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1、Cavotricuspid Isthmus,三尖瓣环与欧氏瓣和下腔静脉开口之间的峡部宽度约为23cm，是房扑折返环中最窄、传导最为缓慢的共同通道。峡部肌小梁交错、重叠，电传导各向异性并呈双向传导。,Fischer等将右房峡部分为三区区：三尖瓣环下腔静脉 成功率70%区：三尖瓣环冠状窦口 成功率30%区：冠状窦口下腔静脉 成功率10%,Figure 6.,Figure 5,Illustration showing the importance of obtaining both RAO and LAO views to ascertain multielectrode catheter posi
2、tion.The top panel in the RAO view the catheter tip points posteriorly.The bottom panel shows correct positioning of the catheter.Note the tip of the catheter is in the plane of the CS and when advanced will not advance posteriorly as the case when positioned behind the Eustachian ridge.,左心房,左房腔体 心耳
3、肺静脉口二尖瓣环,左房腔体,Heart Rhythm,7(2):269 2010,左房腔体,The heart has been cut through the ridge to show its pointed profile formed by the infolding of the atrial wall.Note the continuation of LA musculature onto the LSPV.The broken line marks the isthmus between the orifice of the LIPV and the mitral annulus
4、.,左房腔体,Heart Rhythm,7(2):269 2010,Carina,carina fibers must have an endocardial to epicardial route near the perimeter of the veins and thus are less amenable to endocardial ablation at the perimeter周界.,compact atrioventricular node,Compact Atrioventricular Node,Heart Rhythm,7(2):269 2010,肺静脉,77%的人有
5、双侧肺静脉左侧肺静脉开口较右侧高下肺静脉的开口更接近于后壁上肺静脉与水平面的夹角较下肺静脉大,AFCARTO MERGE,左心房肺静脉解剖变异,肺静脉解剖,肺静脉解剖,左房毗邻,前壁:主动脉，肺动脉后壁:食道，降主动脉后下壁:冠状静脉顶壁:肺动脉底部:左室,左房的毗邻,前壁:AO,PA,后壁:食道，降主动脉,Possible determinants of the risk of thermal damage to the esophagus:1.fat pad surrounding the esophagus,2.wall thickness of the LA and esophagus
6、,3.spatial relationship of the esophagus and LA,There is a protective layer of fat between the esophagus and the posterior LA,yet this layer is often discontinuous and,in 2%of normal subjects,completely absent.,Esophagus,Esophagus,食管前壁平均厚度1.9-5.3 mm,LA后壁的平均厚度 1.3-3.1 mm.食管与LA之间最小距离为 3.3 mm;1.9+1.3+3
7、.3=6.5 mm,Esophagus,Circulation.2004;110:3655-3660,Esophagus,食管 Esophagus,左房和食管接触的长度和宽度:长度:5814 mm 宽度:13 6 mm.食管和左房之间解剖方向的复杂性:56%的病人食管与左侧肺静脉平行,其中36%为左上肺静脉向右下肺静脉斜行;其余44%偏右或居中,Esophagus,Circulation.2004;110:3655-3660,食管 Esophagus,Cardiac Dyna CT,The view of the cardiac base has most of the atrial wall
8、s removed to show the proximity of the LAA to the left coronary artery and the pulmonary trunk.Note the relationship of the aorta to the anterior walls of the atria.,Aorta,Aorta,the posterior LA is directly opposed by a large portion of the anterior surface of the descending aorta,with an average co
9、ntact area of 18.9 4.4 mm.aorta compressing the LA and left inferior PV,Left Circumflex Artery,LCx is located in the posterior atrioventricular groove in continuity with the CS;there is commonly a separating layer of fat.The LCX is also located in close proximity to the inferior aspect of the LAA.Th
10、e mean distance between the LCx and the LAA was 3.3 mm(0.719.6 mm),and the median distance between the CS and the LCx was 2.0 mm(0.49.7 mm).,Bronchial Tree,AP,PA,B,A,the PVs,particularly the superior PVs,are in close contact with the bronchial tree.,Phrenic Nerve,左房腔体,Weve been all the way to the moon and back,but have trouble crossing the street to meet the new neighbor,.,
