Electrophysiology: The Basics, 2e THE BASICS

Description:

Fully revised and updated, the second edition of Electrophysiology: The Basics remains a trusted, practical reference for those who are learning the foundational concepts of electrophysiology. A clear, non-technical style, a new full-color format, and heavily updated content make this an ideal reference not only for cardiology fellows in EP rotations, but also for residents, nurses, medical students, physicians reviewing for recertification, and staff in the arrhythmia/cardiac device clinic.

Table of contents:

I: Evaluation and Management

Chapter 1: Bradycardia

Sinus Rhythm

Figure 1-1

Sinus Bradycardia

Autonomic Blockade

Sinoatrial Block

Sinus Node—Corrected Recovery Time and Sinoatrial Conduction Time

Figure 1-2

Figure 1-3

Figure 1-4

Figure 1-5

Figure 1-6

Atrioventricular Junction

Atrioventricular Block

Nodal Block and Intra- or Infra-Hisian Block

Comment Regarding Predictive Value of Provocative Test for Disclosing Patients with Unearthing Sinus Node or Atrioventricular Node Dysfunction

Figure 1-7

Figure 1-8

Figure 1-9

Figure 1-10

Figure 1-11

Figure 1-12

Figure 1-13

Key Points

Suggested Readings

Chapter 2: Supraventricular Tachycardia: AVNRT, AVRT

Chapter 2 Introduction

Epidemiology

Clinical Presentation

Figure 2-1

Table 2-1: Categorization of Narrow-complex Supraventricular Tachycardias Based on Regularity of QRS Complexes and RP versus PR Relationship on the ECG

Atrioventricular Nodal Reentrant Tachycardia

Electrophysiology

Pharmacologic Treatment

Catheter Ablation

Figure 2-2

Figure 2-3

Figure 2-4

Figure 2-5

Figure 2-6

Figure 2-7

Figure 2-8

Figure 2-9

Wolff–Parkinson–White Syndrome, Atrioventricular Reentrant Tachycardia

Epidemiology

Electrophysiology

Risk Stratification

Pharmacologic Treatment

Catheter Ablation

Figure 2-10

Figure 2-11

Figure 2-12

Figure 2-13

Figure 2-14

Figure 2-15

Summary

Key Points

References

Suggested Readings

Chapter 3: Atrial Arrhythmias

Atrial Fibrillation

Diagnosis and Epidemiology

Pathophysiology

Classification

Symptoms and Clinical Presentation

Initial Evaluation

Prognosis and Complications

Antithrombotic Therapy

Nonpharmacologic Stroke Prevention

Pharmacologic Therapy for Rhythm and Rate Control

Electrical Cardioversion

Catheter and Surgical Ablative Therapy

Figure 3-1

Table 3-1: Conditions Associated with AF

Figure 3-2

Figure 3-3

Figure 3-4

Table 3-2: Stroke Risk According to the CHA2DS2-VASc Index

Figure 3-5

Table 3-3: 2014 AHA/ACC/HRS Guidelines for Antithrombotic Therapy for Patients with Nonvalvular AF

