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 II. Conductivity 심전도연수강좌 : 처음시작하는사람들을위한심전도
Session II. Bradycardias and Pacemaker Conduction System of Heart Bundle branches P Q R S T Sinus node node AV bundle His Dysarrhythmia Tachycardia Bradycardia Formation: Site formation conduction Supraventricular Sinus Atrial Junctional Ventricular Sinus node dysfunction SA exit block AV block 1 st 2 nd : Type I/II 3 rd High degree Bundle branch block Sinus arrest, pause Sinus pause is not a multiple of the PP interval Sinus arrest is longer than a sinus pause 심전도연수강좌 : 처음시작하는사람들을위한심전도
안민수 :Bradyarrhythmia Tachycardia-bradycardia syndrome Sinus pause=26sec In the transition between the tachycardia and the bradycardia, long pause caused by inappropriate suppression of the sinus node are present Indication of pacemaker in Sinus node dysfunction CLASS I Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C) Permanent pacemaker implantation is indicated for symptomatic Symptomatic chronotropic incompetence. (Level of Evidence: C) Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C) Dysarrhythmia Tachycardia Bradycardia Formation: Site formation conduction Supraventricular Sinus Atrial Junctional Ventricular Sinus node dysfunction SA exit block AV block 1 st 2 nd : Type I/II 3 rd High degree Bundle branch block 심전도연수강좌 : 처음시작하는사람들을위한심전도
Session II. Bradycardias and Pacemaker First degree atrioventricular block PR interval > 200 msec 368 msec CASE 1-1-1 ECG Second degree type I AV block PR interval progressively lengthens RR interval progressively shortens The interval including the dropped beat is less than the sum of two PP interval 심전도연수강좌 : 처음시작하는사람들을위한심전도
안민수 :Bradyarrhythmia Mobitz type I AV block (Wenckebach periodicity) SAN A AVN V 840 840 840 840 840 840 840 340 420 340 420 340 420 A=920 B=1580 2 x A > B 2007-11-05 Second degree type II AV block PR intervals are constant the pause is exactly equal to two 800ms 800ms 800ms 800ms 800ms 800ms 800ms 800ms 160 160 160 160 160 160 160 1600ms 800ms 800ms 800ms 1600ms 2:1 AV block PR intervals are constant P:R=2:1 심전도연수강좌 : 처음시작하는사람들을위한심전도
Session II. Bradycardias and Pacemaker High degree AV block At least two consecutive P waves need to be blocked One beat was conducted to the ventricles PR interval remains constant and PP cycle is regular Third degree(complete) AV block complete block of conduction to the ventricles Indication for for Acquired Atrioventricular Block in Adults third-degree and advanced second-degree AV block at any anatomic level associated with bradycardia with symptoms (including heart failure) or ventricular arrhythmias presumed to be due to AV block. (Level of Evidence: C) third-degree and advanced second-degree AV block at any anatomic level associated with arrhythmias and other medical conditions that require drug therapy that results in Symptomatic symptomatic bradycardia. (Level of Evidence: C) Ventricular arrhythmia third-degree and advanced second-degree AV block at any anatomic level in awake, symptom-free patients in Asystole sinus rhythm, with documented 3sec periods of asystole greater than or equal to 3.0 seconds Escape or any rate escape rate <40bpm less than 40 bpm, or with an escape rhythm that is below the. (Level of Evidence: C) 심전도연수강좌 : 처음시작하는사람들을위한심전도