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Korean 환자교육 심장서비스 전기생리학 부정맥들 심장의펌프질은심장자체안의전기력체계에의해서통제됩니다.

심장박동의리듬은보통정규적입니다. 심장전기력체계에 속도조절문제 의이유로아주느린, 너무빠른, 아니면불규칙적인박동을부정맥이라고불립니다.

대부분의경우부정맥은심실 ( 아랫쪽펌프실 ) 로부터그리고심방 ( 심실의윗쪽 ) 으로부터오는두가지중요한부분으로분류됩니다.

1 Korean 환자교육 심장서비스 전기생리학 부정맥들 심장의펌프질은심장자체안의전기력체계에의해서통제됩니다. 심장안의특수세포들이심근을자극하고그것으로인하여심장을수축시키는전류를내보냅니다. 심전도 (ECG) 검사에이러한전기충격들은기록될수있습니다. 심장박동의리듬은보통정규적입니다. 심장전기력체계에 속도조절문제 의이유로아주느린, 너무빠른, 아니면불규칙적인박동을부정맥이라고불립니다. 만일부정맥이생기면, 심장의어느부분이관여하는지를확인하는것이중요합니다. 대부분의경우부정맥은심실 ( 아랫쪽펌프실 ) 로부터그리고심방 ( 심실의윗쪽 ) 으로부터오는두가지중요한부분으로분류됩니다. 상체로부터의정맥혈액 몸으로보내는산화된혈액 허파로가는산소를제거한혈액허파로부터오는산화된혈액허파판막대동맥판막우심오른방실판막 허파로가는산소를제거한혈액허파로부터오는산화된혈액좌심방승모판막좌심실 심실사이막 하체로부터온정맥혈 우심실 심장의 4 개의방을통과하는혈액.

2 Page 2 심장과 전기생리학 심실조기수축 (PVCs) PVCs 는가장흔한유형의부정맥입니다. 심실의한부분에서일찍아니면두서없이전류를쏘아낼떄생깁니다. 이러한조기박동을흔히 건너뜀 이나또는 여분 의박동이라고합니다. 만일 PVCs 가자주또는집단적으로일어나면, 두근거림이나펄렁거리는느낌이생길수도입니다. 만일이런일이생기면, 담당의사선생님께전화하십시오. PVCs 는다량의카페인, 담배, 아니면알코올사용에의해서올수도있습니다. 또한신경과민이나피로와함께올수도있습니다. 빠른맥빠른맥 ( 빠른심장박동 ) 은심실위빠른맥 (SVT) 을만들어내는심실윗쪽에서 시작할수도있고아니면심실성빈맥 (VT) 을만들어내는심실안에서. 시작할수있습니다. 빠른맥질환이있는환자분에게있을수있는증상들 : 어지러움증 현기증 가슴이두근거림 가슴이불편함 땀흘림만일이와같은증세가지속되거나, 자주일어나거나, 또는아주빠른심장박동이포함될경우의학적치료가필요할수도있습니다. 빠른맥의치료는빠른심장박동을일으키는원인에달려있습니다. 빠른맥의일정한특징들은약물치료, 기구삽입, 진단연구, 또는수술이필요한지아닌지를보여줄것입니다. 심실위빠른맥은여러종류가있습니다. 그종류에는 : 심방잔떨림 / 조동 심장의윗쪽방에서시작하는보통불규칙적이고빠른비정상심장박동 이소성심방빈맥 (EAT) 굴심방결절 (SA) 이아닌심방한곳에서집중적으로시작되는빠른박동. 방실결절재입빠른맥 (AVNRT) 원형박동양식이생기게하는방실결절 (AV) 근처에 누전 이있음으로인한빠른박동. 월프파킨스화이트증후군 전기통로가정상적인방실결절과심방과심실을연결하는비정상적인여분의통로를둘다쓸때일어나는비정상적인빠른박동.

