Cardiac Mapping E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 3414

Veröffentlichungsjahr: 2019

Beschreibung

The expanded guide to cardiac mapping

The effective diagnosis and treatment of heart disease may vitally depend upon accurate and detailed cardiac mapping. However, in an era of rapid technological advancement, medical professionals can encounter difficulties maintaining an up-to-date knowledge of current methods. This fifth edition of the much-admired Cardiac Mapping is, therefore, essential, offering a level of cutting-edge insight that is unmatched in its scope and depth.

Featuring contributions from a global team of electrophysiologists, the book builds upon previous editions' comprehensive explanations of the mapping, imaging, and ablation of the heart. Nearly 100 chapters provide fascinating accounts of topics ranging from the mapping of supraventricular and ventriculararrhythmias, to compelling extrapolations of how the field might develop in the years to come. In this text, readers will find:

• Full coverage of all aspects of cardiac mapping, and imaging
• Explorations of mapping in experimental models of arrhythmias
• Examples of new catheter-based techniques
• Access to a companion website featuring additional content and illustrative video clips

Cardiac Mapping is an indispensable resource for scientists, clinical electrophysiologists, cardiologists, and all physicians who care for patients with cardiac arrhythmias.

Leseprobe

Table of Contents

Cover

About the Companion Website and Companion Digital Edition

Companion website

Companion digital edition

List of Videos

List of Contributors

Editors of Previous Editions

Preface to the Fifth Edition

Preface to the First Edition

Foreword

Part I: Fundamentals of Cardiac Mapping

1 History of Cardiac Mapping

Introduction

Early days of electrocardiography: indirect recordings of the electrical activity of the heart

Mechanisms of reentrant arrhythmias

Advances in technology: from single‐electrode mapping to panoramic four‐dimensional mapping

References

2 Embryology, Anatomy, and Pathology of Ventricular Outflow Tracts Related to Cardiac Mapping and Arrhythmias

Introduction

Development of the outflow tract

Developmental basis for RVOT arrhythmias

Anatomy of the right ventricle

Anatomy of the left ventricle

Atrioventricular conduction system and ventricular outflow tracts

Pathology of non‐ischemic arrhythmias from the ventricular outflow tract

References

3 Arrhythmogenic Venous Extremity of the Cardiac Tube

Introduction

The cardiac tube

The venous extremity of the cardiac tube

References

Further Reading

4 The Impact of Embryology and Anatomy on Cardiac Electrophysiology

Introduction

Embryology

Anatomical and embryological correlates: practical applications in clinical electrophysiology

Anatomical considerations

References

5 Cardiac Morphology Relevant to Mapping

Introduction

Cavotricuspid isthmus

Mitral isthmus

Ventricular outflow tracts

Endocavitary structures and the distal conduction system

The pericardial space

References

6 Anatomy of the Outflow Tract Region: Relevance to Arrhythmias and Catheter Ablation

Introduction

Right ventricular outflow tract

Left ventricular outflow tract

Aortic root

Aortomitral continuity

Pulmonic valve

Mitral valve annulus

Left ventricular summit

General approach for ECG localization

References

7 Fundamentals of Cardiac Mapping

Introduction

Contact catheter mapping

Unipolar and bipolar recordings

Activation mapping

Pace mapping

Entrainment mapping

Electroanatomical mapping

Mapping complex arrhythmias

Mapping and characterizing the arrhythmic substrate

References

8 Troubleshooting to Avoid Failed Ablation

Introduction

Goals of invasive therapy

Assessment of outcomes of ablation

Preprocedural planning (table 8.1)

Procedural preparation

Reasons for failed ablation

Troubleshooting to avoid failed ablation (Box 8.1)

Occurrence of new arrhythmia

References

Part II: Imaging Technologies in Cardiac Mapping and Ablation

9 Intracardiac Echocardiography

Introduction

ICE platforms

Sinus node modification

ICE‐guided transseptal catheterization

Atrial fibrillation ablation

Ventricular tachycardia ablation

Visualization of the arrhythmia substrate

Detecting and preventing complications

References

10 Role of Cardiac Computed Tomography Imaging to Guide Catheter Ablation of Arrhythmias in Complex Cardiac Morphologies

Introduction

Intraatrial anatomical landmarks

Computed tomography analysis of the pulmonary veins

Anatomical barriers in transvenous interventions

Extracardiac anatomical landmarks relevant to catheter‐based ablation

Assessment of coronary arteries with CT

Other anatomical variants and incidentally found congenital anomalies

Computed tomography demonstration of pathologies

References

11 Role of Cardiac Magnetic Resonance Imaging and Late Gadolinium Enhancement in Relation to Arrhythmias in Different Cardiomyopathies

Introduction

Hypertrophic cardiomyopathy

Arrhythmogenic right ventricular dysplasia

Cardiac sarcoidosis

Left ventricular non‐compaction

Cardiac amyloid

References

12 Multimodal Imaging for Cardiac Mapping

Definition of and rationale for multimodal imaging

Characteristics of specific imaging modalities: preprocedural and/or intraprocedural aspects

Disease states and/or arrhythmia substrate and potential use of imaging modalities

Disclosure of interest

Dedication

References

13 Light and the Heart: Cardiac Optogenetics

Introduction

Optogenetic sensors

Optogenetic actuators

Combined optogenetics sensing and actuation

References

14 Cardiac Mapping and Imaging in Patient Selection for Cardiac Resynchronization Therapy: How to Identify Super‐responders, Responders, and Non‐responders

Introduction

Assessment of coronary sinus anatomy

Assessment of left ventricle electrical dyssynchrony

Assessment of left ventricle mechanical dyssynchrony

Assessment of scar tissue

Assessment of optimal left ventricle lead position

Future directions in cardiac resyncrhonization therapy mapping and imaging: from multimodality integration to the on‐site real‐time approach

Disclosure of interest

References

Part III: Advances in Technology

15 Towards Non‐invasive Mapping and Imaging of Cardiac Arrhythmias

Introduction

Atrial fibrillation

Sudden cardiac death: ventricular tachyarrhythmias and ventricular fibrillation

References

16 New High‐Density and Automated Mapping Systems

Limitations of prior generation electroanatomical mapping systems

Technological advances to facilitate ultra‐high‐density mapping

Specific advances in new mapping systems

Residual gaps and limitations: new frontiers

Disclosure of interest

References

17 Non‐invasive Body Surface Potential Mapping of Reentrant Drivers in Human Atrial Fibrillation

Introduction

Principles of non‐invasive mapping

Non‐invasive mapping in practice

Localized drivers identified by non‐invasive mapping

Ablation guided by non‐invasive mapping

Limitations and future directions

References

18 Electrophysiology of Heart Failure: Non‐invasive Mapping of Substrate and Guidance of Cardiac Resynchronization Therapy with Electrocardiographic Imaging

Introduction

Electrocardiographic imaging methodology and procedure

Electrophysiological substrate of heart failure

Cardiac resynchronization therapy

Electrophysiological substrate in relation to ventricular arrhythmia

Acknowledgments

References

19 Contact Mapping and Ablation of Complex Cardiac Arrhythmias

Introduction

Optical mapping of complex cardiac arrhythmias

Clinical mapping techniques vary in cardiac fibrillation and should be matched to the type of acquired signal

Difficulties of reconstructing activation contours from clinical electrograms to map complex rhythms and fibrillation

Computational mapping of complex arrhythmias using dynamic physiological information to interpret electrograms

How Can map‐guided ablation eliminate fibrillation?