Figure 3-6

Table 3-4: Indications for Catheter Ablation of AF

Atrial Flutter

Definition

Epidemiology

Incidence

Risk Factors

Clinical Presentation

Symptoms

Electrocardiogram

Complications

Pathophysiology

Mechanism

Origin

Categorization

Diagnosis

Pharmacologic Maneuvers

Electrophysiologic Maneuvers

Therapy

Acute Treatment

Long-term Treatment

Catheter Ablation

Anticoagulation

Figure 3-7

Figure 3-8

Figure 3-9

Figure 3-10

Figure 3-11

Atrial Tachycardia

Definitions and Classifications

Epidemiology

Prognosis

Management

Acute Therapy

Long-Term Pharmacologic Therapy

Multifocal Atrial Tachycardia

Mapping and Ablation Strategy for Atrial Tachycardia

Figure 3-12

Table 3-5: Classification of ATs and Common Characteristics

Figure 3-13

Key Points

Atrial Fibrillation

Atrial Flutter

Atrial Tachycardia

Suggested Readings

Chapter 4: Ventricular Tachycardia

Chapter 4 Introduction

VT Mechanisms

Figure 4-1

Clinical Evaluation Prior to Ablation Procedure

Figure 4-2

Ablation of Idiopathic VT

Figure 4-3

Ablation of Outflow Tract VT

LV Idiopathic VT

Ablation of VT in Structural Heart Disease

Scar-Related Monomorphic Sustained VT

Entrainment Mapping

Substrate Ablation

Figure 4-4

Figure 4-5

Summary

Key Points

Suggested Readings

Chapter 5: Syncope

Chapter 5 Introduction

Figure 5-1

Cardiac Syncope

Disorders of Autonomic Function

Arrhythmias

Figure 5-2

Figure 5-3

Figure 5-4

Noncardiac Syncope

Conclusions

Figure 5-5

Key Points

Suggested Readings

Chapter 6: Sudden Cardiac Death and the Cardiac Arrest Survivor

Chapter 6 Introduction

Clinical Causes

Ischemic Heart Disease

Nonischemic Cardiomyopathy

Arrhythmogenic Right Ventricular Cardiomyopathy

Hypertrophic Cardiomyopathy

Long QT Syndrome

Brugada Syndrome

Catecholaminergic Polymorphic Ventricular Tachycardia

Early Repolarization Syndrome

Short QT Syndrome

Short-Coupled Ventricular Fibrillation

Other Causes

Initial Investigation Strategy

Resting Electrocardiogram

Assessment of Cardiac Structure and Function

Coronary Artery Assessment

Figure 6-1

Figure 6-2

Figure 6-3

Figure 6-4

Figure 6-5

Further Testing in Unexplained Cardiac Arrest

Exercise Testing

Signal-Averaged ECG

Epinephrine Provocation

Brugada Syndrome and Sodium Channel Blocker Provocation

Invasive Electrophysiology Testing

Other Considerations

Figure 6-6

Figure 6-7

Figure 6-8

The Genetics of Sudden Death

Treatment

Acute Management of Sudden Cardiac Arrest

Secondary Prevention

Device Therapy

Medical Therapy

Ablation

Surgery

Conclusion

Acknowledgment

Key Points

Clinical Causes of SCA

Investigation of SCA Survivor

Suggested Readings

Ii: The Electrophysiology Laboratory

Chapter 7: Electrophysiology Equipment

Chapter 7 Introduction

Multichannel Physiologic Recorders

Figure 7-1

Stimulators

Catheters

Figure 7-2

Fluoroscopy

Energy Sources for Ablation

Cryoablation

Three-Dimensional Mapping Systems

Carto Electroanatomic Mapping (Biosense Webster, Inc. Diamond Bar, California)

Impedance-Based Mapping Systems: Ensite Velocity (St. Jude Medical, Inc., St. Paul, Minnesota)

Three-Dimensional Image Integration

Rhythmia (Boston Scientific Corp., Natick, Massachusetts)