3 Page 3 심장과 전기생리학 우심방 동방결절 좌심방 방실결절 좌심실 우심실 심장을통과하는전기통로들. 심실잔떨림 (VF) 심장정지, 급성심장사, 또는심실세동정지라고도알려진심실잔떨림은심장을경련시키거나떨리게하는혼란한전기패턴의원인입니다. 결과적으로심장이갑자기피를펌프질하는것을멈추게되고의식을잃는원인이됩니다. 이런상황에서는지체없이전기쇼크 ( 세동제거 ) 를가하여정상심장박동을회복할수있을때까지심폐소생술 (CPR) 이필요합니다. 심실잔떨림은그자체의뜻을갖고있는 심장마비 란용어와혼동해서는않됩니다. 전기생리학 (EP) 검사 전기생리학검사 (EP 검사 ) 는심장의전기적기능을확인하는데쓰이는검사입니다. 이것은심장안의전기신호측정에의하여행해집니다. EP 검사는부정맥을진단하고항부정맥약의효과를검사하고때로는부정맥의치료를위해행해집니다.

4 Page 4 심장과 전기생리학 EP 검사를위해서쓰이는기술은심장도관술에쓰이는것과비슷합니다. 이것은 2 개나그이상의도관 ( 전기신호를탐지하는길고, 가늘고, 잘휘는튜브 ) 을사타구니나어깨에있는혈관속에삽입해서검사합니다. 검사하기전 EP 검사전날밤에는, 자정이후몆모금의물로예정된약을드시는것외에는음식이나음료수를들지마십시오. 복용하고계실수도있는어떠한항부정맥약에의한혈액수치뿐만아니라일과적인혈액검사를받을것입니다. EP 검사하는동안 EP 검사실은보통서늘하고여러가지큰모니터용장비들이있습니다. 똑바로누워계시는동안두개의심장모니터, 심전도기계, 그리고산소모니터장치에연결되실것입니다. EP 검사는살균상태하에서행해집니다. 환자분을도관이삽입될부분만노출시키고무균덮게로커버할것입니다. 그전에도관의삽입부위를면도하고살균용액으로닦아내고준비시킬것입니다. 의사선생님께서심장속으로넣어야할도관을안내하기위하여플루라스코프 ( 엑스레이 ) 라는기계가환자분위에놓여질것입니다. 만일임신하셨을가능성이조금이라도있으면의사선생님또는간호사에게말하십시오. 시술하는동안편안하시도록약을투여받으실것입니다. 도관이삽입되기전에, 혈관부위피부에감각을없애기위하여국부마취제를주사받으실것입니다. 환자분들은흔히이런주입을 벌에쏘인것같은느낌 이라고묘사합니다. 마취제가효과를발휘하면환자분은의사선생님께서시술하고있는자리에약간의압박감만을느끼셔야합니다. 의사선생님께서엑스레이를이용하여조심스럽게도관을심장으로유도할것입니다. 대부분의환자분들은심장에들어간도관의감각을느끼지않으십니다. 일단도관이심장에자리를잡으면심장의전기활동의측정이시작될것입니다. 도관중한개가심장박동을조절하기위하여심박조율기로사용될것입니다. 의사선생님께서심박조율기를켰을때환자분은심장이빨리뛰는것을느끼실수도있습니다. 이것이환자분의부정맥을초래할수도있습니다. 이러한박동은저절로정상으로돌아갈수도있거나또는정상심장박동을복구하기위하여전기조율을멈춰야하거나아니면전기충격 ( 세동제거 ) 이필요할수도있습니다. 만일부정맥이유발될경우에는전에겪었던비슷한증상을느끼실수도있습니다. 만일통증, 가슴압박감, 메스꺼움, 또는어지러움증을느끼시면의사선생님께말씀하십시오. 환자분은고도로숙련된의사선생님과간호사들이이러한증세를즉시치료할수있는관리가된환경에계신다는것을유념하고계십시오.