Clinical results from map‐guided ablation of complex arrhythmias

Disclosure of interest

References

20 Advances in Atrial Fibrillation Ablation

Introduction

Advances in mapping and imaging techniques

Advances in ablation techniques and catheters

Recent trials in atrial fibrillation ablation (Table 20.4)

Strategies for catheter ablation of atrial fibrillation: a stepwise approach

Advances in surgical approaches for atrial fibrillation ablation

Emerging concepts in catheter ablation of atrial fibrillation

Current controversies

Radiation exposure

Guidelines and consensus reports

Acknowledgments

References

21 Integration of Contact Force into Mapping and Ablation Systems: Does It Improve the Results?

Introduction

Contact force and ablation

Contact force sensing technologies

Impact of contact force sensing on clinical atrial fibrillation ablation

Optimizing contact force parameters during ablation

References

22 Advances in Molecular Imaging Relevant to Arrhythmias

Introduction

Potential molecular imaging targets for assessing susceptibility to cardiac arrhythmias

References

Part IV: Mapping in Experimental Models of Cardiac Arrhythmias

23 Optical Mapping of Sarcoplasmic Reticulum Ca

2+

and Transmembrane Potential in the Intact Heart: Insights into Ca

2+

‐mediated Arrhythmias

Introduction

Optical mapping of free intra‐SR Ca

2+

Insights into normal SR Ca

2+

handling and excitation–contraction coupling

Insights into arrhythmogenesis

Acknowledgments

References

24 Electrophysiological Substrates for Gender Difference in the Incidence of Torsades de Pointes Arrhythmias

Introduction

Gender difference of epicardial

I

Ca‐L

and

I

NCX

in adult guinea pig hearts

Gender difference in EAD susceptibility and spatial dispersion of action potential duration

Mathematical modeling of LQT3 and the effects of

I

Ca‐L

Early

V

m

/Ca

2+

i

uncoupling predestinates the duration of VT in guinea pig AP‐A model

Acknowledgments

References

25 Rotors in Animal Models of Atrial Fibrillation

Introduction

Reentrant activity during acute AF in the isolated sheep heart

Formation of reentrant activity

Increased intraatrial pressure and rotor dynamics

Activation frequency and rotor drivers in persistent AF

Acknowledgments

References

26 Atrial Fibrillation from a Unipolar, High‐resolution Perspective

Introduction

High‐resolution intraoperative epicardial mapping

Unipolar or bipolar electrograms?

Wave mapping

Endocardial–epicardial asynchrony

Mapping of the Bachmann bundle (BB)

Clinical applications

References

27 Mechanisms Underlying Arrhythmogenesis in the J‐wave Syndromes

Ionic currents contributing to the ventricular action potential in the human heart

J‐wave syndromes and arrhythmogenic mechanisms

Approach to therapy of the J‐wave syndromes

Pharmacological approach to therapy

Approach to therapy of ERS

Acknowledgments

References

28 Relationship Between Cardiac Alternans, Calcium Cycling, and Ventricular Arrhythmias

Introduction

Spatially discordant repolarization alternans

Ca

2+

cycling and repolarization alternans

Ca

2+

cycling and DADs

Subcellular mechanisms of Ca

2+

alternans and Ca

2+

waves: the three Rs theory

Acknowledgments

References

29 Fibrosis and Arrhythmogenesis

Introduction

Fibrosis as an electrical insulator leading to discontinuous electrical propagation in atria and ventricle

The myofibroblast as a direct contributor to arrhythmogenesis?

Acknowledgments

References

30 Triggered Ventricular Tachyarrhythmias Initiated by Enhanced Late Inward Na and Ca Currents: Novel Therapeutic Targets

Introduction

Molecular and cellular mechanisms of VT/VF mediated via CaMKII activation

Selective AAD therapy of CaMKII‐mediated VT/VF

Clinical implications

Acknowledgments

References

31 Experimental VT: A New Porcine Model of Infarct‐related Reentrant VT

References

32 Experimental Mapping of Ventricular Arrhythmias: Intramural Pathways and Substrate

Introduction

Intramural mapping of extracellular potentials

Methods

Intramural mapping of membrane potentials

References

33 The Molecular Basis of Long QT Type 2 (LQT2)‐related Arrhythmias: How Sex Modifies the Risk of Torsades de Pointes

Introduction

Optical mapping in LQTS models

References

34 Optical Mapping of Arrhythmogenic Remodeling in the Failing Human Heart

Introduction

Remodeling of activation and conduction

Remodeling of repolarization

Remodeling of excitation–contraction coupling and calcium transients

Remodeling of response to acute ischemia and reperfusion

Remodeling of response to adrenergic stimulation

References

35 Optical Mapping of Successful and Failed Defibrillation

Introduction

Reentrant arrhythmia

Early theories on defibrillation

Virtual electrode polarization

Clinical implications of virtual electrode hypothesis of defibrillation

Toward optimal‐energy defibrillation

References

36 Atrial Patterns of Neurally Induced Repolarization Changes: Neuroablative Studies in Canines

Introduction

Electrophysiologically guided identification of neural targets

Mapping of neurally induced repolarization changes

An atlas of atrial projections of ganglionated plexus neural influences

Neuroablative studies

Perennity of antiarrhythmic protection in relation to possible reinnervation of atrial tissues

Spinal cord stimulation

References

Part V: Mapping and Imaging in Atrial Fibrillation, Flutter, and Atrial Tachycardias

37 Clinical Relevance of Functional Models of Atrial Reentry and Fibrillation

Introduction

Classical ideas about AF mechanisms

Newer ideas about AF mechanisms

Clinical implications of these concepts

Acknowledgments

References

38 Rotor Mapping in Patients with Atrial Fibrillation

Introduction

Initiation of AF by triggers: diffuse or localized mechanisms?

Is clinical AF maintained by diffuse or localized mechanisms? theory

Is clinical AF maintained by diffuse mechanisms or localized sources? optical and clinical mapping in humans

Focal impulse and rotor (rotational source) mapping of human AF

Clinical mapping of AF sources in patients

Long‐term follow‐up after FIRM‐guided ablation

Reconciling differences in rotor mapping studies between centers

References

39 Rotor Mapping and Ablation in Persistent Atrial Fibrillation

Introduction

What is a rotor? from bench to bedside

How to map rotors: Taipei approach

Acknowledgments

References

40 Mapping and Ablation of Atrial Flutter and its Variants

Introduction

Atrial flutter terminology

Pathophysiological mechanisms of CTI‐dependent AFL

ECG diagnosis of CTI‐dependent AFL

Standard catheter mapping of CTI‐dependent AFL

Radiofrequency catheter ablation of CTI‐dependent AFL

Procedure end points for radiofrequency catheter ablation of CTI‐dependent AFL

Outcomes and complications of catheter ablation of CTI‐dependent AFL

Alternative energy sources for ablation of CTI‐dependent AFL

Computerized three‐dimensional mapping in diagnosis and ablation of CTI‐dependent AFL

Simplified approach to ablation of CTI‐dependent AFL

Mapping and diagnosis of atypical right AFL

References

41 Mapping and Ablation of Left Atrial Flutter and Tachycardia: New Observations

Introduction

Role of imaging

Mapping modalities

Catheter ablation strategies

Limitations

References

42 Mapping and Ablation of Atrial Tachycardia

Introduction

Classification of atrial tachycardias

References

43 Image‐based Risk Stratification for Stroke in Atrial Fibrillation

Introduction

Current risk stratification for stroke in AF

Limitations of CHA

2

DS

2

‐VASc score

Role of left atrial appendage

Clinical perspective

References

44 Revisiting Non‐pulmonary Vein Triggers

Introduction

General approach

Left atrial posterior wall

Superior vena cava

Coronary sinus

Left atrial appendage

Other sites

References

45 Mechanisms of Antifibrillatory Agents for Atrial Fibrillation: Evidence Obtained from Experimental Models

Introduction

Class I antiarrhythmic drugs

Class III antiarrhythmic drugs

“Novel” agents

References

46 Stepwise Approach to Atrial Fibrillation Mapping and Ablation in Persistent and Long‐standing Persistent Atrial Fibrillation: Short‐ and Long‐term Results

Introduction

Technique of the stepwise ablation approach

Clinical outcomes

Predictors of success

Limitations and problems of the stepwise approach

References

47 Mapping and Ablation of the Cardiac Autonomic Nervous System to Treat Atrial Fibrillation

Autonomic innervation of the heart

Atrial fibrillation mediated by hyperactivity of the CANS

Autonomic denervation targeting the major atrial ganglionated plexi

References

48 Remodeling in Atrial Fibrillation: Novel Mapping Studies

Introduction

Mapping of AF within different atrial substrates

Mapping of human hearts with persistent AF

Clinical mapping studies

References

49 Magnetic Resonance Imaging Mapping of Atrial Fibrosis and Atrial Fibrillation

Introduction

Imaging techniques

Quantification of pre‐ablation fibrosis

Left atrial fibrosis: a new paradigm in atrial fibrillation

Relationship between LA fibrosis and LA enhancement

Left atrial fibrosis and clinical AF

Left atrial fibrosis and stroke

Left atrial fibrosis and AF management: Utah classification of AF

Lesion assessment after ablation

Utah classification of AF and AF management: the Utah paradigm

Changes of atrial fibrosis after AF ablation

References

50 Fibrotic Atrial Cardiomyopathy: Implications for Ablation of Atrial Fibrillation

Introduction

Pathophysiological cornerstones of AF

Fibrotic atrial cardiomyopathy

Implications for catheter ablation

References

51 Mapping and Ablation of the Left Atrial Appendage

Introduction

Embryology and anatomy

Mapping

Atrial fibrillation

Atrial tachycardia

Investigational studies

References

52 Electrogram‐based Mapping and Ablation in Atrial Fibrillation

Introduction

Electrogram‐guided PV isolation

Electrogram‐guided substrate ablation in AF

References

53 Phase Mapping of Human Atrial Fibrillation

Introduction

Phase analysis of physiological signals

Phase representation of the action potential time course

Phase representation of an EGM time course

The Hilbert transformation

Phase mapping of AF

Limitations and challenges of phase mapping

Future directions

References

54 Trials on Atrial Fibrillation Mapping and Ablation

References

Part VI: Mapping of Supraventricular Arrhythmias

55 Entrainment Mapping in Supraventricular Tachycardias

Introduction

Definitions

Methods

Technical points

Benefits provided by entrainment mapping

What can entrainment mapping

not

do?

