Electrophysiology of Arrhythmias: Practical Images for Diagnosis and Ablation

 

Description:

 

Concise yet comprehensive, this practical guide to the diagnosis and ablation of cardiac arrhythmias in the electrophysiology laboratory is an indispensable resource for electrophysiologists and general cardiologists. It contains an extensive, unmatched collection of intracardiac recordings, fluoroscopic and ICE images, and 3D color-coded electroanatomic maps (EAMs), making it the premier electrophysiology reference for gaining a better understanding of cardiac arrhythmias. Each chapter focuses on a specific arrhythmia and presents a systematic discussion of diagnostic and ablation criteria, followed by an atlas of electrophysiologic recordings. These illustrations demonstrate all key aspects of the arrhythmia: electrophysiologic features, mode of induction and termination, response to diagnostic pacing maneuvers, classic presentations, unusual manifestations, mapping techniques, and target site criteria for ablation.

 

 

Table of Contents:

 

1.   Bradycardias

SINUS NODE FUNCTION

SINUS NODE RECOVERY TIME

SINO-ATRIAL CONDUCTION TIME

INTRINSIC HEART RATE

CAROTID SINUS MASSAGE

AVN–HIS-PURKINJE AXIS

AVN FUNCTION

AVN REFRACTORY PERIODS

WENCKEBACH CYCLE LENGTH

HIS-PURKINJE FUNCTION

PHYSIOLOGIC VERSUS PATHOLOGIC BLOCK

ATROPINE OR ISOPROTERENOL

PROCAINAMIDE

LOCALIZING THE SITE OF AV BLOCK

12-LEAD ECG

HIS BUNDLE RECORDINGS

Intranodal Block

Intrahisian Block

Infrahisian Block

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

PAROXYSMAL AV BLOCK

BILATERAL BBB

SUPERNORMALITY

FATIGUE PHENOMENA

INFRAHISIAN AV BLOCK DURING ATRIAL FIBRILLATION/FLUTTER

PSEUDO AV BLOCK

Nonpropagated His Bundle Extrasystoles

Nodo-Fascicular/Ventricular Accessory Pathways

Self-Perpetuating Cycle of Intranodal AV Block and Phase IV BBB

REFERENCES

2.   Mechanisms of Tachycardia

MECHANISMS

REENTRY

Circuit

Initiation

Resetting and Entrainment

Criteria of Transient Entrainment

Termination

ENHANCED AUTOMATICITY

Initiation

Resetting and Overdrive Suppression

Termination

TRIGGERED ACTIVITY

Initiation

Overdrive Acceleration

Termination

MAPPING

ENTRAINMENT MAPPING

First Criteria of Transient Entrainment versus Entrainment Mapping

ACTIVATION MAPPING

REFERENCES

3.   Intracardiac Echocardiography

TYPES OF ICE CATHETERS

ICE VIEWS

HOME VIEW

LEFT ATRIUM

RIGHT ATRIUM

RIGHT VENTRICLE

LEFT VENTRICLE

ICE MONITORING

REFERENCES

4.   Transeptal Catheterization

FOSSA OVALIS

EMBRYOLOGY/ANATOMY

TRANSEPTAL CATHETERIZATION

EQUIPMENT

AVOIDING CRITICAL STRUCTURES

PULL-DOWN TECHNIQUE

Pull-down

Tenting

The Puncture

TD/TS Deployment

PUNCTURE TYPES

Double Transeptal Puncture

Site-Selective Transeptal Puncture

TROUBLESHOOTING

FIRST PASS FAILURE

DIFFERENT SEPTA

REFERENCES

5.   Narrow Complex Tachycardias

ELECTROPHYSIOLOGIC FEATURES

12-LEAD ECG

RP Interval

P-Wave Morphology

QRS Alternans

NCT Rate

ELECTROPHYSIOLOGIC STUDY

VA Interval

Atrial Activation Pattern

AV Relationship

Bundle Branch Block

ZONES OF TRANSITION

INITIATION

Spontaneous

Induced

TERMINATION

Spontaneous

Induced

PACING MANEUVERS FROM THE VENTRICLE (INVERSE RULE)

DURING NSR (AV NODE VERSUS AP)

Ventricular Extrastimulation (Retrograde RBBB)

Differential RV Pacing

Parahisian Pacing

DURING NCT

Diastolic VPDs

Entrainment from the Ventricle

PACING MANEUVERS FROM THE ATRIUM

ΔAH VALUE

VA LINKING (AT VERSUS AVNRT/ORT)