5 Page 5 심장과 전기생리학 모든정보가수집된이후도관은제거될것입니다. 출혈을방지하기위하여의사선생님께서도관이제거된후삽입부위를약 5 분동안꽉누르실것입니다. EP 검사후사타구니에들어갔던도관이제거된후 4-6 시간동안다리를쭉뻗은상태로똑바로누워계셔야할필요가있습니다. 이것은멍이드는것이나출혈을방지할것입니다. 다리를쭉뻗고계실수있으면옆으로누워계셔도됩니다. 일단입원실에돌아오시면, 간호사가출혈이있는지를확인하기위하여도관이삽입된부위를자주검사할것입니다. 또한심장박동과혈압을확인할것입니다. 의사선생님께서검사이후에환자분, 그리고가족들과함께상담하러오실것입니다. 시술이일단끝나고나면식사와음료수를드실수있습니다. 부정맥을위한치료약물치료항부정맥제라고불리는비정상적인심장박동조절을돕는약은단독적으로나아니면수술이나삽입장치와같은다른치료와함께쓰입니다. 만일항부정맥제를드시면체내에있는약의양을재는혈액검사를때떄로받으실수도있습니다. 다른검사들 ( 심전도, 홀터모니터기록, 가슴엑스레이, 검안, 호흡검사등등 ) 을드시는약의안정성과효과를확인하기위하여정기적으로받으실수도있습니다. 영구심장박동조율기영구심장박동조율기는보통매우느린심장박동을조절하기위해서삽입됩니다. 국부마취하에보통왼쪽에있는쇄골바로밑을작게절개합니다. 심장박동조율기전극, 또는부드러운전선이정맥에삽입된다음심장의아래쪽방 ( 우심실 ) 으로들어갑니다. 어떤환자분들은오른쪽윗방 ( 우심방 ) 에추가의전극을필요로합니다. 전극은피부밑에놓여질전지동력맥박발전기에연결됩니다. 끝마치기까지 1-4 시간정도걸리는이시술동안환자분은깨어있을것입니다. 환자분이편안하시도록약이주어질것입니다. 심장박동조율기가삽입된이후심방박동을지켜볼입원실로돌아가실것입니다. 전극이떨어질위험성을감소하기위하여어깨멜방과 / 아니면침대요양을지시받을수도있습니다. 또한회복기동안 90 도이상은팔을올리지마시라고요청받을수도있습니다.

6 Page 6 심장과 전기생리학 삽입형잔떨림제거시스템 (IDS) 삽입형잔떨림제거시츠템 (IDS) 은생명을위협하는심장박동을치료하기위하여고안된장치입니다. 이것은징후가있거나조절이않되는심실빠른맥을갖은환자분을치료하고심장정지나심실잔떨림을겪으셨던환자분을보호하는데쓰입니다. 잔떨림제거기가심실빠른맥이나심실잔떨림을탐지할떄정상박동을회복하기위하여전파를심장으로보냅니다. 잔떨림제거기는여러회사에서제조하기때문에이름이다양할수도있습니다. 각각다른회사의기구마다프로그램이약간다릅니다. 잔떨림제거기는, 맥박발생기와발전기를심장으로연결시키는인도시스템의두부분으로되어있습니다. 맥박발생기는환자분의심장박동을감시합니다. 이것이부정맥을탐지할때, 맥박발생기는더한층정상박동을회복시키기위하여전파를심장으로보냅니다. 사용되는치료요법은사전에프로그램된박동요법이나또는 내부 충격입니다. 맥박발생기는보통왼쪽쇄골아래피부나근육속에삽입되어집니다. 삽입형잔떨림제거기는수술실에서전신마취하에삽입됩니다. 시술도중에의사선생님께서그장치가제대로감지하고교정하는지를확인하기위하여환자분의부정맥을자극할것입니다. 환자차후관리는잔떨림제거기의종류에따라서매 3 개월에서 4 개월마다심장과진단센터의컴퓨터프로그램으로잔떨림제거기점검이포함됩니다. 잔떨림제거기로부터쇼크를받으시면즉시의사선생님께전화하십시오. 도관절제수술월프파킨슨화이트 (WPW) 증후군과방실결절재진입성빈맥을갖은환자분들은그로인해상성심실빈맥 (SVTs), 또는아주빠른심장박동의결과를초래할수도있는부속이나가외의통로를심방과심실사이에갖고있습니다. 만일이러한부정맥들이빈번하지않으면약으로써조절할수있습니다. 이러한질병을위한또다른치료선택은도관절제시술일수도있습니다. 도관절제술은빠른맥을일으키는여분의통로를차단하기위하여고주파에저지를사용합니다. 여분의통로는비록정확한위치는전기생리학검사에의해서만확정되지만때로는심전도검사에의해서알아낼수도있습니다. 도관절제술은기준선전기생리학검사와비슷합니다. 도관들이사타구니와빗장뼈아래혈관에삽입될것입니다. 이러한삽입을함으로써고주파가전달되어지는특별한도관이여분통로의정확한위치에대어질수있습니다. 이것은심장박동이