Figure 7-3

Figure 7-4

Figure 7-5

Figure 7-6

Echocardiography in the EP Lab

Transthoracic Echocardiography

Transesophageal Echocardiography

Intracardiac Ultrasound

Figure 7-7

Figure 7-8

Remote Navigation Systems

Magnetic Navigation

Robotic Navigation

Cardioverter Defibrillators

Key Points

EP Laboratory Equipment

Suggested Readings

Chapter 8: Electrophysiologic Testing: Indications and Limitations

Chapter 8 Introduction

Diagnostic EP Study

Figure 8-1

Figure 8-2

Paroxysmal Supraventricular Tachycardia

Figure 8-3

Figure 8-4

Figure 8-5

Figure 8-6

Figure 8-7

Figure 8-8

Risk Stratification in Patients with Structural Disease

Limitations of Electrophysiologic Risk Stratification

Technical Aspects of Programmed Ventricular Stimulation

Figure 8-9

EP Testing in WPW

EP Evaluation in Patients with Brugada Syndrome

Figure 8-10

Syncope in Patients with a Normal Heart

Figure 8-11

Figure 8-12

Electrophysiologic Study and Catheter Ablation of Specific Arrhythmias

Atrial Flutter

Catheter Ablation of Atrial Fibrillation

Ablation of the AV Junction

Ventricular Arrhythmias

Figure 8-13

Figure 8-14

Figure 8-15

Figure 8-16

Figure 8-17

Figure 8-18

Summary

Key Points

Suggested Readings

Chapter 9: Principles of Mapping and Ablation

Introduction

Catheter Ablation: Historical Development

Biophysics of Catheter Ablation

Figure 9-1

Figure 9-2

Other Energy Sources for Ablation

Figure 9-3

Catheter Mapping and Ablation: Vascular Access and Cardiac Chamber Approach

Figure 9-4

Goals of Cardiac Mapping

Tools for Cardiac Mapping

Figure 9-5

Specific Mapping Techniques: Activation Mapping

Figure 9-6

Specific Mapping Techniques: Pace Mapping

Figure 9-7

Specific Mapping Techniques: Entrainment Mapping

Figure 9-8

Specific Mapping Techniques: Substrate Mapping

Figure 9-9

Figure 9-10

Key Points

Table 9-1: Comparison of Mapping Techniques

References

Suggested Readings

Chapter 10: Indications for Cardiac Rhythm Management Devices

Chapter 10 Introduction

Physiologic Pacing

Table 10-1: Potential Adverse Effects of Ventricular Pacing (RV) in SND

Table 10-2: Important Clinical Trial in Pacing and Mode Selection

Figure 10-1

Table 10-3: Indications for Pacing

Pacing for Sinus Node Dysfunction

Pacing for Acquired or Chronic Atrioventricular Block

Indications for Pacing Not Related to SND or AV Block

Indications for Internal Cardioverter-Defibrillator Implantation

Table 10-4: Primary and Secondary Prevention Indications for ICD

Figure 10-2

Table 10-5: Secondary Prevention ICD Trials

Table 10-6: Primary Prevention ICD Trials

Subcutaneous Implantable Defibrillator

Table 10-7: S-ICD: Ideal Candidate and Contraindications

Wearable Cardioverter-Defibrillator

Figure 10-3

Cardiac Resynchronization Therapy

Figure 10-4

Temporary Venous Pacing

Table 10-8: Indications for Temporary Transvenous Pacing

Summary

Key Points

References

Suggested Readings

Guidelines

Clinical Trials and Review Articles: Pacing

Clinical Trials: ICD Therapy

Clinical Trials and Review Articles: CRT

Chapter 11: Ambulatory Electrocardiographic Monitoring

Chapter 11 Introduction

Figure 11-1

Figure 11-2

Smartphone-Based Monitoring

Holter Monitoring

Event Recorders

Ambulatory Cardiovascular Telemetry

Selection of Appropriate AECG Monitoring Technologies

Implantable Loop Recorders

Figure 11-3

Indications for Ambulatory ECG Monitoring

Palpitations

Syncope

Atrial Fibrillation

Figure 11-4

Figure 11-5

Table 11-1: Indications for ILRs in Patients with Syncope

Table 11-2: Reasons for Ambulatory ECG Monitoring in Patients with Known AF

Figure 11-6

Summary

Key Points

Suggested Readings

Iii: The Pacemaker and Defibrillator Clinic

Chapter 12: Device Interrogations and Utilization of Diagnostic Data

Introduction

Getting Started

Table 12-1: Phone Numbers of Major Device Companies

Device Functional Information

Basic Programmed Data

Battery Status

High Voltage Charge Circuit Status

Lead Status

Impedance (Resistance)

Sensing Threshold

Pacing Threshold

Figure 12-1

Figure 12-2

Figure 12-3

Figure 12-4

Figure 12-5

Figure 12-6

Patient Rhythm Diagnositics

Figure 12-7

Figure 12-8

Rhythm-Specific Information

Figure 12-9

Figure 12-10

Figure 12-11

Appropriate Programming Based on Observed Data

Atrial Fibrillation with Fast Pacing Rate

Loss of Capture

Failure to Pace

Inappropriate Shocks by an ICD

Failure to Detect Ventricular Tachycardia by an ICD

Other Monitored Parameters

Figure 12-12

Remote Monitoring

Conclusion

Key Points

Suggested Readings

Chapter 13: Lead Management and Extraction

Chapter 13 Introduction

Figure 13-1

Lead Infection

Epidemiology

Risk Factors for CIED Infection

Microbiology

Clinical and Economic Consequences

Clinical Signs and Symptoms

Indications Lead Extraction for CIED Infection

Management of Suspected CIED Infection

Table 13-1: Risk Factors for CIED Infection

Figure 13-2

Figure 13-3

Figure 13-4

Figure 13-5

Lead Design and Recalls

Lead Design

Lead Failure

Lead Durability

Lead Recalls

Medtronic Sprint Fidelis

St. Jude Medical Riata

Lead Management and Extraction with Nonfunctional Leads

Table 13-2: Lead Design Considerations Impacting Long-Term Durability due to Complexity