AVNRT VERSUS JT

VAGAL MANEUVERS

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

NCT WITH AV DISSOCIATION

DUAL ANTEGRADE RESPONSE TACHYCARDIA

NARROW QRS VT

REFERENCES

6.   Long RP Tachycardias

ELECTROPHYSIOLOGIC FEATURES

PACING MANEUVERS

His Refractory VPDs (Identifying Presence of a Decremental AP)

Entrainment

ABLATION

SUMMARY

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

CYCLE LENGTH ALTERNANS

COUMEL’S LAW IN THE ATRIUM

REFERENCES

7.   Atrio-ventricular Nodal Reentrant Tachycardia

DUAL AV NODE PHYSIOLOGY

ECG MANIFESTATIONS OF DUAL AV NODE PHYSIOLOGY

Dual Antegrade Response versus His Bundle Extrasystole

ELECTROPHYSIOLOGIC STUDY

ATRIO-VENTRICULAR NODAL REENTRANT TACHYCARDIA CIRCUIT

ELECTROPHYSIOLOGIC FEATURES OF AVNRT

12-LEAD ECG

ELECTROPHYSIOLOGIC STUDY

AV Relationship

Bundle Branch Block

ZONES OF TRANSITION

INITIATION

TERMINATION

PACING MANEUVERS FROM THE VENTRICLE

DIASTOLIC VPDs

Preexcitation Index

HIS Refractory VPD (“V on H” Maneuver)

ENTRAINMENT FROM THE VENTRICLE

“AV” Response

Post-pacing Interval (PPI)

ΔHA Value

ΔVA Value

ONSET OF VENTRICULAR OVERDRIVE PACING

PACING MANEUVERS FROM THE ATRIUM

AVNRT VERSUS AT (VA LINKING)

AVNRT VERSUS JT

Atrial Overdrive Pacing

Diastolic APDs

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

CYCLE LENGTH ALTERNANS

DUAL TACHYCARDIAS

CTI/SVC BLOCK

REFERENCES

8.   Ablation of Atrio-ventricular Nodal Reentrant Tachycardia

ANATOMY OF THE AV NODE

ABLATION OF THE SLOW PATHWAY (RIGHT INFERIOR EXTENSION)

SINUS RHYTHM MAPPING OF THE SLOW PATHWAY

RETROGRADE MAPPING OF THE SLOW PATHWAY

LEFT-SIDED ABLATION

MONITORING DURING RF DELIVERY

PROCEDURAL ENDPOINTS

REFERENCES

9.   Basic Evaluation of Accessory Pathways

HALLMARKS OF MANIFEST PREEXCITATION

12-LEAD ECG

ELECTROPHYSIOLOGIC STUDY

AP LOCALIZATION

12-LEAD ECG

Delta-Wave Axis

P-Wave Axis

ELECTROPHYSIOLOGIC STUDY

Earliest Site of Ventricular Activation

Earliest Site of Atrial Activation

Accessory Pathway Potentials

ELECTROPHYSIOLOGIC PROPERTIES OF THE AP

ANTEGRADE AP ERP

ANTEGRADE 1:1 CYCLE LENGTH

RETROGRADE AP ERP

RETROGRADE 1:1 CYCLE LENGTH

RISK OF SUDDEN DEATH

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

PHASE 4 BLOCK

FATIGUE

AUTOMATICITY

SUPERNORMALITY

LONGITUDINAL DISSOCIATION

AV BLOCK

REFERENCES

10.   Orthodromic Reciprocating Tachycardia

MECHANISM

ELECTROPHYSIOLOGIC FEATURES

12-LEAD ECG

ELECTROPHYSIOLOGIC STUDY

AV Relationship

Bundle Branch Block

ZONES OF TRANSITION

INITIATION

Atrial Stimulation

Ventricular Stimulation

Bundle Branch Reentrant Beats (“V3 Response”)

TERMINATION

Spontaneous

Induced

His Refractory VPD

PACING MANEUVERS FROM THE VENTRICLE

DIASTOLIC VPDs

Preexcitation Index

His Refractory VPD (“V on H” Maneuver)

ENTRAINMENT FROM THE VENTRICLE

Orthodromic Capture of the His Bundle

“AV” Response

Post-pacing Interval

ΔHA Value

ΔVA Value

ONSET OF VENTRICULAR OVERDRIVE PACING

PACING MANEUVERS FROM THE ATRIUM

ORT VERSUS AT (VA LINKING)

