsyExercise

testExercisetestingmaybehelpfulwhenthesymptomsareassociatedwithexertionorstress.ExercisetestExercisetestinTransesophagealleftatrialpacingandECGIfECGmonitoringcannotdetectcardiacarrhythmias,

Electrophysiologictestingmaybeusefulinevaluatingrhythmdisturbances.TransesophagealleftatrialpacIntra-cardiacelectrophysiologicalstudy(EPS)IfECGmonitoringcannotdetectcardiacarrhythmias,

Electrophysiologictestingmaybeusefulinevaluatingrhythmdisturbances.Intra-cardiacelectrophysioloPurposeofEPS

Evaluationofrecurrentsyncopeofpossiblecardiacorigin;Differentiationofsupraventricularfromventriculararrhythmias;Evaluationoftherapyinpatientswithaccessoryatrioventricularpathways;EvaluationoftheefficacyofpharmacotherapyEvaluationofpatientsforcatheterablationproceduresorantitachycardiadevicesPurposeofEPSEvaluationofAutonomictesting(tilt-tabletesting)Syncopemaybeneurocardiogenicinorigin,mediatedbyexcessivevagalstimulationoranimbalancebetweensympatheticandparasympatheticautonomicactivity.Head-uptilttabletestingcanidentifypatientswhosesyncopemaybeonavasovagalbasis.Autonomictesting(tilt-tabletArrhythmiaornotWhichkindandpossiblemechanismsSeverityPossibleetiologyAssessmentofthetreatment

PurposeofdiagnosesArrhythmiaornotPurposeofdiEtiological

diagnosisEtiologicaldiagnosisGeneticabnormalities(mostoftenaffectingionchannals)AcquiredstructuralheartdiseaseSusceptibilitytoarrhythmiasresultsfromtreatmentAnti-arrhythmiaagentsNon-drugtreatment:ablation＆pacmaker

Geneticabnormalities(mostoftElectrolyteabnormalitiesMyocardialischemiaDrugeffects(suchasQTintervalprolongationorchangesinautomaticity,conduction,andrefractoriness)Hormonalimbalances(thyrotoxicosis,hypercatecholaminergicstates)HypoxiaIncreasedriskofarrhythmiasmaybecorrectinducingfactortreatmentElectrolyteabnormalitiesIncreTreatmentofArrhythmiaEtiologicaltreatmentEliminationofinducementAdjustmentofarrhythmiaElectrictherapiesRadicalcureTreatmentofArrhythmiaEtiologEtiologicaltreatmentTreatmentofprimarydiseases,heartdiseasesorunderlingdiseasesheartfailuremyocardialischemia……EtiologicaltreatmentTreatmentEliminationofinducementRemedyelectrolyte

disturbanceRemedyacid-basedisturbancesDrug

withdrawal

Relieve

mentalstressEliminationofinducementRemeAdjustmentofarrhythmiaToavoidthebadsequencesincludingpalpitation,weakness,dizziness,syncope,heartfailure,anginapectoris,evendeadnessTorelievesymptomsToterminateattackTopreventattackAdjustmentofarrhythmiaToavoVagalstimulationBreathholdingVomitingEyeballmassagecarotidsinusmassageWecanusethemethodofvagalstimulationtoterminateSVTAdjustmentofarrhythmiaVagalstimulationAdjustmentofAnti-arrhythmiaagentstreatmentCorrectdiagnosisisveryimportantPaymoreattentiontosideeffectsIndividualdosageDrugcombinationaccordingtoEPcharacteristics

