*

/


(
)

: :
..
Carina Blomstrom-Lundqvist, Melvin M. Scheinman,
MD, PhD, FESC MD, FACC
Representing: ESC Representing: ACC/AHA
University Hospital in Uppsala Professor of Medicine
Department of Cardiology University of California San Francisco
S-751 85 Uppsala MU East Tower, 4th Flr.S., Box 1354
SWEDEN 500 Parnassus Ave
San Francisco, CA 94143-1354-USA

: (46) 18 611 27 35 : (415) 476 5708

: (46) 18 51 02 43 : (415) 476 6260
E-mail: E-mail:
carina.blomstrom.lundqvist@akadenmiska.se mels@medicine.ucsf.edu

:
1. Etienne Aliot, Nancy, France
2. Joseph S. Alpert, Tuscon, USA
3. Hugh Calkins, New York, USA
4. A. John Camm, London, UK
5. W. Barton Campbell, Nashville, USA
6. David E. Haines, Charlottesville, USA
7. Karl H. Kuck, Hamburg, Germany
8. Bruce B. Lerman, New York, USA
9. D. Douglas Miller, Saint-Louis, USA
10. Charlie W. Shaeffer, Jr., Rancho Mirage, USA
11. William G. Stevenson, Boston, USA
12. Gordon F. Tomaselli, Baltimore, USA

(ESC):
1. Keith McGregor, Sophia-Antipolis, France
2. Veronica Dean, Sophia-Antipolis, France
3. Dominique Poumeyrol-Jumeau, Sophia-Antipolis, France
4. Catherine Desprs, Sophia-Antipolis, France

*
(), -
(), (ESC):
(European Heart Journal, 2003; 24 [20]: 1857-1897).
 I.

I. . 3 (SVAs) ,
,
II. : [ (Ss), ]
[
. . 5 (VNRT)]. -
. . 5 , e -
. -
-
,
III. . (.
. (inappropriate) . 8 )
. -
. (PSVT) 2-3 1000. -
-
(VNRT) . 9 ( ).
.

( ) . 11 -
(SVT, ). -
. re-entry - ,
( ) . 12 .
SVT . //ESC -
. . 15

. . 15 , .
. re-entry . 17
,
. . 20 (ESC), -
() -
().
IV. . 31 -
, ,
.
.

2 3
 II. :
, -
: . ( 1)

():
 ,
I: , /
, .
 -
() ().
, -
.

II: , -
/ - ( SVT). -
/ - re-entry -
. , - (V) (..
AVNRT, AVRT).
 ,
II: .
.
.
IIb: / - 1. QRS-
. (QRS) (- 120 ms), -
-
( 2). -
III: , / -
, ( 3). QRS--
()/() Adenosine ( 4) -
(). .

4 5
2. QRS- ( 5)

QRS-
(- 120 ms) *
: -

) SVT () ( ),
) SVT AV- , I
) (VT). QRS- (SVT) Adenosine I
- QRS- Verapamil, Diltiazem I
, , - - II b
( 5). miodarone II b
Digoxin II b

3. QRS-
SVT ,  SVT -
VT. -  Flecainide I
SVT (Verapamil Diltiazem) - SVT/AF Ibutilide I
VT. (. Procainamide I
VT - DC I
) -
. -  Procainamide I
(DC). Sotalol I
QRS- Amiodarone I
: Lidocaine II b
 Wolff-Parkinson-White (WPW) [ Adenosine II b
()+]. - III
 Verapamil** III
, . DC I
 QRS- . Amiodarone I
 QRS- QRS- Lidocaine
- DC I
a .

, , -
. ,
. , -
//ESC (2).
* .
IID, 1.
.
Adenosine , -
.
.
- -
, outflow .
** Verapamil LV -
. AF= ; = ; DC= ; ECG=;
LV= ; QRS= ; SVT= .

6 7
 III. .
(VNRT)
. (inappropriate) AVNRT re-entry , V-, -
- . ()
, - AV- () -
, , .
. 90% . AVNRT (85-90%)
, AV-
. - . -
AVNRT R-
: P P- III aVF ,
QRS.
 [
() > 100 ./min] ,

, 24- Holter-. ,
 . AV- (-
 - , , Adenosine).
. , , -
 (,
.
, ).
. ,
,
. - ,

66%. - . ,
(S) (< 1%) AV-
. .


-

- I
Verapamil, Diltiazem II
II b
/


, , -
. ,
. -
//ESC (2).
* .

8 9
 AVNR .