Problems with entrainment mapping

Disclosure of interest

References

56 The Problematic Postpacing Interval

Introduction

Definitions

Proper use of the postpacing interval

Problems with the postpacing interval

Disclosure of interest

References

57 Mapping and Ablation of Typical and Atypical Accessory Pathways

Introduction

Prevalence and demographic considerations

Anatomy of accessory pathways

Arrhythmias observed with accessory pathways

Electrocardiographic localization of accessory pathways

Approaches to catheter mapping

Disclosure of interest

References

58 Preexcited Atrioventricular Junctional Reentrant Tachycardia: Electrophysiological Characteristics of the Reentrant Circuits

Introduction

Antidromic reentrant tachycardia

Coexistence of the typical form of AV nodal reentry and WPW syndrome

Electrophysiological tips, techniques, maneuvers, and pitfalls in the diagnosis of PAVJRT

Accessory pathways with decremental antegrade conduction

Acknowledgments

References

59 Mapping and Ablation of Atrioventricular Nodal Reentry Tachycardia and its Variants: Current Understanding and Controversies

Tachycardia circuit

Typical atrioventricular nodal reentry tachycardia

Atypical atrioventricular nodal reentry tachycardia

Absolute AH and VA times

Upper and lower common pathways

Implications of mapping for classification of atrioventricular nodal reentry tachycardia types

Implications of mapping for catheter ablation

References

60 Electrical Stimulation Maneuvers to Differentiate Different Forms of Supraventricular Tachycardias

Introduction

Baseline characteristics during tachycardia

Pacing maneuvers

References

61 Mechanisms of Persistent Atrial Fibrillation: What Do the Clinical Mapping Studies Teach Us?

Introduction

Role of the pulmonary veins in persistent atrial fibrillation

Models of wavefront propagation and reentry in atrial fibrillation

Spatiotemporal organization in atrial fibrillation

Epicardial mapping of persistent atrial fibrillation

Novel mapping techniques for persistent atrial fibrillation

Disclosure of interest

References

62 Imaging and Mapping of Arrhythmias in Hypertrophic Cardiomyopathy

Introduction

Atrial fibrillation

Ventricular arrhythmias

References

63 Mapping and Ablation of Supraventricular Arrhythmias in Congenital Heart Disease

Introduction

Anatomy of the conduction system in congenital heart disease

Supraventricular arrhythmias in congenital heart disease

Approach to mapping and ablation

Arrhythmias in common forms of congenital heart disease

References

64 Cardiac Mapping and Imaging: Arrhythmias in Patients with Congenital Heart Disease

Introduction

Invasive electrophysiology in congenital heart disease patients

Understanding the anatomy

Use of 3D mapping systems for catheter ablation in congenital heart disease patients

Catheter ablation techniques

References

Part VII: Mapping and Imaging of Ventricular Arrhythmias

65 Mapping and Ablation of Ventricular Tachycardia in Normal Hearts

Introduction

Outflow tract ventricular tachycardia

Papillary muscle ventricular tachycardia

Malignant variant idiopathic premature ventricular contractions

References

66 The Combination of a Basket Catheter and EnSite™ Mapping System Improves Catheter Ablation of Right Ventricle Outflow Premature Ventricular Contraction

Introduction

Mechanism of right ventricle outflow premature ventricular contractions

Conventional mapping techniques for successful catheter ablation

Usefulness of EnSite mapping for catheter ablation of right ventricle outflow premature ventricular contractions

Usefulness of the multielectrode basket catheter for catheter ablation

References

67 Mapping and Ablation of Ventricular Arrhythmias: Patients with Non‐Ischemic Cardiomyopathy

Introduction

Types of ventricular arrhythmias in non‐ischemic cardiomyopathy

Anatomical substrate for ventricular arrhythmias in dilated cardiomyopathy

Electrophysiological findings and scar patterns in dilated cardiomyopathy

Initial assessment of ventricular tachycardia in the electrophysiology laboratory

Substrate mapping

Endocardial voltage mapping

Substrates in specific pathologies

Outcome of ablation for ventricular tachycardia in non‐ischemic cardiomyopathy

References

68 Mapping and Ablation of Ventricular Arrhythmias in Patients with Congenital Heart Disease

Introduction

References

69 Substrate Ablation for Ventricular Tachycardia in Structural Heart Disease

Introduction

Substrate mapping for ventricular tachycardia ablation

Strategies for substrate ablation of ventricular tachycardia

References

70 Coronary Mapping and Ablation of Arrhythmias

Introduction

Right coronary artery

Left main coronary artery

Cardiac venous system

References

71 Endocardial Catheter Pace Mapping of Ventricular Tachycardias

Introduction

Techniques

Uses

Limitations

References

72 Resetting and Entrainment Phenomena: Application to Mapping of Ventricular Tachycardia

Concept of resetting

Concept of entrainment

Recognition of resetting

Recognition of entrainment

Determinants of resetting: importance of double extrastimuli

Determinants of entrainment

Recognition and determinants of fusion during resetting and entrainment

Similarities and differences between resetting and entrainment

Informative content of resetting and entrainment

Application to mapping of ventricular tachycardia

References

73 Mapping and Ablation of Idiopathic Ventricular Fibrillation

Introduction

Catheter ablation of ventricular fibrillation triggers: clinical experience

Mapping of idiopathic ventricular fibrillation

F substrate in patients with IVF

Ablation strategies

Procedural outcomes

References

74 Mapping and Ablation in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Epicardial and Endocardial Mapping and Long‐Term Results

Introduction

Mechanism of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy and implications for catheter ablation

Role of non‐invasive programmed stimulation/high‐dose isoproterenol infusion

Patterns of scar in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Endocardial ablation strategy in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Epicardial ablation

Results of catheter ablation

Future directions and novel therapies

References

75 Mapping and Ablation of Ventricular Arrhythmias in Patients with Cardiac Sarcoidosis

Introduction

Preprocedural assessment and considerations

Mapping and ablation of ventricular arrhythmias in cardiac sarcoidosis

References

76 Cardiac Mapping and Imaging in Patients with Ventricular Arrhythmias in Chagas Disease Undergoing Catheter Ablation of Ventricular Tachycardia

Introduction

Pathophysiology of Chagas cardiomyopathy

Scar distribution in Chagas cardiomyopathy

Imaging in Chagas disease

Arrhythmia mechanisms in Chagas cardiomyopathy

Substrate mapping in Chagas ventricular tachycardia

Strategies for ablation of ventricular tachycardia in patients with Chagas disease

Results of Chagas ventricular tachycardia ablation

References

77 Magnetic Resonance Imaging Mapping of Ventricular Tachycardia in Patients with Different Cardiomyopathies (Arrhythmogenic Right Ventricular Dysplasia, Amyloidosis, etc.)