7 심장과 전기생리학 질문있으십니까? 로전화하십시오. 귀하의질문은중요합니다. 만약질문이나걱정되는점이있으시면담당의사선생님이나의료진에게연락하십시오. 또한 이통로위로지나가는것을막기위한 상처 를낼것입니다. 시술은약 4-8 시간정도걸리고환자분이편안하시도록진정제를받으실것입니다. 시술이후. 가슴엑스레이를찍고대개심장초음파검사를다음날받으실것입니다. EP 검사를하셨으면 4-6 시간동안침대에똑바로누워계실것입니다. 병실에돌아오실떄쯤에는약간어지러움을느끼실수도있습니다. 원하시면, 식사와음료수를드실수도있습니다. 차후관리예약은담당심장전문의사선생님과하게될것입니다. 만일아래와같은증상이생기면의사선생님꼐전화하십시오 : 빠른맥의자각 현기증을느낌 UWMC 의직원들은 어지러움증을느낌 언제든지도와드릴준비가되어있습니다. 의식을잃을것같은느낌 심장과 EP 실험실 집무시간이후에는 으로전화하여교환수에게전기생리학담당의사선생님또는전기생리학당직의사선생님을호출해달라고하십시오. Box N.E. Pacific St. Seattle, WA University of Washington Medical Center Korean 01/2004 Translation by UWMC Interpreter Services Reprints: Health Online

The rhythm of the heartbeat is usually regular. A very slow, rapid or irregular rhythm caused by a timing problem in the heart s electrical system is called an arrhythmia.

9 Patient Education Arrhythmias The pumping action of the heart is controlled by an electrical system inside the heart itself. Special cells in the heart send out electrical currents that stimulate the heart muscle and cause it to contract. These electric impulses can be recorded during an electrocardiogram (ECG). The rhythm of the heartbeat is usually regular. A very slow, rapid or irregular rhythm caused by a timing problem in the heart s electrical system is called an arrhythmia. If an arrhythmia occurs, it is important to determine what area of the heart is involved. Most times, arrhythmias are divided into two major categories, those that come from the ventricles (lower pumping chambers) and those that come from the atria (above the ventricles). Blood flow through the four chambers of the heart.

10 Page 2 Premature Ventricular Contractions (PVCs) PVCs are the most common type of arrhythmia. They occur when an area in the heart s ventricle fires early or out of turn. These premature beats are often referred to as skipped or extra beats. If PVCs become frequent or occur in groups, palpitations or a fluttering feeling may result. If this occurs, call your doctor. PVCs may be brought on by too much caffeine, tobacco, or alcohol. They may also accompany nervousness or fatigue. Tachycardia Tachycardia (rapid heart beat) may start above the ventricles, producing supra ventricular tachycardia (SVT) or, within the ventricles, producing ventricular tachycardia (VT). Patients with tachycardia may have symptoms such as: Lightheadedness Dizziness Palpitations Chest discomfort Sweating Medical treatment may be needed if these episodes are prolonged, occur often, or involve very rapid heart rates. Treatment of tachycardia depends on the cause of the rapid heartbeat. Certain characteristics of the tachycardia will show whether medications, an implanted device, diagnostic studies, or surgery are needed. There are many types of SVTs. Among them are: Atrial fibrillation/flutter An abnormal, usually irregular rapid rhythm, which starts in the upper chambers of the heart. Ectopic atrial tachycardia (EAT) A rapid rhythm starting from a single focus in the atrium, not the sinoatrial (SA) node. Atrioventricular nodal re-entry tachycardia (AVNRT) A fast rhythm resulting from the presence of a short circuit near the atrioventricular (AV) node, which allows a circular rhythm pattern to occur. Wolff-Parkinson White syndrome An abnormally fast rhythm that occurs when an electrical pathway uses both the normal AV node and an abnormal extra pathway connecting the atria and ventricles.