CombinationwithothertreatmentsAdjustmentofarrhythmiaAnti-arrhythmiaagentstreatmeAnti-arrhythmiaagentstreatmentAdjustmentofarrhythmiaNotreatmentofanti-arrhythmiaagentsifnobadsequencesofarrhythmiasAnti-arrhythmiaagentshavelimitedefficacyandproducefrequentsideeffectsAnti-arrhythmiaagentstreatmeTheriskofanti-arrhythmicagentshasbeenhighlightedbytheCAST,inwhichtwoclassIcagentsandaclassIaagentincreasedmortalityratesinpatientswithasymptomaticventricularectopyaftermyocardialinfarction.Theriskofanti-arrhythmicagheartarrestAAD心衰WhyAADincreasedmortalityrates?ProarrhythmiceffectDepressleftventricularfunctionheartarrestAAD心衰WhyAADincreClassificationofantiarrhythmicsAnti-tachyarrhythmicdrugsAnti-bradyarrhythmicdrugsClassificationofantiarrhythm內(nèi)科學(xué)英文課件：CardiacArrhythmiamoricizineAADareoftendividedintofourclassesbasedupontheirelectropharmacologicactions.Andsomehavemultipleactions.moricizineAADareoftendivideClassI（sodiumchannelblockers）ThreesubclassesarefurtherdefinedbytheeffectonthePurkinjefiberactionpotential(AP)_ClassI（sodiumchannelblockerClassIaTodepressphase0depolarizationToprolongrepolarizationToprolongAPdurationToslowconductionTotreatatrialandventriculararrhythmiasAPdurationQuindineProcainamideMoricizineDispyramideClassIaAPdurationQuindineClassIbToshortenrepolarizationToshortenAPdurationTotreatventriculararrhythmiasonlyAPdurationLidocaineMexiletinePhenytoinClassIbAPdurationLidocaineClassIcTomarked

depressphase0depolarizationToslightlyslowrepolarizationToprolongAPdurationTomarkedslowconduction-QRSdurationincreased

TotreatatrialandventriculararrhythmiasAPdurationPropafenoneFlecainideClassIcAPdurationPropafenoneClassII(β-blocker)Toinhibitphage4--decreaseautomaticityToprolongAVconductionToprolongeffectiverefractoryperiod（ERP）Totreatatrialandventriculararrhythmias_MetoprololPropranololEsmololClassII(β-blocker)_MetoproloAmiodaroneSotalolDofetilideIbutilideBretyliumClassⅢ（potassiumchannelblockers)TodelayAPDandERPmarkedlyToprolongrepolarizationToWidentheQRSandprolongtheQTcAtrialandVentricularboth

AmiodaroneClassⅢ（potassiumcToinhibitphage0,4andERPofslowreactionfibersTodecreaseautomaticityandAVconductionTotreatSN，atrialandAVNtachycardia

EffectivetoventriculartachycardiaduetotriggeractivityVerapamilDiltiazemClassIV(Slowcalciumchannelblockers)Toinhibitphage0,4andERPoOthersDigitalis（cedilanid,digoxin）ATP,adenosineToterminatePSVTorHRcontrolinAFOthersClassificationofantiarrhythmicsAnti-tachyarrhythmicdrugsAnti-bradyarrhythmicdrugsClassificationofantiarrhythmTo

increase

automaticityandconductivityAnticholinergicdrugs-atropineToreducevagaltoneToincreaseHRToaccelerateconductionToincreaseautomaticityandb-receptor

agonistisoproterenolTo

increase

automaticityandconductivityb-receptoragonistToincreasElectrictherapiesElectricalconversion（Cardioversion）Electricalpacing（pacemaker）ElectrictherapiesElectricalcCardioversionAprocedureusedtoconvertanirregularheartrhythmtoanormalheartrhythmbyapplyinghighenergyshock

CardioversionAprocedureusedIndicationsofCardioversionVentricularflutterVentricularfibrillationOtherdrugrefractorytachycardiaAF、AfVTSVTIndicationsofCardioversionVeContraindicationsofCardioversionShortepisodeattackDurationofAF>1yrSSSDigitalisintoxicationDisturbanceofelectrolyteacutemyocarditis

ContraindicationsofCardioverSynchronizedVT、SVT、AF、AfNon-synchronizedVFVfMethodofCardioversionSynchronizedMethodofCardioveAftertheProcedure:Blood