Introduction

Ischemic cardiomyopathy

Dilated non‐ischemic cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy

Hypertrophic cardiomyopathy

Amyloid cardiomyopathy

Chagas disease

References

78 Mapping and Ablation of Ventricular Arrhythmias of Unusual Sites

Introduction

Right ventricle

Left ventricle

Cardiac venous system

References

79 Mapping and Ablation of Ventricular Tachycardia in Coronary Artery Disease

Introduction

Pathophysiology of postinfarction ventricular tachycardia

Use of electrocardiogram in localizing postinfarction ventricular tachycardia

Determination of the mechanism of ventricular tachycardia during electrophysiology study

Mapping

References

80 Epicardial Mapping in Different Ventricular Tachycardia Substrates: Technique and Instrumentation, Short‐ and Long‐term Results

Introduction

Substrates

Techniques

Complications

Mapping and ablation

References

81 Usefulness of the 12‐Lead ECG to Identify Epicardial Ventricular Substrate and Epicardial Ventricular Tachycardia Site of Origin

Introduction

Myocardial substrate favoring epicardial ventricular tachycardia

Twelve‐lead electrocardiogram clues to identify epicardial ventricular tachycardia substrate

Twelve‐lead electrocardiogram recognition of epicardial ventricular tachycardia origin

References

82 Mapping and Imaging of Fascicular Ventricular Tachycardia

Mechanism and clinical presentation

Imaging

Management

Catheter ablation

References

83 Scar‐Related Ventricular Tachycardia Mapping and Ablation Using Contrast‐Enhanced Magnetic Resonance Imaging

Introduction

Magnetic resonance imaging with delayed enhancement: technical aspects and limitations

Quantification and characterization of delayed enhancement

Preprocedural magnetic resonance imaging for planning ventricular tachycardia mapping and ablation procedure

Limitations of electroanatomical mapping of scar‐related ventricular tachycardia

Non‐invasive substrate mapping using contrast‐enhanced magnetic resonance imaging

Integration of magnetic resonance imaging‐derived images into the navigation system

Future directions

References

Part VIII: Future Directions and Technologies in Cardiac Mapping and Imaging of Cardiac Arrhythmias

84 Myocardial Elastography

Introduction

Mechanical deformation of normal and ischemic or infarcted myocardium

Myocardial elastography

Simulations

Phantoms

Myocardial ischemia and infarction detection in canines

in vivo

Validation of myocardial elastography against computed tomography angiography

Acknowledgments

References

85 Electromechanical Wave Imaging

Cardiac arrhythmias

Clinical diagnosis of atrial arrhythmias

Treatment of atrial arrhythmias

Electromechanical wave imaging

Imaging the electromechanics of the heart

Electromechanical wave imaging sequences

Characterization of atrial arrhythmias in canines

in vivo

Electromechanical wave imaging in normal human subjects and those with arrhythmias

Acknowledgments

References

86 Principles of Diffusion Tensor Imaging of the Myocardium: Clinical Applications

Introduction

Physics of DTI

DTI imaging

DTI of cardiac muscle

Clinical applications

Differential diagnosis

Inflammation, fibrosis, and remodeling

Acknowledgments

References

87 Diffusion Magnetic Resonance Imaging Tractography of the Heart

Introduction

Principles of DTI

Diffusion imaging sequences

Whole‐heart DTI

Free‐breathing acquisition

Role of DTI in cardiac electrophysiology

References

88 Molecular Magnetic Resonance Imaging in Cardiac Electrophysiology

Introduction

General concepts in target selection

Molecular magnetic resonance imaging agents

Preclinical imaging

Molecular MRI in translation

Outlook: molecular MRI versus radiolabeled probes

References

89 Real‐Time MRI Mapping and Ablation

Introduction

MR catheters and EP recording system

MRI for EP procedures

Real‐time mapping and catheter ablation workflow

Catheter ablation of typical atrial flutter

Procedural complications

Limitations

References

90 Robotic Navigation for Atrial Fibrillation: Mapping and Ablation

Introduction

Principles of robotic navigation

Techniques of robotic navigation

Advantages and disadvantages of robotic navigation, and clinical experience

Randomized clinical trials

References

91 Mapping and Ablation in patients with VT Storm: Role of Neuraxial Therapeutics

Introduction

Anatomy of the cardiac sympathetic neuraxis

Cardiac sympathetic control of ventricular electrophysiology and arrhythmogenesis

Functional and structural neural remodeling

Neuraxial modulation in electrical storm

Employing neuraxial modulation in electrical storm

References

92 Appropriateness of Mapping and Imaging Modalities in Interventional Electrophysiology

Background and definitions for appropriateness in medicine

Procedures involving cardiac implantable electronic devices

Procedures involving ablation

Other considerations

Future directions

References

93 How to Avoid Complications of Mapping and Ablation

Introduction

Systemic embolic complications

Atrio‐esophageal fistula

Perforation/pericardial tamponade

Pulmonary vein stenosis

Valvular injury

Nerve injury

Complete heart block

Coronary artery injury

Vascular complications

Pericarditis

Proarrhythmia

Radiation exposure

Death

References

94 Summary and Consensus of Guidelines for Cardiac Mapping and Ablation

Introduction

Ablation for atrial fibrillation

Ablation for ventricular tachycardia

References

95 A Roadmap to a Non‐invasive Radiosurgical Approach to Ablate the Pulmonary Vein Antra for an Effective Treatment of Atrial Fibrillation: Basic and Technical Principles

Introduction

Stereotactic radiosurgery and stereotactic body radiotherapy techniques

Dose delivery technologies

Medical imaging

Simulation

Treatment planning

Dose

Localization

Method of gating

Discussion

References

96 Future of Cardiac Mapping

Introduction

Cardiac mapping: evolution through the years

Preprocedure imaging

Intraprocedure mapping adjuvants

Postprocedure imaging

Concepts in development and future directions

References

97 The Evolution of Cardiac Mapping: Past, Present, Future

Introduction

The past

The present

The future

Acknowledgments

References

Epilogue

Index

End User License Agreement

List of Tables

Chapter 8

Table 8.1 Preprocedural and procedural preparation checklist.

Chapter 15

Table 15.1 Assessment of arrhythmogenic substrate with non‐invasive imaging tech...

Table 15.2 Non‐invasive imaging techniques to assist ventricular tachycardia abl...

Chapter 16

Table 16.1 Explanation of the terminology used for the Precison mapping system.

Chapter 19

Table 19.1 Atrial fibrillation mechanisms differ by mapping modality.

Chapter 20

Table 20.1 Integration of different mapping/imaging modalities.

Table 20.2 Role of different imaging modalities in patients with AF.

Table 20.3 Advantages, disadvantages, and possible complications of energy sourc...

Table 20.4 Trials on catheter ablation of AF.

Table 20.5 Society guidelines and expert consensus.

Chapter 21

Table 21.1 Clinical studies comparing the impact of contact force sensing (CFS) ...

Table 21.2 Clinical studies assessing ablation efficacy with respect to catheter...

Chapter 27

Table 27.1 Genes associated with the Brugada and early repolarization syndromes.

Chapter 38

Table 38.1 Forest plots showing pooled outcomes for long‐term freedom from AF (l...

Chapter 40

Table 40.1 Success rates for radiofrequency catheter ablation of atrial flutter.

Chapter 42

Table 42.1 Basic arrhythmia mechanisms responsible for atrial tachycardias.

Chapter 43

Table 43.1 Definition of the four types of LAA morphologies.

Table 43.2 Baseline demographic characteristics of studies included in the meta‐...

Chapter 46

Table 46.1 Short‐ and long‐term results of the stepwise approach for persistent ...

Table 46.2 Predictors of short‐ and long‐term successful clinical outcome after ...

Chapter 48

Table 48.1 Structural and functional characteristics of animal models of atrial ...

Chapter 55

Table 55.1 Response to pacing at various sites as guide to circuit location. ...

Chapter 56

Table 56.1 Unexpected behavior of the postpacing interval (PPI).

Chapter 57

Table 57.1 Important attributes of different types of accessory pathways.

Table 57.2 Arrhythmias observed in patients with accessory pathways.

Chapter 58

Table 58.1 Historical background.

Table 58.2 Prevelance of various conditions relevant to preexcited atrioventr...

Table 58.3 Published data on PAVJRT (1974–2016).

Chapter 59

Table 59.1 Conventional classification of AVNRT types.

Table 59.2 Simplified classification of AVNRT types.

Chapter 60

Table 60.1 Characteristics of narrow complex tachycardia and differential dia...

Chapter 63

Table 63.1 Summary of supraventricular arrhythmias typically encountered in c...

Chapter 68

Table 68.1 Published series results for VT ablation in TOF patients.

Chapter 71

Table 71.1 Comparison of mapping techniques.

Chapter 74

Table 74.1 Acute and long‐term results of ventricular tachycardia catheter ab...

Chapter 75

Table 75.1 Case reports and observational studies investigating the role of c...

Table 75.2 Studies assessing the characteristics and procedural outcomes of V...

Chapter 79

Table 79.1 General principles in localizing exit site of postinfarction VT.

Table 79.2 Substrate ablation approaches for postinfarction VT.

