Clinical Handbook of Cardiac Electrophysiology

Description

This book provides a detailed summary of all aspects of cardiac electrophysiology, presented in an easy to use handbook. For each arrhythmia the aetiology, classification, clinical presentation, mechanism, and electrophysiology is set up (including precise set up and ablation parameters) and trouble-shooting are presented and demonstrated using interesting images, fluoroscopy images, ECG’s and electrograms. The overall aim of this book is to provide a logical and practical approach to cardiac arrhythmia management. It acts as a useful resource and, importantly, helps to promote this sub-specialty. This book is aimed at cardiac electrophysiologist’s, fellows, cardiologists, physicians, family practitioners, cardiology trainees, students, allied professionals and nurses. Given its succinct summary of electrophysiology is a useful reference guide for the electrophysiology laboratory. It is aimed at an international audience and provides an important guide for those studying for all heart rhythm exams.​ Foreword Preface Contents Contributors Chapter 1: Cardiac Anatomy and Electrophysiology The Cardiac Action Potential Phase IV (Resting Phase) Phase 0 (Depolarization) Phase I (Early Repolarization) Phase II (Plateau Phase) Phase III (Repolarization) Refractoriness Arrhythmia Mechanisms Re-entry Automaticity Afterdepolarizations and Triggered Activity Anatomy of the Cardiac Chambers The RA The SN Crista Terminalis (CT) RA Conduction Cavotricuspid Isthmus (CTI) LA Atrio-Ventricular (AV) Junction His Bundle The CS LV Conduction System RV Conduction System Aberrant Ventricular Conduction ECG Signal Acquisition Autonomic Innervation of the Heart References Chapter 2: Cardiac Electrophysiology Study, Diagnostic Maneuvers and Ablation Indications for an EP Study and Ablation Supraventricular Arrhythmias (SVT) Typical Atrial Flutter Atrial Fibrillation (AF) Ventricular Arrhythmias EP Study and Ablation: Patient Preparation EP Study and Ablation: Potential Risks Collateral Damage During Ablation Pericardial Effusion Phrenic Nerve Injury Esophageal Injury Coronary Artery Injury Important Note on Ionizing Radiation Administration of Sedation and Anesthesia Peri-procedural Anticoagulation EP Laboratory Set-Up How Electrograms Are Derived: Amplification and Filtering Electrogram Signals: Unipolar and Bipolar RF Generation and Ablation Cryoablation Ablation Catheters Ablation Catheter Size Irrigation Contact Force Catheters Vascular Access Femoral Cannulation Subclavian/Axillary Vein Internal Jugular Vein Electrophysiology Catheters and Positioning Baseline Measurements Sinus Node Recovery Time (SNRT) Sinoatrial Conduction Time (SACT) AV Conduction Times (AH and HV Intervals) Refractory Periods (AERP, AVNERP, VERP, VANERP) AV Wenckebach Point Basic EP Study VT Stimulation Protocol SVT Diagnostic Maneuvers Baseline Observations Initiation and Termination VA Relationship and Atrial Activation Effect of Bundle Branch Block RV Entrainment PVC During Tachycardia Para-Hisian Pacing Stimulus: Atrial Interval (SA) His: Atrial Interval (HA) Atrial Activation Sequence (AAS) Transseptal Access Equipment Trans-septal Needles Transseptal Sheaths Guidewires Fluoroscopic Approach Echocardiographic Visualization References Chapter 3: Electroanatomic Mapping General Principles of EAM Mapping Reference Point Window of Interest Activation Mapping (Isochronal) Voltage Map (Isopotential) Entrainment Mapping Specific Mapping Systems CARTO Mapping System (© Biosense Webster, Inc) Merging the Baseline CT/MRI onto the Anatomic Map Additional Features of Carto Ensite Velocity System (St Jude Medical, Minnesota 55442, USA) Rhythmia Mapping System (Rhythmia Mapping, Rhythmia Medical, Boston Scientific Inc., Marlborough, MA, USA) References Chapter 4: AV Nodal Re-entry Tachycardia (AVNRT) Introduction Anatomy Mechanism Classification Slow/Fast AVNRT (Typical AVNRT) Fast/Slow AVNRT (Atypical AVNRT) Slow/Slow AVNRT Electrophysiological Evaluation Baseline Data Risks of EP Study and Ablation Procedure Differentiation