pressureandheartrateAnycomplicationsECGmonitorMedicine

AftertheProcedure:BloodpresArtificialcardiacpacingClassificationTherapeuticpacingTemporaryPermanentICDArtificialcardiacpacingClassIndicationsofpermanentpacingSickSinusSyndrome(SSS)Sinusbradycardia：≤40bpm，≥1min;Sinusarrest：>3sTypeIISABBradycardia-tachycardiasyndromeHighdegreeAVB(MobitzII)CompleteAVBBi-ortri-bundlebranchblockIndicationsofpermanentpacinComplicationsArrhythmiaBleedingInfectionsHeartperforationContractionofdiaphragmComplicationsArrhythmiaElectricmechanicpacemakerElectrontubepacemakerElectricmechanicpacemakerEleTransistorpacemakerEarlyintegratndcircuitpacemakerTransistorpacemakerEarlyinteVVIPacemakerleadsputinRVInpatientswithsingle-chamberpacemakers,thelackofanatrialkickmayleadtotheso-calledpacemakersyndrome,inwhichthepatientexperiencessignsoflowcardiacoutputwhileupright.VVIPacemakerleadsDDDPacemakerleadsputinRAandRVApacemakerthatsensesandpacesinbothchambersisthemostphysiologicapproachtopacingpatientswhoremaininsinusrhythm.DDDPacemakerleadsputinRAaICDTreatchronicrecurrentVTAbortedVfICDTreat內(nèi)科學(xué)英文課件：CardiacArrhythmia內(nèi)科學(xué)英文課件：CardiacArrhythmia內(nèi)科學(xué)英文課件：CardiacArrhythmia內(nèi)科學(xué)英文課件：CardiacArrhythmiaRadicalcure

SurgicaltreatmentAblation

Radiofrequencycatheterablation(RFCA)DCablationRadicalcureSurgicaltreatmeMazeoperationTotreatAFMazeoperationTotreatAFRFCARadiofrequencycatheterablationhasbecometheprimarymodalityfortreatmentofmanyarrhythmias.RFCARadiofrequencycatheteraIndicationsofRFCAWPWAVNRTandAVRTATAFLandAfVTandVPBsPJRTandMahaimfiberAndsoonIndicationsofRFCAWPWEffectofRFablation—WPWsyndromeEffectofRFablation—WPWsynHowdoesRFCAworkinAf?AblationofAfismorecomplexandinvolveselectricalisolationofthepulmonaryveins,whichareoftenthesiteofinitiationofatrialfibrillation,orplacinglinearlesionswithintheatriatopreventspreadoftherhythm.HowdoesRFCAworkinAf?AblatTachyarrhythmiasSupraventriculararrhythmiasVentriculararrhythmiasBradycardiasandconductiondisturbancesTachyarrhythmiasSupraventriculClassificationofTachyarrhythmias

Brady-arrhythmia:slowheartrates(lessthan60beatsperminute)Tachy-arrhythmia:

fastheartrates(morethan100beatsperminute)ClassificationofTachyarrhythClassificationBrady-arrhythmias

Sinus,sinusarrest,sino-atrialblockandSicksinussyndrome（SSS）JunctionalescaperhythmVentricularescaperhythmConductionblocksClassificationBrady-arrhythmiaBrady-arrhythmiaBrady-arrhythmiaSinusBradycardia<60bpmSinusBradycardiaisaheartrateslowedthan60beats/minduetoincreasedvagalinfluenceonthenormalpacemakerororganicdiseaseofthesinusnode.SinusBradycardia<60bpmSinusSinusarrestDefinitionSinusarrestisrecognizedbyapauseinthesinusrhythm.SinusarrestDefinitionSinusaECGofSinusarrestDifferentiationfromSABECGofSinusarrestDifferentiaSinusbradycardiaSinusRhythmrate<60bpmECGcharacteristics:sinusrhythmispresentandtheheartrateislessthan60beats/minSinusbradycardiaSinusRhythmESinusBradycardiaAsanormalvariant,manynormalandolderpeoplehavesinusbradycardiaItcommonlyoccursinthefollowingconditions:duringsleep,drugsorsicksinussyndrome……Mostpeoplewithsinusbradycardiahavenosymptoms.Ifthepatienthaschronicsinusbradycardiacausesymptoms,anpacemakermaybeneeded.SinusBradycardiaAsanormalvSickSinusSyndrome,SSSDefinitionSSSisappliedtoasyndromeencompassinganumberofsinusnodalabnormalitiesaboutdisorderedsinusnodeautomaticityandSAconductionSickSinusSyndrome,SSSDefinitEvaluationofsinusfunctionsEKGHolterAtropinetestEPSSNRTSACTEvaluationofsinusfunctionsEECGofSSSSinusbradycardiaSinusarrestSino-atrialblockECGofSSSSinusbradycardiaSinVeryslowAFVentricularescaperhythmBrady-tachysyndromeVeryslowAFVentricularescapeEKGRecognition:Sinusbradycardia：≤40bpm，≥1min;Sinusarrest：>3sTypeIISABBradycardia-tachycardiasyndrome