Chapter 80

Table 80.1 Epicardial VT ablation: characteristics of the patient population....

Table 80.2 ECG criteria predictive of an epicardial exit of ventricular arrhy...

Table 80.3 Complications of epicardial VT access/ablation.

Table 80.4 Major complications associated with epicardial procedures.

Chapter 83

Table 83.1 Late gadolinium enhancement characterization techniques, based on ...

Chapter 88

Table 88.1 Advantages and disadvantages of molecular imaging modalities.

Chapter 92

Table 92.1 A variety of imaging modalities are frequently used in electrophys...

Table 92.2 Available electroanatomical mapping systems.

Table 92.3 Standard average reference radiation doses from common electrophys...

Chapter 93

Table 93.1 Serious complications of cardiac mapping and catheter ablation.

Table 93.2 Common reversible complications of cardiac mapping and ablation.

Chapter 94

Table 94.1 Indications for catheter ablation of ventricular tachycardia (VT)....

Chapter 95

Table 95.1 Summary of mean dose (cGy) to the target and the organs at risk.

Chapter 96

Table 96.1 A brief list of the currently available imaging modalities for cre...

Table 96.2 Advantages and disadvantages of the currently available imaging mo...

List of Illustrations

Chapter 1

Figure 1.1 (a) A cardiograph recorded by AD Waller in 1887 (front to Hg; back t...

Chapter 2

Figure 2.1 The developing outflow tract of the human heart. (a) At this stage t...

Figure 2.2 Developmental basis for RVOT arrhythmias. The adult RVOT has formed ...

Figure 2.3 The tripartite, coarsely trabeculated right ventricle. A, Inflow, ho...

Figure 2.4 The outflow tract of the right ventricle from the moderator band to ...

Figure 2.5 (a) Original drawing of the moderator band by Leonardo da Vinci. (b)...

Figure 2.6 Close‐up of the pulmonary infundibulum (right ventricular outflow tr...

Figure 2.7 (a) Pulmonary arterial root: all the cusps are attached to muscle. (...

Figure 2.8 Basal short axis section of a cardiac specimen. The right and left o...

Figure 2.9 (a) Long axis view of the ventricular outflow tract. Asterisk indica...

Figure 2.10 Left ventricle in a long axis view. Note the inflow hosting the mit...

Figure 2.11 The left ventricular outflow tract. Note the mitral valve free from...

Figure 2.12 (a) Aortic root: the whole non‐coronary cusp and part of the left c...

Figure 2.13 The AV conduction system, which is mostly exposed to the left ventr...

Figure 2.14 Arrhythmogenic cardiomyopathy with fibro‐fatty replacement of the r...

Figure 2.15 Segmental arrhythmogenic cardiomyopathy with fibro‐fatty replacemen...

Figure 2.16 Electrophysiological mapping of extensive electrical scars and an e...

Figure 2.17 Electrophysiological mapping showing infundibular electrical scars ...

Figure 2.18 Extensive electrical scar by electroanatomical mapping and transmur...

Figure 2.19 Negative electroanatomical mapping and acute myocarditis from an en...

Figure 2.20 Normal electrical activity (negative electrophysiological mapping) ...

Figure 2.21 Ventricular tachycardia with left bundle branch morphology in a pat...

Figure 2.22 Fatty infiltration with mild fibrosis of the right ventricle in a p...

Chapter 3

Figure 3.1 The three hypotheses of conduction system development. (a) The four‐...

Figure 3.2 (a) Schematic depiction of the cardiac tube in a developing embryo a...

Figure 3.3 Details regarding the presence of the myocardial sleeves in the pulm...

Figure 3.4 (a) Details regarding the presence of myocardial sleeves in the pulm...

Figure 3.5 Schematic depiction of the coronary sinus development in the human e...

Chapter 4

Figure 4.1 Diagramatic representation of the different types of myocardium in t...

Figure 4.2 Rapid pacing from electrode pair 1,2 of a circular mapping catheter ...

Figure 4.3 Cavotricuspid isthmus. Arrows show the Eustachian valve. IVC, inferi...

Figure 4.4 Anatomical specimen of human right and left atriums (superior view)....

Figure 4.5 Orientation of the heart in the thorax and x‐ray projections (

left p

...

Figure 4.6 (

Left panel

) Angiogram of a patient with persistent left superior ve...

Figure 4.7 Computed tomography of the LA and ostia of superior left and right p...

Figure 4.8 Right posterior view of the heart demonstrates the close relationshi...

Chapter 5

Figure 5.1 (a) Heart cut along the plane of tricuspid annulus (TA); a part of c...

Figure 5.2 Lower loop conduction. The top center panel demonstrates typical atr...

Figure 5.3 (a) Mitral isthmus (MI), a part of the posterior wall of the left at...

Figure 5.4 (a)A deep pouch (d on image) at the mitral isthmus (MI). (b) Branche...

Figure 5.5 Mitral annuli dysjunction is a condition with a separation between t...

Figure 5.6 The complex outflow tract anatomy and their corresponding characteri...

Figure 5.7 View from above demonstrates cross‐section of the aortic valve centr...

Figure 5.8 (a) The left ventricle (LV) is incised to demonstrate the location o...

Figure 5.9 The section illustrates papillary muscles of the right ventricle inc...

Figure 5.10 Utility of intracardiac echocardiography in visualizing catheter‐pa...

Figure 5.11 (a) The transposed diagram of the pericardium outlines the posterio...

Figure 5.12 View of the specimen without fibrous pericardium to illustrate the ...

Chapter 6

Figure 6.1 Anatomy of the outflow tract region. The anterior view is mostly dom...

Figure 6.2 RV anatomy. The free wall was separated from the septal wall by crea...

Figure 6.3 RVOT anatomy. In this image the RV free wall has been resected by an...

Figure 6.4 Anatomy of the LV ostium after removal of the atria and great vessel...

Figure 6.5 The LV ostium and its components after resection of the LA, showing ...

Figure 6.6 Left ventricular summit (LVS) with main anatomical relationships. Th...

Figure 6.7 Attitudinally based schema to understand the ECG patterns of outflow...

Figure 6.8 Determination of frontal plane axis to rapidly localize the site of ...

Chapter 7

Figure 7.1 Conventional contact catheter mapping. (a) Fluoroscopic images in th...

Figure 7.2 Unipolar and bipolar electrogram recordings. The bars in both (a) an...

Figure 7.3 Pace mapping. Automated template‐matching algorithm to quantify degr...

Figure 7.4 Commonly used electroanatomical mapping systems. (a) The CARTO elect...

Figure 7.5 High‐resolution electroanatomical mapping using the Rhythmia mapping...

Figure 7.6 Non‐invasive electrocardiographic imaging (ECGI) to localize ventric...

Figure 7.7 Calculation of dominant frequency and organisational index. The high...

Figure 7.8 Phase mapping of electrogram signals. Filtered electrogram signals a...

Figure 7.9 Conduction velocity mapping. Example of maps showing left atrial con...

Chapter 8

Figure 8.1 Conversion of orthodromic reentry tachycardia into AVNRT after a His...

Figure 8.2 Patient on isoproterenol testing. Lasso catheter in SVC, ablation ca...

Figure 8.3 Comparative mapping between sinus rhythm and ventricular tachycardia...

Figure 8.4 Ablation catheter placed via retrograde aortic access with tip in co...

Figure 8.5 Note the prominent Eustachian ridge and pouch in the cavotricuspid i...

Figure 8.6 Worley sheath via left subclavian access through which a renal cathe...

Figure 8.7 Irrigated catheter tip in contact with left ventricular inferior wal...

Figure 8.8 Right atrial electroanatomical map during atrial flutter in a patien...

Chapter 9

Figure 9.1 Catheter ablation of inappropriate sinus tachycardia (IST) guided by...

Figure 9.2 Sequential clockwise torque of the ICE catheter (

from panel A to F

) ...

Figure 9.3 Imaging of the left atrial appendage (LAA) from within the right atr...

Figure 9.4 Catheter ablation of a premature ventricular complex from within the...

Figure 9.5 (

Left panel

) Short axis view of the aortic cusp region from the righ...

Figure 9.6 ICE view of the posteromedial papillary muscle with mapping/ablation...

Figure 9.7 ICE imaging of the substrate with evidence of inferobasal wall thinn...

Figure 9.8 Large pericardial effusion detected at ICE.

Chapter 10

Figure 10.1 Atrial anatomical landmarks. (a) Superior view of the atria. (b) Ri...

