Clinical Cardiac Electrophysiology - E-Book

A Practical Guide

Demosthenes G Katritsis, Fred Morady

• Publisher: Elsevier
• Year: 2021
• ISBN:
  9780323793391
• Topic: Medicina
• Subtopic: Cardiologia

Offering a clear and consistent framework for recognition, diagnosis, and treatment of a wide range of cardiac arrhythmia disturbances, Clinical Cardiac Electrophysiology: A Practical Guide covers the fundamental analytical skills needed in this challenging area. This portable, highly accessible handbook focuses on the basics of clinical electrophysiology— how and when to perform an electrophysiology study as well as principles of ablation and other invasive therapies—all in a succinct and modern format.

• Focuses on using an effective, consistent, decision-making process in recognizing, diagnosing, and treating rhythm disturbances of the heart, including supraventricular tachycardias, atrial fibrillation, ventricular tachycardias, and other rapid or irregular heartbeats.
• Covers anatomic fundamentals of cardiac structures, clinical indications for electrophysiology studies, practicalities and methodology of performing an electrophysiology study, and problems encountered during the procedure.
• Includes quick clinical summaries and more than 180 illustrations: electrophysiology recordings, ECGs, cardiac anatomy, radiographic images, and electroanatomic maps.
• Discusses key topics such as mechanisms of arrhythmias, conventional and electroanatomic mapping systems, fundamentals of cardiac mapping, biophysics of catheter ablation, and much more.
• Offers real-world guidance on contemporary practice from leading cardiac electrophysiologists Drs. Demosthenes G Katritsis and Fred Morady, with input from a multinational team of electrophysiology fellows and cardiologists.
• Ideal as a stand-alone resource or used in conjunction with Dr. Douglas Zipes' renowned textbook, Cardiac Electrophysiology: From Cell to Bedside.

1: Classification of arrhythmias

Bradyarrhythmias are due to sinus nodal disease (Box 1.1) or atrioventricular conduction block (Box 1.2).

Box 1.1

Sinus Node Dysfunction (with accompanying symptoms)

• Sinus bradycardia
• Sinoatrial exit block
• Sinus pauses (>3 s)
• Sinus node arrest
• Tachycardia-bradycardia syndrome
• Chronotropic incompetence*

*Maximum predicted heart rate is calculated as 220 – age (y).

Box 1.2

Atrioventricular Block

• First-degree AV block
• Second-degree AV block
  • Type I AV block (Mobitz I or Wenckebach)
  • Type II AV block (Mobitz II)
• Third-degree (complete) AV block.

AV. Atrioventricular.

Tachyarrhythmias are classified as ventricular or supraventricular. The term supraventricular literally indicates tachycardias (atrial rates > 100 beats per minute [bpm] at rest) arising from the His bundle or above.^1-3 Traditionally, the term supraventricular tachycardia (SVT) has been used to describe all tachycardias that are not solely infra-Hisian in origin, including atrial fibrillation and tachycardias such as atrioventricular reentry as a result of an accessory connection that involves both the atrium and ventricle (Box 1.3). The term narrow QRS tachycardia indicates tachycardia with a QRS duration ≤ 120 milliseconds (ms). A wide QRS tachycardia refers to one with a QRS duration > 120 ms.

Box 1.3

Classification of Tachyarrhythmias

Atrial tachycardias

• Sinus tachycardia
• • Physiologic sinus tachycardia
• • Inappropriate sinus tachycardia
• • Sinus nodal reentrant tachycardia
• Focal atrial tachycardia
  • • Microreentry
  • • Automatic
• Multifocal atrial tachycardia
• Macroreentrant atrial tachycardia
• • Cavotricuspid isthmus dependent
  • • Typical atrial flutter, counterclockwise (common) or clockwise (reverse)
  • • Other cavotricuspid isthmus dependent
• • Noncavotricuspid isthmus dependent
  • • Right atrial
  • • Left atrial
• Atrial fibrillation

Atrioventricular junctional tachycardias

• Atrioventricular nodal reentrant tachycardia
• • Typical
• • Atypical
• Nonreentrant junctional tachycardia
• • Junctional ectopic tachycardia (focal or automatic junctional tachycardia)
• • Other nonreentrant variants

Atrioventricular tachycardias

• • Orthodromic
  • • Concealed or manifest atrioventricular accessory pathway conducting in retrograde direction, with anterograde conduction through the atrioventricular node node/His-Purkinje system
  • • Nodofascicular or nodoventricular bypass tract conducting in retrograde direction, with anterograde conduction through the atrioventricular node/His-Purkinje system
• • Antidromic
  • • Atrioventricular accessory pathway conducting anterograde with retrograde conduction through the AV node or, r...