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

CYCLE LENGTH ALTERNANS

QRS ALTERNANS

CTI/MITRAL ISTHMUS/SVC BLOCK

REFERENCES

11.   Unusual Types of Accessory Pathways

MULTIPLE APs

12-LEAD ECG

ELECTROPHYSIOLOGIC STUDY

PERMANENT FORM OF JUNCTIONAL RECIPROCATING TACHYCARDIA

ELECTROPHYSIOLOGIC FEATURES

12-lead ECG

Electrophysiologic Study

ZONES OF TRANSITION

Initiation

Termination

PACING MANEUVERS FROM THE VENTRICLE

His Refractory VPD

Entrainment from the Ventricle

Onset of Ventricular Overdrive Pacing

ACCESSORY PATHWAYS ORIGINATING/INSERTING INTO THE AV NODE–HIS-PURKINJE SYSTEM

NODO-FASCICULAR/NODO-VENTRICULAR AP

Electrophysiologic Features

AV Block

Orthodromic NFRT

Antidromic NFRT

AVNRT with Manifest/Concealed Bystander NF AP

ATRIO-FASCICULAR AP (OR LONG ATRIO-VENTRICULAR AP)

Electrophysiologic Features

Antidromic AFRT

FASCICULO-VENTRICULAR AP

Electrophysiologic Features

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

DOUBLE TACHYCARDIA (ORT AND AVNRT)

REFERENCES

12.   Ablation of Accessory Pathways

CLASSIC ATRIO-VENTRICULAR ACCESSORY PATHWAYS (BUNDLE OF KENT)

MAPPING

Antegrade

Retrograde

ABLATION

SPECIFIC LOCATIONS

Right versus Left versus CS Posteroseptal

Parahisian versus NCC

ATYPICAL ACCESSORY PATHWAYS

PERMANENT FORM OF JUNCTIONAL RECIPROCATING TACHYCARDIA

MAHAIM FIBERS

REFERENCES

13.   Atrial Tachycardia

12-LEAD ECG

SPECIFIC P-WAVE MORPHOLOGIES

Sinus-Like Morphology

Atypical AVNRT-Like Morphology

Biphasic (Negative–Positive) Morphology

Concordance

ELECTROPHYSIOLOGIC FEATURES

AV RELATIONSHIP

BUNDLE BRANCH BLOCK

ZONES OF TRANSITION

PACING MANEUVERS FROM THE VENTRICLE (“AAV” RESPONSE)

PACING MANEUVERS FROM THE ATRIUM (ABSENCE OF VA LINKING)