Figure 10.2 Anatomy of the interatrial septum and patent foramen ovale (PFO). S...

Figure 10.3 Anatomical variants of the pulmonary vein (PV) insertion. Common os...

Figure 10.4 Anatomic variants of the left atrium (LA), including supernumerary ...

Figure 10.5 Variants of Bachman bundle (BB) and CS–LA muscle continuity. (a) BB...

Figure 10.6 Images demonstrate duplicated superior vena cava (SVC) with left SV...

Figure 10.7 Right atrial (RA) anatomical variants that may cause difficulty in ...

Figure 10.8 Mechanical barriers for venous intervention: (a,b) Valve of Vieusse...

Figure 10.9 (a) Unusual close proximity of the descending aorta to the right in...

Figure 10.10 Delayed esophageal perforation in a 62‐year‐old male with status p...

Figure 10.11 Spectrum of findings in a 70‐year‐old male with chronic atrial fib...

Figure 10.12 (a) Fatty infiltration (

double‐headed arrow

) of the right ve...

Figure 10.13 Anatomical locations of the heart where fat infiltration due to ex...

Chapter 11

Figure 11.1 (a) Short axis image of left ventricle in patient with hypertrophic...

Figure 11.2 Patient with ARVC. There is extensive LGE, predominantly affected t...

Figure 11.3 (a) Four‐chamber view of a patient with LV non‐compaction. Signific...

Figure 11.4 (a,b) Two short axis views of the left ventricle in a patient with ...

Figure 11.5 (a) Short axis view of a patient with cardiac sarcoidosis. There is...

Chapter 12

Figure 12.1 Use of MediGuide to implant LV lead. (See text for details.)

Figure 12.2 Use of MediGuide to perform atrial fibrillation ablation. (See text...

Figure 12.3 Fluoroscopy time during atrial fibrillation ablation as a function ...

Figure 12.4 Transseptal puncture guided by integrated imported three‐dimensiona...

Figure 12.5 Use of Univu to perform atrial fibrillation ablation. (a) Simulated...

Figure 12.6 Arrhythmogenic right ventricular cardiomyopathy imaged with CMR. (a...

Figure 12.7 Hypertrophic cardiomyopathy imaged with CMR. Left ventricular hyper...

Figure 12.8 Ischemic cardiomyopathy, non‐ischemic cardiomyopathy, myocarditis, ...

Figure 12.9 Ischemic cardiomyopathy imaged with CMR and with voltage mapping. (...

Figure 12.10 Implantable cardioverter defibrillator RV lead seen imaged with CM...

Figure 12.11 3‐D representation of the left atrium performed after an initial p...

Figure 12.12 Integration of ICE, 3D mapping, and contact force for PVI. (See te...

Figure 12.13 MRA of left atrium with LA diverticulum as origin of focal AT. (Se...

Figure 12.14 Electroanatomical mapping to guide endomyocardial biopsy for sarco...

Figure 12.15 Three‐dimensional mapping system with integrated intracardiac echo...

Figure 12.16 Acoustic radiation force impulse (ARFI) of the ligament of Marshal...

Chapter 13

Figure 13.1 Schematic drawing illustrating calcium/voltage‐sensing mechanism of...

Figure 13.2 GECI and GEVI imaging of hiPSC‐CMs. (a) Optical imaging of intracel...

Figure 13.3 ArcLight‐based optical mapping of hiPSC‐CMs cultures. Activation ma...

Figure 13.4 Optogenetic modulation of excitability in cardiomyocyte co‐cultures...

Figure 13.5 Optogenetic pacing of the isolated perfused rat heart. The ChR2 tra...

Figure 13.6 Multisite optogenetic pacing for cardiac resynchronization. (a‐f) O...

Chapter 14

Figure 14.1 Imaging of coronary sinus (CS) anatomy and ventricular lead course ...

Figure 14.2 (a) Real‐time 3D transoesophageal echocardiography (TEE) and 3D spe...

Figure 14.3 (a) Bullseye view of motion map points in one patient divided into ...

Figure 14.4 Mapping of LV voltage and local activation time for identification ...

Chapter 15

Figure 15.1 Assessment of left atrial dimensions with two‐ (a) and three‐dimens...

Figure 15.2 Classification of the left atrial roof shape by angiography and mul...

Figure 15.3 Assessment of left atrial (LA) fibrosis with late gadolinium‐enhanc...

Figure 15.4 Imaging of epicardial fat using echocardiography and MDCT. Short ax...

Figure 15.5 Evaluation of LA function with speckle tracking strain echocardiogr...

Figure 15.6 Evaluation of pulmonary vein anatomy and dimensions with multidetec...

Figure 15.7 Three‐dimensional anatomical model of the human atria based on diff...

Figure 15.8 Assessment of electrical remodeling with tissue Doppler imaging in ...

Figure 15.9 Assessment of myocardial scar with SPECT myocardial perfusion imagi...

Figure 15.10 Assessment of mechanical dispersion using speckle tracking echocar...

Figure 15.11 SPECT imaging with

123

I‐ MIBG. (a) The global myocardial

123

I‐MIBG...

Chapter 16

Figure 16.1 Differences in dense scar region in a substrate map made with a con...

Figure 16.2 The mini‐basket multielectrode catheter (Orion™) is shown in low pr...

Figure 16.3 Discordance between the circular map catheter and mini‐basket cathe...

Figure 16.4 Display of beat acceptance criteria (

upper right box

). Thresholds o...

Figure 16.5 Activation map of a paroxysmal and incessant focal atrial tachycard...

Figure 16.6 Patient with prior inferior myocardial infarction and recurrent ven...

Figure 16.7 Filters applied sequentially in order to optimize the validity of a...

Figure 16.8 The top two images show MRI signal intensity maps obtained from con...

Figure 16.9 Example of “ripple mapping” to visualize timing, size, and directio...

Figure 16.10 This bipolar voltage map is from a patient with a large inferior i...

Figure 16.11 The Score Map allows rapid display of mapping points as scored by ...

Figure 16.12 (a) Epicardial substrate mapping in the Precision system with frac...

Chapter 17

Figure 17.1 Non‐invasive mapping process. (a) The 252‐electrode vest is placed ...

Figure 17.2 Phase map of reentrant driver. (

Top left panel

) Phase map at the dr...

Figure 17.3 Model of reentry during AF. The AF substrate consists of partial sc...

Figure 17.4 Significance of driver regions. (a) The number of driver regions is...

Figure 17.5 Remapping after ablation. Mapping before ablation identifies severa...

Figure 17.6 Termination of AF at a site of unstable trajectory. (a) Reentrant s...

Chapter 18

Figure 18.1 The ECGI procedure. (

Bottom

) The electrical data; 250 electrocardio...

Figure 18.2 Images of post‐MI electrical and anatomical scar. (a) Electrical sc...

Figure 18.3 Additional images of post‐MI electrical and anatomical scars. ECGI‐...

Figure 18.4 Late potentials (LP) within electrical scar. (a) ESM from a patient...

Figure 18.5 Epicardial activation maps of native rhythm in four representative ...

Figure 18.6 Guidance of CRT lead placement with ECGI. Activation maps for five ...

Figure 18.7 Activation maps from two patients who responded to CRT. Native rhyt...

Figure 18.8 (a, b) Activation maps from two patients who have not responded to ...

Figure 18.9 CRT with single LV electrode pacing. Isochrone maps during LV pacin...

Figure 18.10 Activation maps in a patient who had a normal QRSd despite LBBB pa...

Figure 18.11 Scatter plots of electrical dyssynchrony (ED) versus QRSd for CRT ...

Figure 18.12 Anterior scar‐related VT with a double‐loop pattern. (a) VT activa...

Chapter 19

Figure 19.1 Spiral wave reentry may drive human cardiac fibrillation. (a) Spira...

Figure 19.2 Human AF electrograms may show far‐field and noise. (a) Epicardial ...

Figure 19.3 Electrogram summates multiple waves in fibrillation which alters el...

Figure 19.4 Electrograms in human cardiac fibrillation may oversense and unders...

Figure 19.5 Dynamic rate‐dependence of action potential duration (APD, repolari...

Figure 19.6 Computer simulations reveal mechanisms for the termination of human...

Figure 19.7 Cumulative freedom from AF in patients off antiarrhythmic medicatio...

Figure 19.8 Human VF rotors revealed by endocardial and epicardial mapping. (a)...

Chapter 20

Figure 20.1 (a) Annual volume of catheter ablation procedures by indication. An...