11 Page 3 Electrical pathways through the heart. Ventricular Fibrillation (VF) Ventricular fibrillation, also known as cardiac arrest, sudden cardiac death, or VF arrest, is a chaotic electrical pattern that causes the heart to fibrillate, or quiver. As a result, your heart suddenly stops pumping blood, causing you to lose consciousness. This condition requires immediate cardiopulmonary resuscitation (CPR) until the delivery of an electric shock (defibrillation) can restore the normal heartbeat. Ventricular fibrillation should not be confused with the term heart attack, which has its own meaning. EP Studies An electrophysiology study (EP study) is a test used to check the electrical function of the heart. This is done by measuring the electrical signals inside the heart. EP studies are done to diagnose arrhythmias, check the effectiveness of antiarrhythmic drugs, and sometimes to treat arrhythmia. The technique used for the EP study is similar to that used for a heart catheterization. It requires insertion of two or more catheters (long,

12 Page 4 narrow, flexible tubes that detect electrical signals) into a blood vessel in the groin and/or shoulder. Before the Study The night before the EP study, no food or drink is allowed after midnight, except for sips of water with scheduled medications. Routine blood tests will be taken, as well as blood levels of any antiarrhythmic medications you may be taking. During the EP Study The EP lab is usually cool, and you will notice several large pieces of monitoring equipment. While lying on your back, you will be connected to two cardiac monitors, an ECG machine, and an oxygen monitoring device. The EP study is done under sterile conditions. You will be covered with sterile drapes, exposing only the area where the catheters will be inserted. Prior to that, the insertion sites will be shaved and prepped with an antiseptic solution. A machine called a fluoroscope (X-ray) will be placed over you so the doctor can guide the catheters into the heart. Tell the doctor or nurse if there is any possibility that you may be pregnant. You will be given medication to make you comfortable during the procedure. Before the catheters are inserted, a local anesthetic is given to numb the skin around the blood vessel. Patients often describe this insertion as feeling like a bee sting. After the anesthetic has taken effect, you should feel only a slight sensation of pressure where the doctor is working. Your doctor will use the fluoroscope to carefully guide the catheters to the heart. Most patients do not feel the presence of the catheter in the heart. Once the catheter is positioned in the heart, measurement of the heart s electrical activity will begin. One of the catheters will be used as a pacemaker to control your heart rhythm. You may feel your heart beating faster when the doctor turns on the pacemaker. This may cause your arrhythmia to occur. This rhythm may return to normal on its own, or it may require electrical pacing to interrupt the rhythm, or an electric shock (defibrillation) to restore the heart s normal rhythm. If your arrhythmia is triggered, you may feel the same symptoms you experienced in the past. If you feel any pain, chest pressure, nausea, or dizziness, please tell your doctor. Keep in mind, you are in a controlled environment where highly skilled doctors and nurses will treat these symptoms right away.

13 Page 5 After the information has been gathered, the catheters will be removed. To prevent bleeding, the doctor will apply firm pressure to the insertion site for about five minutes after the catheter has been removed. After the EP Study You will need to keep your leg straight and lie flat when the catheters are in the groin and for four to six hours after they have been removed. This will prevent bruising or bleeding. You may lie on either side, as long as you keep your leg straight. Once you return to your room, your nurse will check often for bleeding at the catheter insertion site. Your heart rhythm and blood pressure will also be checked. Your doctor will come to talk with you and your family after the test. You will be allowed to eat and drink once the procedure is over. Treatment for Arrhythmias Medications Medications that help control the heart s abnormal rhythm, called antiarrhythmic drugs, are used either alone or in combination with other treatments, such as surgery or an implanted device. If you receive antiarrhythmic drugs, a blood test to measure the amount of drug in your system may be done from time to time. Other tests (ECGs, Holter monitor recordings, chest X-rays, eye exams, breathing tests, etc.) may be done regularly to ensure the safety and effectiveness of the drugs you are taking. Permanent Pacemaker A permanent pacemaker is usually implanted to control a very slow heart rhythm. Under local anesthesia, a small incision is made just beneath the collarbone, usually on the left side. A pacemaker electrode, or soft wire, is inserted into a vein and then advanced to the lower chamber (right ventricle) of the heart. Some patients require an additional electrode for the right upper chamber (atrium). The electrode(s) is connected to a battery-powered pulse generator, which is placed under the skin. You will be awake during this procedure, which takes one to four hours to complete. Medication will be given to keep you comfortable. After the pacemaker has been implanted, you will return to your room, where your heart rhythm will be monitored. To reduce the risk of dislodging the electrode, an arm sling and/or bed rest may be ordered. You may also be asked not to raise your arm greater than 90 degrees during your recovery phase.