：

Nonsinustachyarrhythmia(SVT,AForAf)，sinusbeatgetback>2.0s.24hHolter:24hsinusbeat：<5-8tenthousand24haveragesinusbeat：<60bpmSinusarrest：always>2.0-2.5sEPSTUDY:SNRT>1530ms,SNRTc>525msInstinctheartrate<80bmp

SickSinusSyndrome(SSS)EKGRecognition:SickSinusSynHeartblockBlockposition:Sinoatrial;intra-atrial;atrioventricular;intra-ventricularBlockdegree:TypeI:prolongtheconductivetime;TypeII:partialblock;TypeIII:completeblockHeartblockBlockposition:SinCardiacconductionblockBlockposition:Sinoatrialintra-atrialatrioventricularintra-ventricularBlockdegreeTypeI:prolongtheconductivetimeTypeII:partialblockTypeIII:completeblockCardiacconductionblockBlockIdegree:ECGnegativeIIdegree:

foundbyECGMorbizITypeMorbizIITypeIIIdegree:

undistingrashedfromsinusarrest

Sinoatrialblock(SAB)Idegree:ECGnegativeSinoatrSinoatrialBlock1stdegree:ECGnegative2rddegree:foundbyECG3rddegree:undistingrashedfromsinusarrestSinoatrialBlockAtrioventricularBlockEtiology:Atheroscleroticheartdiseasemyocarditisrheumaticfevercardiomyopathydrugtoxicityelectrolytedisturbancecollagendiseaselev’sdiseaseAVblockisadelayorfailureintransmissionofthecardiacimpulsefromatriumtoventricle.AtrioventricularBlockEtiologyAtrioventricularblock(AVB)FirstdegreeAtrioventricularblock(AVB)FiSeconddegreetypeISeconddegreetypeISeconddegreetypeIISeconddegreetypeIIThirddegreeThirddegreeManifestations:First-degreeAVblock:almostnosymptoms;SeconddegreeAVblock:palpitation,fatigueThirddegreeAVblock:Dizziness,agina,heartfailure,lightheadedness,andsyncopemaycausebyslowheartrate,Adams-StokesSyndromemayoccursinseverecase.Firstheartsoundvariesinintensity,willappearboomingfirstsoundAtrioventricularBlockManifestations:AtrioventriculaRightBundlebranchblockRightBundlebranchblockLeftBundlebranchblockLeftBundlebranchblockCausesofBrady-arrhythmiaCardiac

diseasesDegenerationofconductivesystemInjuriesConnective

tissuediseasesEtc.CausesofBrady-arrhythmiaCardManifestationsofBrady-arrhythmiaIschemiaofimportantorgans(heart,brainandkidney）Dizziness,weakness,chestdistressandcardiacinsufficiencyOrmoreseveresuchasAdams-StokesManifestationsofIschemiaofTreatmentofBrady-arrhythmiaTreatmentoftheunderlyingdisorderNotreatmentMedication(atropineandisoproterenol)PacemakerTreatmentofBrady-arrhythmiaTClassificationTachy-arrhythmiasPrematurebeats:

Atrial,junctionalandventricular.Tachycardias:

sino,supraventricularandventricularFlutterandfibrillation:

atrialandventricularClassificationTachy-arrhythmiaSinusTachycardia>100bpmSinusTachycardiaisdefinedasaheartratefastedthan100beats/minthatiscausedbyrapidimpulseformationfromthenormalpacemaker.SinusTachycardia>100bpmSinusSinustachycardiaSinusRhythmrate>100bpmPalpitationmaybetheonlysymptomSinustachycardiaSinusRhythmPSinustachycardiaSinustachycardiaisanarrhythmia,butnotnecessarilyanabnormalrhythm.Thefollowingconditionscandevelopsinustachycardia:Suchasexercise,anxiety,fever,myocarditis，somedrug，anemia.SinustachycardiaSinustachycPalpitationmaybetheonlysymptomPalpitationmaybetheonlysyTreatmentofSinusTachycardiaTreatthe

etiologicalfactorsNo-therapySedativeagentor

b

–blockers

TreatmentofSinusTachycardiaPrematurebeatsOneortwoearlyorextraheartbeatsfromheartexceptsinusnodePrematurebeatsOneortwoearlPrematurebeatsAtrialJunctionalVentricularPrematurebeatsAtrialSymptomsandSigns

(Prematurebeats)thesensationoffeelingheartbeat(palpitation)thesensationofstoppedorskippedbeatsInmanycases,mayhavenosymptoms