Figure 20.2 (

Left

) Globe array with 16 ribs and 122 gold‐plated electrodes. (Ri...

Figure 20.3 Prevalence and distribution of sustained non‐pulmonary vein trigger...

Figure 20.4 A sketch of type A, B, and C lesions for AF ablation. This figure s...

Figure 20.5 Prevalence of pulmonary vein reconnection in patients undergoing re...

Figure 20.6 (a) Preferred strategy for first ablation of persistent, but not lo...

Chapter 21

Figure 21.1 The integration of contact force data into the CARTO 3 electroanato...

Figure 21.2 CARTO 3 with Visitag. On the left side of the screen are the parame...

Figure 21.3 Distribution of contact force in the right and left WACA. Upper fig...

Figure 21.4 Contact force variability. Contact force (CF) waveform over time at...

Figure 21.5 Factors affecting impedance drop during ablation. (a) Contact force...

Chapter 22

Figure 22.1 Quantitation of myocardial scar with contrast‐enhanced MRI (CMR) an...

Figure 22.2 Anterior whole‐body images (

99m

Tc‐DPD) from four patients with susp...

Figure 22.3 PET images of a 43‐year‐old male who presented with recurrent VT an...

Figure 22.4 Kaplan–Meier survival curves (all‐cause mortality) for 1322 HF pati...

Figure 22.5 Occurrence of 70 arrhythmic events (sudden cardiac death, resuscita...

Figure 22.6 Illustration of

123

I‐

m

IBG SPECT quantitation with adjustment for ov...

Figure 22.7 Example of quantitative displays from PET imaging of myocardial blo...

Figure 22.8 CMR and PET (

15

O‐water and

11

C‐HED) in two patients (A–D and E–G) w...

Chapter 23

Figure 23.1 (a) Schematic diagram showing intracellular versus SR Ca

2+

fluoresc...

Figure 23.2 (a) Representative

V

m

and SR Ca

2+

optical traces during continuous ...

Figure 23.3 Frequency‐dependent SR Ca

2+

response. (a) Diastolic [Ca

2+

]

SR

increa...

Figure 23.4 Effect of isoproterenol (ISO, 100 nM) on SR Ca

2+

release and reupta...

Figure 23.5 SR Ca

2+

release alternans versus diastolic SR Ca

2+

load alternans. ...

Figure 23.6 Effect of caffeine on

V

m

and SR Ca

2+

alternans. (a) Maps of spectra...

Figure 23.7 Comparison of [Ca

2+

]

SR

and [Ca

2+

]

i

signals during VF. (a) Dual imag...

Chapter 24

Figure 24.1 (a) Representative L‐type Ca

2+

current:

I

Ca‐L

traces from fem...

Figure 24.2 Ventricular myocytes isolated from sections of epicardium approxima...

Figure 24.3 Action potentials (APs) recorded using the current clamp mode: (a) ...

Figure 24.4 Spatial dispersion of APD. For quantitative description of spatial ...

Figure 24.5 Action potential (AP) simulation generated by incorporating gender ...

Figure 24.6 Recordings obtained from an experiment in an adult male guinea‐pig ...

Figure 24.7 Recordings obtained from an experiment in an adult female guinea pi...

Figure 24.8 Another experiment in an adult female guinea‐pig heart, illustratin...

Figure 24.9 Spatiotemporal entropy of the ST/VT shown in Figure 24.8a. (a) A ru...

Figure 24.10 Spatiotemporal measure of the NST/VT. The figure illustrates the

V

Chapter 25

Figure 25.1 Reentrant sources of AF. (a) Isochrone map of optical activity from...

Figure 25.2 Phase representation of wave breakup and reentry formation. (a) A s...

Figure 25.3 (a, b) DF maps from one heart at IAPs of 5 and 18 cmH

2

O, respective...

Figure 25.4 (a) Schematic directionality of activity from the pulmonary veins t...

Figure 25.5 Simultaneous optical mapping of (a) the intact posterior left atriu...

Figure 25.6 (a, b) DF values obtained from the implantable loop recorder (ILR, ...

Figure 25.7 Simulations predict consequences of ion channel remodeling on rotor...

Chapter 26

Figure 26.1 (a) Positions and orientations of a 192‐electrode array plotted on ...

Figure 26.2 Isochronal map of the right atrial free wall constructed during per...

Figure 26.3 Three isochronal maps (a) and their corresponding wave maps (b) of ...

Figure 26.4 (a) Endocardial–epicardial asynchrony in excitation during a 3‐s re...

Figure 26.5 (a) Post‐mortem human hearts demonstrating the anatomical location ...

Figure 26.6 Mapping of (a) induced AF in a patient with coronary artery disease...

Chapter 27

Figure 27.1 Cellular basis for electrocardiographic and arrhythmic manifestatio...

Figure 27.2 New interpretation of fractionated electrogram activity and late po...

Figure 27.3 Radiofrequency ablation (RFA) of the epicardial surface abolishes t...

Figure 27.4 Indications for therapy of patients with Brugada syndrome. ES, extr...

Figure 27.5 Indications for therapy of patients with early repolarization syndr...

Chapter 28

Figure 28.1 (a) Spatially concordant and (b) spatially discordant repolarizatio...

Figure 28.2 Initiation of reentry by a PVC during spatially discordant APD alte...

Figure 28.3 Primary Ca

2+

alternans. A voltage‐clamped rabbit ventricular myocyt...

Figure 28.4 Positive and negative Ca

2+

–APD coupling. During the Ca

2+

transient,...

Figure 28.5 Subcellular spatially discordant Ca

2+

alternans. During rapid pacin...

Figure 28.6 Ca

2+

waves and DADs. (a) Ca

2+

waves after a five‐beat pacing train ...

Figure 28.7 Coexistence of suprathreshold and subthreshold DADs causing initiat...

Figure 28.8 The cardiac Ca

2+

cycling network of Ca

2+

release units (CRU). (a) C...

Figure 28.9 The three Rs model of the cardiac calcium cycling CRU network. Arra...

Figure 28.10 Relating the three Rs theory to molecular alterations causing Ca

2+

Chapter 29

Figure 29.1 Principles of discontinuous conduction and source‐to‐sink mismatch....

Figure 29.2 Fractionated unipolar extracellular electrograms recorded from an i...

Figure 29.3 Zig‐zag conduction in the rectangle shown in Figure 29.2. The actua...

Figure 29.4 Myofibroblast–myocyte coupling and its effect on electrical conduct...

Chapter 30

Figure 30.1 (a) Increased

I

Na‐L

with ATX II and initiation of EADs and tr...

Figure 30.2 Continuous microelectrode and cardiac electrogram recordings of car...

Figure 30.3 Masson trichrome staining (blue) in adult and aged ventricles. (a) ...

Figure 30.4 Initiation of EAD‐mediated transient triggered activity in an isola...

Figure 30.5 Glass microelectrode AP recording and optical mapping of AP activat...

Figure 30.6 Optical actions potentials during stable monomorphic VT (a) recorde...

Figure 30.7 Spontaneous initiation of VT/VF in an aged rat heart exposed to 0.1...

Figure 30.8 Spontaneous initiation of VF in an aged rabbit exposed to 0.1 mM H

2

Figure 30.9 Cryoablation of midmyocardium and endocardial structures in an aged...

Figure 30.10 (a–e) Suppression of hypokalemia‐induced VF by CaMKII inhibition o...

Figure 30.11 Suppression of H

2

O

2

‐induced spontaneous VT/VF in an isolated perfu...

Figure 30.12 Flow chart showing downstream signaling of CaMKII activation leadi...

Chapter 31

Figure 31.1 Swine model of infarct‐related healed infarction with reentrant ven...

Figure 31.2 Progressive QRS fusion. See text for details.

Figure 31.3 Activation maps post‐infarction reentrant ventricular tachycardias....

Figure 31.4 Conduction velocities during ventricular tachycardia: two separate ...

Figure 31.5 Effect of wavefront propagation on conduction velocities. See text ...

Figure 31.6 Entrainment mapping overestimates the size of the isthmus. See text...

Figure 31.7 Correlation between the VT circuit and sinus map. See text for deta...

Chapter 32

Figure 32.1 The sinus activation sequence mapped from an isolated human heart. ...

Figure 32.2 Intramural mapping of ventricular extracellular electrical activity...

Figure 32.3 Distribution of the stimulus artifact, intramurally mapped in the

i

...

Figure 32.4 Intramural extracellular potential mapping in the

in vivo

pig heart...