Figure 13-6

Table 13-3: Types of Lead Failure

Figure 13-7

Figure 13-8

Venous Occlusion and Chronic Pain

Venous Occlusion

Chronic Pain

Lead Abandonment

Figure 13-9

Lead Extraction

Lead Design and Extraction

Predictors of Extraction Difficulty

Terminology and Defining Success

Extraction Team and Approach

Complications Associated with Lead Extraction

Clinical Outcomes with Lead Extraction

Key Points

Suggested Readings

Iv: Miscellaneous Topics

Chapter 14: Approach to the Patient with Wide Complex Tachycardia

Introduction

Uniform-Morphology Wide Complex Tachycardia—Diagnostic Possibilities

Table 14-1: Relative Frequency and Clinical Settings of WCTs

Ventricular Tachycardia versus Supraventricular Tachycardia with Aberration

Table 14-2: ECG Distinctions between VT and SVT

Figure 14-1

Figure 14-2

Figure 14-3

Figure 14-4

Figure 14-5

Figure 14-6

Polymorphic Wide Complex Tachycardia

Figure 14-7

Figure 14-8

Figure 14-9

Management of Wide Complex Tachycardia

Figure 14-10

Summary

Key Points

Considerations in WCT Diagnosis

References

Suggested Readings

Chapter 15: Antiarrhythmic Medications

Chapter 15 Introduction

Antiarrhythmic Drug Classification

Class I Drugs

Class IA Drugs—Quinidine, Procainamide, and Disopyramide

Class IB Drugs—Lidocaine, Mexiletine, and Phenytoin

Class IC Drugs—Propafenone and Flecainide

Class II Drugs—β-Blockers

Class III Drugs—Amiodarone, Drodenarone, Dofetilide, Ibutilide, Sotalol, Bretylium, and Vernakalant

Class IV Drugs—Verapamil and Diltiazem

Unclassified Drugs—Adenosine and Digoxin

Drugs under Investigation for their Antiarrhythmic Properties: Ranolazine and Ivabradine

Figure 15-1: The Vaughan Williams Classification and Description of Specific Drugs

Table 15-2: Characteristics and Usual Doses of Various β-blocking Agents

Figure 15-1

The Use of Antiarrhythmic Drugs in Pregnancy

Table 15-3: Definition of FDA Pregnancy Risk Categories

Figure 15-4: Indications and Potential Adverse Effects of Antiarrhythmic Drug Use in Pregnancy

Key Points

Suggested Readings

Chapter 16: Channelopathies

Introduction

Figure 16-1

Figure 16-2

Long-QT Syndrome

LQTS Diagnosis

Risk Stratification and Management of LQTS Patients

Drug-Induced QT Prolongation and the Risk of Proarrhythmia

Figure 16-3

Table 16-1: Genetic Types of the LQTS

Table 16-2: Diagnostic Criteria for Channelopathies According to 2013 HRS/EHRA/APHRS Expert Consensus Statement

Table 16-3: Bazett-Corrected QTc Values for Diagnosing QT Prolongation

Figure 16-4

Table 16-4: Diagnostic Criteria for Long-QT Syndrome

Table 16-5: M-FACT Risk Score

Table 16-6: Indications for ICD Implantation in Patients with Channelopathies (According to HRS/EHRA/APHRS 2013 Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes)

Table 16-7: Drugs That Prolong the QT Interval (for more complete listing please visit www.qtdrugs.org)

Short Qt Syndrome

Figure 16-5

Brugada Syndrome

Figure 16-6

Figure 16-7

Catecholaminergic Polymorphic Ventricular Tachycardia

Figure 16-8

Early Repolarization

Figure 16-9

Summary

Key Points

Suggested Readings

Channelopathies

Long-QT Syndrome

Short-QT Syndrome

Brugada Syndrome

Catecholaminergic Polymorphic Ventricular Tachycardia

Early Repolarization

 

 

An aparitie	2017
Autor	Jonathan S. Steinberg and SUneet Mittal
Dimensiuni	1.3 x 12.7 x 19.7 cm
Editura	LWW
Format	Paperback
ISBN	9781496340016
Limba	Engleza
Nr pag	348