MAPPING AND ABLATION

FOCAL ATRIAL TACHYCARDIA

Activation Mapping

Pacemapping

Atrial Overdrive Pacing

MACROREENTRANT ATRIAL TACHYCARDIA

Pacemapping

Entrainment Mapping

Nonpropagated Extrastimulus

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

REFERENCES

14.   Atrial Flutter

ANATOMY OF THE CAVO-TRICUSPID ISTHMUS

CTI-DEPENDENT ATRIAL FLUTTER

CIRCUIT

ELECTROPHYSIOLOGIC FEATURES

12-Lead ECG

Electrophysiologic Study

CTI DEPENDENCY

MAPPING AND ABLATION OF THE CTI

MAPPING

During Atrial Flutter

During NSR

GAP MAPPING

DIFFICULT CTI ABLATION

PROCEDURAL ENDPOINTS

WIDELY SPACED DOUBLE POTENTIALS

ATRIAL ACTIVATION/ELECTROGRAM POLARITY REVERSAL

POSITIVE TERMINAL P-WAVE FORCES

DIFFERENTIAL ATRIAL PACING

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

DOUBLE WAVE REENTRY

LOWER LOOP REENTRY

INTRA-ISTHMUS REENTRY

TRANSPLANT FLUTTER

LONGITUDINAL DISSOCIATION OF THE CTI

UNUSUAL ATRIO-VENTRICULAR CONDUCTION RATIOS

1:1 AV Conduction

Alternating Wenckebach

REFERENCES

15.   Atrial Fibrillation

PATHOPHYSIOLOGY

FOCAL TRIGGERS

ARRHYTHMOGENIC SUBSTRATE

MODULATING FACTORS

ATRIAL FIBRILLATION ABLATION

FOCAL TRIGGERS

Radiofrequency Ablation

Cryoablation

SUBSTRATE MODIFICATION

Electrogram-Based Ablation

Linear Lesions

Mechanistic-Based Ablation

MODULATING FACTORS

Vagal Denervation

TAILORED APPROACH

ENDPOINTS

POST-ABLATION LEFT ATRIAL FLUTTER/TACHYCARDIA

REFERENCES

16.   Sinus Node and Atrio-ventricular Junction Modification/Ablation

SINO-ATRIAL NODE AND AV NODE–HIS BUNDLE AXIS

SINO-ATRIAL NODE MODIFICATION

ATRIO-VENTRICULAR JUNCTION MODIFICATION/ABLATION

RIGHT-SIDED APPROACH

Direct Compact AV Node Ablation

Electrical Isolation of the AV Node

LEFT-SIDED APPROACH

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

IAST IN THE TRANSPLANTED HEART

REFERENCES

17.   Wide Complex Tachycardias

12-LEAD ECG

BASELINE

VT VERSUS SVT WITH BBB

QRS Morphology

QRS Width and Intrinsicoid

QRS Axis

Atrio-Ventricular Relationship

Zones of Transition

Algorithms

VT VERSUS PREEXCITED TACHYCARDIA

ELECTROPHYSIOLOGIC STUDY

HIS BUNDLE ELECTROGRAM/HV INTERVAL

AV RELATIONSHIP

PACING MANEUVERS

During NSR

During WCT

REFERENCES

18.   Preexcited Tachycardias

BYSTANDER PREEXCITED TACHYCARDIAS

ATRIAL FIBRILLATION

ATRIAL FLUTTER/TACHYCARDIA

ATRIO-VENTRICULAR NODAL REENTRANT TACHYCARDIA

Electrophysiologic Features

Zones of Transition

Pacing Maneuvers

ANTIDROMIC REENTRANT TACHYCARDIA

MECHANISM

ELECTROPHYSIOLOGIC FEATURES

AV Relationship

Bundle Branch Block

ZONES OF TRANSITION

PACING MANEUVERS

AVJ-Refractory APD

Rapid Atrial Pacing (Maximal Preexcitation)

Rapid Ventricular Pacing/Entrainment (ΔHA Value/PPI)

REFERENCES

19.   Idiopathic Ventricular Tachycardia and Fibrillation

OUTFLOW TRACT TACHYCARDIAS

MECHANISM

OUTFLOW TRACT ANATOMY

Right Ventricular Outflow Tract

Left Ventricular Outflow Tract

12-LEAD ECG

RVOT VT

RVOT versus LVOT VT

LVOT VT

MAPPING AND ABLATION

Activation Mapping

Pacemapping

PAPILLARY MUSCLE VT

OTHER VT

IDIOPATHIC LEFT VENTRICULAR TACHYCARDIA

MECHANISM

12-LEAD ECG

MAPPING AND ABLATION

Activation Mapping

Pacemapping

IDIOPATHIC VENTRICULAR FIBRILLATION

REFERENCES

20.   Ablation of Scar-Related Ventricular Tachycardia

VT CIRCUIT

CIRCUIT MODEL

12-LEAD ECG DURING VT

MAPPING AND ABLATION

ENTRAINMENT MAPPING

Entrainment Criteria

Entrainment Sites

SUBSTRATE-BASED ABLATION

Sinus Rhythm Ventricular Electrograms

Pacemapping

ENDPOINTS

UNUSUAL ELECTROPHYSIOLOGIC PHENOMENA

NONGLOBAL CAPTURE

SCAR CHANNEL ENTRANCE/EXIT BLOCK

REFERENCES

21.   Bundle Branch Reentrant Tachycardia

CIRCUIT

ELECTROPHYSIOLOGIC FEATURES

ZONES OF TRANSITION

INITIATION

TERMINATION

PACING MANEUVERS

ENTRAINMENT FROM THE ATRIUM

ENTRAINMENT FROM THE VENTRICLE

MAPPING AND ABLATION OF BBRT

RIGHT BUNDLE ABLATION

LEFT BUNDLE ABLATION

INTERFASCICULAR REENTRANT TACHYCARDIA

REFERENCES

22.   Unusual Electrophysiologic Phenomena

SUPERNORMALITY

GAP PHENOMENA

PHASE 4 BLOCK

BILATERAL, EQUAL DELAY

CONCEPT OF CONCEALED CONDUCTION

GROUPED BEATING

WENCKEBACH PERIODICITY

EXIT BLOCK

LONGITUDINAL DISSOCIATION

REFERENCES

Index

 

An aparitie	1 Aug. 2019
Autor	Reginald T. Ho
Dimensiuni	21.59 x 2.54 x 28.19 cm
Editura	LWW
Format	Hardcover
ISBN	9781975101107
Limba	Engleza
Nr pag	578