Between AVNRT and AVRT Differentiation of AVNRT from Atrial Tachycardia Ablation Techniques Ablation Endpoints Trouble Shooting the Difficult Cases References Chapter 5: Accessory Pathway (AP) Conduction Anatomy Mechanisms Classification Electrophysiological Evaluation Baseline ECG Algorithms ECG Features of Posterospetal Accessory Pathway’s Coronary Sinus Accessory Pathways ECG Features of Anteroseptal Accessory Pathway’s ECG Features of Mid-Septal Accessory Pathway’s ECG Features of Left Lateral Accessory Pathway’s ECG Features of Right Freewall Accessory Pathways Risks of EP Study and Ablation Diagnostic EP Study Differentiation Between AVNRT and AT Mapping the Accessory Pathway Ablation of Accessory Pathway’s Posteroseptal Accessory Pathway’s Posteroseptal Accessory Pathway: Difficult Case Anteroseptal Accessory Pathway Midseptal Accessory Pathway Mahaim Accessory Pathways ECG Features EP Study and Mapping of Mahaim Left Lateral Accessory Pathway Right Free Wall Accessory Pathway Accessory Pathway General: Difficult Case References Chapter 6: Atrial Tachycardias Focal Versus Macro Re-entry Locations of Atrial Tachycardias Crista Terminalis Coronary Sinus os Septal Atrial Tachycardias Tricupid and Mitral Isthmus Atrial Tachycardia Pulmonary Vein Atrial Tachycardia Left Atrial Appendage Atrial Tachycardia References Chapter 7: Atrial Flutter Cavotricuspid Isthmus Dependent Atrial Flutter Anatomy ECG Features Ablation of the CTI for Typical Atrial Flutter Decremental Pacing Decremental His to Coronary Sinus Pacing An Alternative Ablation Technique: Maximum Voltage Guided Ablation Potential Complications of Cavotricuspid Isthmus Ablation Difficult CTI Ablation Success of Cavotricuspid Isthmus Ablation Upper and Lower Loop Re-entry Right Atrial Lateral and Postero-Lateral Wall Flutter Left Atrial Flutter Mitral Isthmus Dependent Atrial Flutter References Chapter 8: Atrial Fibrillation Classification of AF Etiology Hypertension Coronary Artery Disease Valvular Heart Disease Diabetes Mellitus Obesity and Obstructive Sleep Apnea (OSA) Autonomic AF Familial AF Oral Anticoagulation Vitamin K Antagonist Non-vitamin K Antagonist Oral Anticoagulation Therapy (OAC’s) Direct Thrombin Inhibitors Factor Xa Inhibitors HAS-BLED Score Catheter Ablation for AF Risks of Catheter Ablation of AF How to Perform a PVI Patient Preparation Transseptal Access Anatomic Reconstruction of the Left Atrium Ablation Technique Pulmonary Vein Potentials and Farfield Signals Confirming Pulmonary Vein Isolation Assessing for Non PV Triggers Cryoablation Hybrid Ablation of AF Ablation of Persistent AF Linear Lesions Roof Dependent Left Atrial Flutter Mitral Isthmus Dependent Atrial Flutter CFAE Mapping and Ablation Rotor Mapping Focal Impulse and Rotor Modulation of Atrial Fibrillation Non-invasive Multi Electrode Mapping References Chapter 9: Ventricular Tachycardia ECG Criteria Scar Related VT Mechanism Mapping and Ablation of Scar Related VT Epicardial Access and Ablation ECG Characteristics Suggestive of Epicardial Involvement Epicardial VT Ablation Epicardial Access Epicardial Mapping and Ablation Epicardial Ablation: The Difficult Case Idiopathic VT Bundle Branch Re-entry EP Study and Ablation for Bundle Branch Re-entry VT Fascicular Re-entry VT EP Study and Ablation for Fascicular VT The Difficult Case Outflow Tract VT Anatomy and ECG Features Outflow Tract Tachycardia: EP Study and Ablation Indications Risks Procedure Initiation and Catheter Positioning Mapping Ablation Endpoints and Success The Difficult Case Lack of Spontaneous Ectopy Lack of Early Sites Continuation of the Arrhythmia Despite Ablation Inability to Deliver Ablation in the Cardiac Venous System Mitral Annular VT References Chapter 10: Anti-arrhythmic Drugs Mechanisms of Action: An Overview Class IA Antiarrhythmics Class IB Antiarrhythmics Class IC Action AAD’s Class II Antiarrhythmics Class III Class IV AAD’s Not in the Vaughan Williams Classification The Future: Novel AAD’s Atrial Repolarization Delaying Agents: Vernakalent Sodium Channel Blockers: Ranolazine References Index