14 Page 6 Implantable Defibrillator System (IDS) The implantable defibrillator system (IDS) is a device designed to treat life-threatening heart rhythms. It is used to treat patients with symptomatic or uncontrollable ventricular tachycardia and to protect patients who have had a cardiac arrest or ventricular fibrillation. When the defibrillator detects VT or ventricular fibrillation, it delivers electrical energy to your heart in an attempt to restore normal rhythm. Defibrillators may vary in name because they are made by different companies. Devices from different companies have slightly different programming. A defibrillator system has two main parts a pulse generator and the lead system that connects the generator to your heart. The pulse generator monitors your heart rhythm. When it detects an arrhythmia, the pulse generator sends an electrical current to your heart to restore a more normal rhythm. The therapy used is either a pre-programmed pacing therapy, or an internal shock. The pulse generator is usually implanted under the skin or muscles below your left collarbone. The IDS is implanted in the operating room under general anesthesia. During the procedure, your doctor will trigger your arrhythmia to ensure that the device will detect it and treat it correctly. Patient follow-up involves having the defibrillator checked with a computer programmer in the cardiology diagnostic center every three or four months, depending on the type of defibrillator system. Call your doctor right away any time you receive a shock from your defibrillator. Catheter Ablation Procedure Patients with Wolff-Parkinson-White (WPW) syndrome and AVNRT have an accessory or extra pathway between the atrium and the ventricle, which may result in supra-ventricular tachycardias (SVTs), or very fast heartbeats. Medications may control these arrhythmias if they are not frequent. Another treatment option for this ailment may be the catheter ablation procedure. Catheter ablation is done by using radio frequency energy to interrupt the extra pathway that allows tachycardia to occur. An extra pathway can sometimes be detected on an ECG, though its exact location can only be determined from an EP study. Catheter ablation is similar to a baseline EP study. You will have catheters placed in your groin and in a vessel below your collarbone. These insertions are done so a special catheter, through which radio frequency waves are transmitted, can be directed to the precise location of the extra pathway. This will cause the area to scar,

15 Questions? Call Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC Clinic staff are also available to help at any time. Cardiology Clinic preventing impulses from traveling over this pathway. The procedure lasts about four to eight hours, and you will receive sedation to ensure your comfort. After the procedure, a chest X-ray is taken, and often an echocardiogram will be done the next day. As with an EP study, you will remain flat in bed for four to six hours. You may feel drowsy when you return to your room. If desired, you may eat and drink liquids. Your follow-up visit will be with your regular cardiologist. Call your doctor if you: Notice tachycardia Feel dizzy Feel lightheaded Feel like you might pass out EP Lab After hours, call the and ask the paging operator to page the EPS fellow on call or EPS attending. Box N.E. Pacific St. Seattle, WA University of Washington Medical Center 01/2004 Reprints: Health Online

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<B0E6C8F1B4EBB3BBB0FA20C0D3BBF3B0ADC1C E687770> 심전도연수강좌 : 처음시작하는사람들을위한심전도 연세대학교원주의과대학순환기내과학교실 안민수 Cardiac Electrophysiology I : Automaticity : 60-100 회 /min, His bundle : 40-60 회 /min Bundle branch : 20-40 회 /min Purkinje fiber : 20 회 /min Cardiac Electrophysiology