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临床条件：1、2项主要标准；2、1项主要标准+3项次要标准；3、5项次要标准 完成的例数完成的例数医院数医院数%75例以下例以下46 41.476-100 1311.7101-2002926.1201-30076.3301-40065.4401-50043.6501-60032.7601-700 0701-800 21.8801以上以上10.9合计合计111100SA node(Origin of Heart Signals)Bundle of His(Junction Area for All Signals Traveling to Ventricles)Right Ventricular Apex(Near Distal End of Electrical Pathway)HighAtrialCatheterBundleof HisCatheterCoronarySinusCatheterRightVentricularApexCatheterIBI-1500T Cardiac Ablation GeneratorMorady F.N Engl.J Med.1999;340:534-544.4.Morady F.N Engl.J Med.1999;340:534-544.Courtesy of Dr.Brian Olshansky.Courtesy of Dr.Brian Olshansky.Flutter waveFlutter stopsHigh to low free-wallCS OS at onset of“F”waveLow to high septalCourtesy of Dr.Brian Olshansky.Local electrogramat successful siteCourtesy of Brian Olshansky.This VT,not adenosine sensitive was from the septumICD系统透视系统透视扩张前造影扩张后造影心健心健PDAPDA堵闭器堵闭器 堵闭术后一周主动脉及肺动脉端堵闭器上可见纤维组织覆盖堵闭术后一周主动脉及肺动脉端堵闭器上可见纤维组织覆盖广东心血管病研究所广东心血管病研究所AmplatzerCardioseal After plantation from selected cineradiogram 3电极接头 高能量输出(7.5 伏)诊断功能?房性心率失常?室性心率失常?房室传导状况 心室间传导障碍或束支传导阻滞导致 心室非同步化激动导致心室充盈及室壁运动异常 通常表现为左束支传导阻滞 双心室起搏的治疗目的 适用于心室失同步化的患者Shamin et al.Eur Heart J 1998;19:abstract 926.Lamp,et al.PACE 1998;2:II-975Aaronson et al.Circulation 1997;95:2660-2667.(1)derivation sample;(2)validation sampleSchoeller et al.Am J Cardiol 1993;71:720-72631%46%27%53%41%Number of Patients宽 QRS*波EF 35%*NYHA III-IV*Representative of criteria used in referenced studies-Therapy OFF-Therapy ON-QRS=160 msQRS=120 msLead V3Electrical:Inter-or Intraventricular conduction delays typically manifested as left bundle branch block Structural:disruption of myocardial collagen matrix impairing electrical conduction and mechanical efficiencyMechanical:Regional wall motion abnormalities with increased workload and stresscompromising ventricular mechanicsTherapeutic intent of atrial synchronized biventricular pacing?Modification of interventricular,intraventricular,and atrial-ventricular activation sequences in patients with ventricular dysynchrony?Complement to optimal medical therapy可能的治疗机制：小结可能的治疗机制：小结A.B.C.D.E.Therapy ONTherapy OFFTherapy ONTherapy OFFCRT 的临床研究的临床研究
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