( )

-

1. ( )
, -
AVNRT I
, AV- His. E
Verapamil, Diltiazem, II a 110 o 250
a-e, Sotalol,
./min AV-.
Amiodarone
, -
Flecainide*, Propafenone* II a . , -
, .
I B , -
AVNRT 5 o 10% AV-.
Verapamil I B
Diltiazem, a-e I C 2.
( )
Digoxin II b
, 70 o
AVNRT, Flecainide*, II a B 120 ./min. , -
- Propafenone*, Sotalol
,
Amiodarone II b C , , -
RF
, .
AVNRT I B - ,
, .

PSVT Verapamil, Diltiazem, I C ( )
AV- - a-e,

- , - Flecainide*, Propafenone* -


I B a-e II

Flecainide II
, AVNRT I C
Propafenone* II
I B
Sotalol* II
I B
Amiodarone * II
Verapamil, Diltiazem, I
a-e II

I I

, , - I
. ,
. - I
//ESC (2).
* , LV - a-e, II
.
Digoxin , , - , , -
. . .
AV = -; AVNRT = ; . , -
LV = ; SVT = ; RF = //ESC (2).
*
10 11
. re-entry
( )
-
, ,
AV-. , . -
, , , -
, - , ,
() - , -
. WPW - , - .
-, .
:

 AVRT (-, 95%) -
AV- - , AV - , Adenosine
. AF . -
, -
 AVRT - - (Flecainide, Procainamide Ibutilide), ,
, AV-- .
( ) -
QRS- .
 - - -
( - ,
) - , -
. . ()
 - , - -
- . 30% , .
WPW - .

 PJRT ( - , -
) -
; - .
RP P- II, III -
aVF . .

WPW - 95% ,
-
, -
, : . -
1) - R-R < 250 -
ms AF, 2) , . AV-
3) 4) Ebstein. 0,17 1,0% -
0,15 - 0,39% . 1,8 o 4%,
WPW , 3 o 10 . 0,08 o 0,13% .

12 13
 , . (FAT)

AT

-
, . -
-
100 250 ./
WPW I B
min ( 300 ./min).
, -
(
Flecainide, Propafenone II a C ( )

re-entry.
Sotalol, Amiodarone, a-e II a C () / -
),
Verapamil, Diltiazem, Digoxin III () -
. 10% -
. AT , -
WPW ( I B -
AF - .
-
AVRT)

AVRT, I (a-e, Digoxin)
. la
Flecainide, Propafenone II a C Ic (Flecainide Propafenone) .
(
Sotalol, Amiodarone II a C i.v. Adenosine,
) a-e (),
a-e II b (-). Adenosine
Verapamil, Diltiazem, Digoxin III
FAT . DC
AT,
I AT re-entry
-
I B .
AVRT
( - Verapamil, I B
)
-
Diltiazem, a-e , AV- , -
II a B . , - -
AV--
Sotalol, Amiodarone II b B . AT -
Flecainide, Propafenone II b C
, AT.
80 o 90% 70 o 80% -
Digoxin III C .
(1 o 2%). AT -
I Koch AV-.
,
a II a B . (MAT)
, , - T -
. , P- .
. - AF. --
//ESC (2). AF= ,
; AVRT= ; . -
WPW = Wolff-Parkinson-White ,
. , DC ,
.
14 15
 * . re-entry
- re-entry
- (250 o 350 ./min). - re-entry ,
. , -
, ,

(CTI, ). - (-
A. ), -
( ).
- DC I B - -
, -
- Adenosine II re-entry.
( -
a-e II mapping), re-entry . -
,
Verapamil II ,
. AV- 2:1, -
Procainamide II , , .
Flecainide, Propafenone II

Amiodarone, Sotalol II , -
B. a-e I .
( - , ,
) Verapamil, Diltiazem I DC .
( ) -
Digoxin Ib , DC . -

, AV-.
- I , -
AT , -
a-e, I
( Ic) -
. 48 ,
Disopyramide II
3 o 4 -
Flecainide, Propafenone II -
TEE.
Sotalol, Amiodarone II . , AV-,
Amiodarone . Ibutilide
- I
ATs
i.v. - -
38 76%; -
- I C Ic.
III, Dofetilide (
III C 73%) . -
, , - , -
. , .
. - CTI
//ESC (2). CTI . CTI
* MAT, a-e Sotalol - ,
. . . 50 88% -
Flecainide, Propafenone Disopyramide , AV-
. AT = ; DC = ; MAT = -
.