SymptomsandSigns(PrematureECGofPrematurebeats1.58s1.42sJPCwithcompletecompensationpauseAPCwithincompletecompensationpauseECGofPrematurebeats1.58s1.4VPCsbigeminyRonT--VfsingleVPCsbigeminyRonT--VfsinglTreatmentofPrematurebeatsEtiologicaltreatmentEliminateInducingfactorsNotherapy,sedativesorβ-blockersAntiarrhythmicsTreatmentofPrematurebeatsEtAntiarrhythmics

APCs?-blocker,propafenone,moricizine,verapamilVPCsNostructureheartdiseaseSymptom:?-blocker,mexiletineWithstructureheartdisease(CAD,HBP)?-blocker,amiodaroneClassIespeciallyclassIcagentsshouldbeavoidedAntiarrhythmics

APCsParoxysmaltachycardiaThreeormoreearlyorextraheartbeatsParoxysmaltachycardiaThreeorClassificationofParoxysmaltachycardiaSupraventricularVentricularClassificationofSupraventricParoxysmalsupraventriculartachycardia

＆WPW-syndromeParoxysmalsupraventriculartaParoxysmalsupraventriculartachycardiaMostduetoreentrantmechanismTheincidenceofPSVTishigherinAVNRT(atrioventricularnodereentrytachycardia)AVRT(atioventricularreentrytachycardia）OccurinanyageindividualsusuallynostructureheartdiseaseParoxysmalsupraventriculartaThemechanismmaybeeithermicroreentryoccurringtotallywithintheAVnode(AV-nodaltachycardia--AVNRT)(Fig.A)ormacroreentryinvolvingoneatrium,anaccessorypathway,oneventricle,andtheAVnode(AV-bypasstachycardia--AVRT)(Fig.BandFig.C).ThemechanismmaybeeithermiAVRThavetwotypes：(1)orthodromicAVRT(2)antidromicAVRTantidromicAVRTisuncommon,ECGshowsWideQRSwave,it’seasytoconfusedwithventriculartachycardiaandPSVTconductedaberrantly.

antidromicAVRT

orthodromicAVRTAVRTAVRThavetwotypes：antidrorthodromicAVRTorthodromicAVRTantidromicAVRTArrowsindicatedeltawavespresentbefore,during,andafterthetachycardia.AsterisksindicateabnormallyappearingPwavesprecedingeachwideQRScomplex.antidromicAVRTArrowsindiPSVT：AVNRTPSVT：AVNRTPSVT：AVRTPSVT：AVRTPre-excitationsyndrome(W-P-Wsyndrome)ThereareseveraltypeofaccessorypathwayKent:adjacentatrialandventricularJames:adjacentatrialandhisbundleMahaim:adjacentlowerpartoftheAVNandventricularPre-excitationsyndrome(W-P-WAVRTalsohavetwotypes(1)orthodromicAVRT(2)antidromicAVRTantidromicAVRTisuncommon,ECGshowsWideQRSwave,it’seasytoconfusedwithventriculartachycardiaandPSVTconductedaberrantly.

antidromicAVRT

orthodromicAVRTAVRTalsohavetwotypesan

orthodromicAVRTantidromicAVRTPre-excitationsyndrome(W-P-Wsyndrome)orthodromicAVRTantidroVentriculartachycardiaVentriculartachycardiaVentriculartachycardiaEtiology:ofteninorganicheartdiseaseCAD,MI,DCM,HCM,HF,longQTsyndromeBrugadasyndrome

Hypokalemiaoverdosageofdrugsetc.longQTsyndromeVentriculartachycardiaEtiologMechanism：ectopicfocusORintraventricularreentrySustainedVT(>30s),NonsustainedVTMechanism：ectopicfocusSustaECGPSVTVTVAdissociationECGPSVTVTVAdissociationAspecialtypeofpolymorphicVT,

rotationoftheQRSaxisaroundthebaseline,theratefrom160-280bpm,SINUS：QTintervalprolonged>0.5s,markedUwaveEtiology:

CongenitaloracquiredLongQTsyndromeantiarrhythmiadrugproarrhythmia(IAorIC)electrolytedisturbanceantianxietydrug,braindisease,bradycardiaTorsadesdepoints(Tdp)AspecialtypeofpolymorphicSanguinetti:1997PTQRSQTQTAntiarrhythmiadrugproarrhythmiaRonTIa、Ic、IIIagentsSanguinetti:1997PTQRSQTQTAntiSymptomsFastHR>160BPMofAbruptonsetandterminationPalpitation,chestdistress,dizzinessandpolyuriaPSVTless→disturbanceofcirculationVT→circulatorydisordersClinicalmanifestationofParoxysmaltachycardiaSymptomsClinicalmanifestatioClinicalmanifestationofParoxysmaltachycardiaOnphysicalexamsFastHRinPSVT：QuiteregularandequalheartsoundinVT：Alittleirregularandunequalheartsound,sometimescannonsoundClinicalmanifestationofOnphTreatmentofPSVTMechanicalVagalstimulation(Valsalva）

MedicalVagalstimulationAntiarrhythmicsElectricalconversionRadiofrequencycatheterablation(RFCA)SurgicaltreatmentTreatmentofPSVTAVNRT&orthodromicAVRTDrug:verapamil,adrenosine,propafenoneAntidromicAVRT&AFwithPre-excitation:Shouldnotuseverapamil,digitalisDrug:propafenone,amiodarone（AF？)DCshock:AFproduceagina,syncopeandhypotensionAVNRT&orthodromicAVRTTreatmentofVT

TreatunderlyingdiseaseAntiarrhythmics:lidocaineandamiodaronearethefirstchoices

;?-blockersElectricalconversionRadiofrequencycatheterablation(RFCA)

ICDSurgicaltreatmentTreatmentofVT

Tdp:AviodorwithdrawlantiarrythmicswhichprolongtheQTinterval(Ia,Ic,III)Magnesiumiv?-blockiv;isoprenalineorpacemakerforlongQTpatient

AtrialFlutterandFibrillationAtrialFlutterandFibrillatioAtrialFlutter（AFL）

regularatrialtachyarrhythmia，atrialactivationatabout250-350bpmduetoanintra-atrialre-entryAtrialFlutter（AFL）AtrialFibrillation

（AF）irregularatrialtachyarrhythmiatrialactivationatabout350-600bpmduetomultimicro-reentryinatriaAtrialFibrillation（AF）SymptomsandsignsofAFLandAFSymptoms：ParoxysmalorpersistPalpitation,chestdistress,poorexercisetoleranceandDyspneaSignsinAFL：Cardiacratemaybeornottoberegular,andchangesabruptlyinAF：HeartrhythmisabsolutelyirregularwithvaryingheartsoundsifHRismorerapidorcontinuous，HemodynamicchangesEmbolismic

ComplicationSymptomsandsignsofSymptomsECGofAFLECGofAFLECGofAFECGofAFTreatmentPrinciplesofAFLandAFTreatmentoftheunderlyingdisorderandinducingfactorsVentricularratecontrol

MedicalconversionSynchronizeddirectcurrentelectricalconversionTopreventrecurPreventionandtreatmentofcomplication

TreatmentTreatmentoftheundTherapy:TreattheunderlyingdiseaseTorestoresinusrhythm:CardioversionEsophagealPulsationModulationRFCADrug(III,Ia,Icclass)Controltheventricularrate:digitalis.CCB,?-blockAnticoagulationAtrialflutterTherapy:AtrialflutterClassIAClassICClassIIIb-blockersCatheterablationPacingImplantableatrial

defibrillatorSurgerymazePharmacologicNon-

pharmacologicPharmacologicCa2+blockers-blockersDigitalisNon-

pharmacologicAVNablation

andpacePharmacologicWarfarinAspirinNon-

pharmacologicRemoval/

isolationleft

atrial

appendageAFTreatmentOptionsMaintenance

ofSRRate

controlStroke

preventionCP1048425-26ClassIACatheterablationPharmAntiarrhythmicDrugTherapytoMaintainSinusRhythminPatientswithRecurrentParoxysmalorPersistentAtrialFibrillationNo(orminimal)FlecainidePropafenoneSotalolCatheterablationYesHypertensionLVH1.4cmNoAmiodaroneFlecainidePropafenoneSotalolAmiodaroneDofetilideHeartdisease?HFAmiodarone,dofetilideCADSotaloldofetilide

AmiodaroneYesAmiodarone,dofetilideAntiarrhythmicDrugTherapytoCammAJ,etal.EurHeartJ.2010Oct;31(19):2369-429.CammAJ,etal.EurHeartJ.JACC2005;45:1807-1812Strokeprevention

PatientsWithAtrialFibrillationandDenseSpo