16 17

/ -
- -
/


I B
 DC I
* II a B
 a-e II
Verapamil, Diltiazem II , * I B
-
Digitalis II b Dofetilide II a C

Amiodarone II b Amiodarone, Sotalol, II b C

Flecainide, Chinidine,
Propafenone,
 - I Procainamide,
Disopyramide

DC I - * I

Ibutilide II
- * I B
Flecainide II b ,
- II a C
Propafenone II b I
Amiodarone
Sotalol II b
AF
Procainamide II b
, * II a B
Amiodarone II b CTI

 Diltiazem Verapamil I
-
a-e I -

Digitalis II b
, , -
Amiodarone II b . ,
. -
, , -
. , //ESC (2).
. - * AV- ,
//ESC (2). -
(INR 2 o 3), -
- 48 h TEE -

. , AF.
Digitalis . Flecainide, Propafenone, Procainamide, Chinidin Disopyramide -
Ibutilide LV. AV-.
Flecainide, Propafenone Procainamide ,
AV-. AF = ; AV = ; CTI =
AV = , DC = ; INR = ,
LV = , TEE =

18 19
. SVT

1.

SVT, , -
. - I
,
. - PSVT Adenosine I
. 1) , , - D I
. 2)
Metoprolol, II
. 3) (- Propranolol
) -
(.. ). , Verapamil IIb
Adenosine i.v. DC . Digoxin I
-
. Metoprolol* I
8 - -
. / Propranolol* II
- 2- 3- . Sotalol*, Flecainide II
-
- Chinidine, IIb
. Propafenone,
Verapamil
Procainamide IIb

- IIb

Atenolol III

Amiodarone III
, , -
. ,
. -
//ESC (2)
* - , .
AV- Flecainide Propafenone
( V).
Atenolol C ( -
)
AV = -; DC = ; PSVT =

20 21
2. SVTs
SVT -


.
, , .
-
, . -
,
.  SD: - I

, SVTs.

. ,
 -
. Mustard Senning I



- ASD I
-
ASD
*

PSVT I
Ebstein -
- -
,


,
-
-
-

* -
.
ASD = ; PSVT =

22 23
 1. 2.
QRS

AVRT = ; -
AVNRT AV- / .
ECG, = ; AF= ; MAT = -
; AV = AV = ; AVNRT = ; AVRT =
;
MAT = , ms = ;
PJRT = ;
QRS = .

24 25
 3. E- I, II III, - 4.
RP ( R- o P-) Adenosine
, - PR-

P P . ECG, = .

AT = ; AV = , AVNRT =
, AVRT = ; IV = ; QRS =
; VT = ..

26 27
 5. 6.
QRS- (- 120 ms)

QRS , ,
. Adenosine
, VF AF
-. Adenosine . 6. 12- E
, . Adenosin , -
(fusion beats) VT. AF, -
, QRS - (.., - .
) . A = ; AF = **Ibutilide ,
; AP = ; AT = ; AV = - EF - 30% VT.
; AVRT = ; BBB = ; LBBB = AF = ; AV = ; BBB = ; DC = ; ECG,
; ms = , QRS = ; RBBB = , SR = : = ; i.v. = : LV = ; QRS = ; SVT = -
SVT = ; V = ; VF = ; VT = . , VT =

28 29
 7. - IV

1) Adapted from the ACC/AHA/ESC Guidelines for the Management of
Patients with
Supraventricular Arrythmias: Executive Summary
C. Bomstrom-Lundqvist and M. M. Scheinman (Chairpersons), E. M. Aliot,
J. S Alpert, H. Calkins. A J. Camm, W B. Campbell, D. E Haines. K. H.
Kud; B. B. Lerman. D D. Miller, C W Shaeffer, Jr. W G. Stevenson, G. F.
Tomaselli
European Heart Journal 2003; 24 (20): 1857-1897

(2) ACC/AHA/ESC Guidelines for the Management of Patients with Atrial

Fibrillation Report from the Joint Task Force of the ESC, ACC AHA
V Fuster (Chairperson), L.E. Ryden (Co-Chair). R.W. Asinger, D S. Cannom,
H. J. Crijns, R.L. Frye, J. L. Halperin, G.N. Kay, W.W. Klein, S. Levy, R.L.
McNamara, E. N. Prystowsky, L. S. Wann, D.G. Wyse
European Heart Journal 2001; 22 (20): 1852-1923

,
, AF.
AF = ; AV = ; CHF =
; DC = ; Ml = .

ESC// -
-
.
, .
-
,
.

30 31
 :

32