Figure 32.5 Intraoperative mapping and reconstruction of induced monomorphic ve...

Figure 32.6 Tissue imaging and three‐dimensional reconstruction of a reperfusio...

Figure 32.7 Intramural reentry in explanted human hearts. Ventricular fibrillat...

Figure 32.8 (a) Schematic of a ventricular wedge preparation. An isolated LV we...

Figure 32.9 Transmural optical action potential measurements from rejected dono...

Figure 32.10 Depth‐resolved optical mapping by alternating illumination of epic...

Chapter 33

Figure 33.1 Simultaneous optical signal tracings of membrane voltage (

V

m

, blue)...

Figure 33.2 Optical voltage tracings from rabbit hearts before

(

insets

) and aft...

Figure 33.3 Incubation with estradiol (E2) increases the density of

I

Ca‐L

Figure 33.4 Spatial heterogeneity of calcium transients (CaT) during regular pa...

Figure 33.5 Calcium imaging at subcellular resolution (100 × 100 pixels, 1.5 µm...

Figure 33.6 An example of calcium signal at subcellular resolution during chaot...

Chapter 34

Figure 34.1 Remodeling of conduction in heart failure. (a, b) Conduction veloci...

Figure 34.2 Increased maldistribution of Cx43 in heart failure. (a) Representat...

Figure 34.3 Remodeling of repolarization in heart failure. (a, b) Representativ...

Figure 34.4 Functional remodeling of

I

Kr

in heart failure. (a, b) APD80 maps an...

Figure 34.5 Remodeling of excitation–contraction coupling in heart failure. (a)...

Figure 34.6 Remodeling of calcium transients in heart failure. (a) Representati...

Figure 34.7 Remodeling of response of repolarization to acute ischemia–reperfus...

Figure 34.8 Remodeling of response of conduction to acute ischemia–reperfusion ...

Figure 34.9 Metabolic changes during low‐flow ischemia in human hearts. (a) Rep...

Figure 34.10 Remodeling of APD response to beta‐adrenergic stimulation in heart...

Figure 34.11 Remodeling of calcium transient response to beta‐adrenergic stimul...

Chapter 35

Figure 35.1 (a) The leading circle concept: activity establishes itself in the ...

Figure 35.2

(

a) Negative and positive polarizations induced by a monophasic sho...

Figure 35.3 Creation of a shock‐induced phase singularity. (a) Polarization pat...

Figure 35.4 Virtual electrode polarization (VEP) and postshock excitation: modu...

Figure 35.5 Reentry induced by shocks applied during pacing at different sites....

Figure 35.6 Dynamics of transmembrane potential during failed 8‐ms monophasic s...

Figure 35.7 Mechanism of cathodal and anodal shock‐induced arrhythmias. (a) An ...

Figure 35.8 The spatial pattern of polarization at the end of the shock produce...

Figure 35.9

(

a) Schematic diagram showing the heart and field of view for optic...

Figure 35.10

(

a) Multistage electrotherapy (MSE). Stage 1 consisted of three mo...

Figure 35.11 High‐density electrical mapping. (a) Representative optical and el...

Chapter 36

Figure 36.1 Mapping the spatial distribution of repolarization changes in respo...

Figure 36.2 Cumulative incidence maps illustrating the spatial distribution of ...

Figure 36.3 Cumulative incidence maps illustrating modifications of the spatial...

Figure 36.4 Rate of atrial fibrillation (AF) induction estimated using the extr...

Figure 36.5 Negative chronotropic responses evoked by cervical right vagus nerv...

Figure 36.6 Cumulative incidence maps of repolarization changes evoked by cervi...

Figure 36.7 Postsynaptic responses to presynaptic nerve stimulation in canine i...

Chapter 37

Figure 37.1 Classical models of AF. Ideas about the mechanisms underlying AF we...

Figure 37.2 Properties of spiral‐wave reentrant rotors. (a) The rotor circulate...

Figure 37.3 Recently formulated concepts about AF mechanisms. AF can be maintai...

Figure 37.4 (a) A two‐dimensional representation of epicardial–endocardial inte...

Figure 37.5 Implications for ablation therapy of mechanisms shown in Figure 37....

Chapter 38

Figure 38.1 Dynamic mechanisms enabling triggers to initiate human atrial fibri...

Figure 38.2 Disordered waves in fibrillation have a stochastic probability of t...

Figure 38.3 Optical mapping of human atria in AF reveals stable microreentrant ...

Figure 38.4 Clinical approach to FIRM‐guided rotor mapping. (a) Workflow. (b) M...

Figure 38.5 AF rotational source, identified by electrograms and FIRM map, wher...

Figure 38.6 FIRM maps of AF in contrast to organized tachycardias. (a) Right at...

Figure 38.7 Cumulative freedom from atrial fibrillation in patients off antiarr...

Figure 38.8 Technical features of successful and unsuccessful studies of FIRM‐g...

Figure 38.9 Rotors may drive recurrent AF if not fully eliminated at index proc...

Chapter 39

Figure 39.1 Bipolar fibrillation electrograms (a) were first band‐pass filtered...

Figure 39.2 Examples of similarity and CFAE maps in a patient with persistent A...

Figure 39.3 (a) Simulation of a rotor in the phase mapping with non‐linear enve...

Figure 39.4 Illustration of the difference between the vector field of (a) a ro...

Figure 39.5 Taipei approach to dynamic phase mapping using bipolar EG recording...

Figure 39.6 Effect of distance from the mapping site to the core of rotor on th...

Figure 39.7 Examples of two rotors in a patient with persistent AF. (a) Similar...

Figure 39.8 Kaplan–Meier survival curves after the index ablation procedure for...

Chapter 40

Figure 40.1 Schematic diagrams demonstrating the activation patterns in the typ...

Figure 40.2 (a) Schematic diagram demonstrating the locations where double pote...

Figure 40.3 (a) A 12‐lead electrocardiogram recorded from a patient with typica...

Figure 40.4 Left anterior oblique (LAO) and right anterior oblique (RAO) fluoro...

Figure 40.5 Endocardial electrograms from the mapping/ablation, Halo, CS, and H...

Figure 40.6 Endocardial electrograms from the RF, Halo, CS, and His bundle cath...

Figure 40.7 A schematic diagram of the right atrium demonstrating the possible ...

Figure 40.8 Intracardiac echocardiographic image of the right atrium and ventri...

Figure 40.9 Surface ECG and endocardial electrogram recordings during ablation ...

Figure 40.10 (a) A schematic diagram of the expected right atrial activation se...

Figure 40.11 (a) Schematic diagrams of the expected right atrial activation seq...

Figure 40.12 Surface ECG leads I, aVF and V1, and endocardial electrograms from...

Figure 40.13 Three‐dimensional electroanatomical maps of the right atrium using...

Figure 40.14 A Carto™ three‐dimensional activation sequence map (LAO caudal vie...

Figure 40.15 A Carto™ three‐dimensional activation sequence map is shown in a p...

Figure 40.16 A Carto™ three‐dimensional activation sequence map is shown in a p...

Figure 40.17 (a) A Carto™ three‐dimensional voltage map of the right atrium and...

Figure 40.18 (a) Left anterior oblique fluoroscopic projection showing the posi...

Figure 40.19 (a) A Carto™ three‐dimensional activation sequence map (RAO view) ...

Figure 40.20 A three‐dimensional Velocity™ activation map in a patient with upp...

Figure 40.21 A Carto™ three‐dimensional activation sequence map (posterior caud...

Figure 40.22 Electrograms and schematic representation of atrial activation in ...

Figure 40.23 Electrograms and schematic representation of atrial activation seq...

Chapter 41

Figure 41.1 Combination of three‐dimensional mapping modalities: three‐dimensio...

Figure 41.2 (a) Activation map acquired with circular mapping catheters: >2500 ...

Figure 41.3 Surface ECG and intracardiac recordings of a left atrial macroreent...

Figure 41.4 Same recordings as in Figure 41.3. At this spot, the return cycle i...

Figure 41.5 Concept of color‐coded three‐dimensional entrainment mapping. At ea...

Figure 41.6 Example of a localized reentry tachycardia in a post‐PVI patient. T...

Figure 41.7 Biatrial activation map using the Rhythmia system. Almost 15 000 el...

Figure 41.8 Examples of typical reentrant mechanisms in color‐coded entrainment...

Chapter 42

Figure 42.1 A suggested algorithm for localization of the site of a focal atria...

Figure 42.2 A typical high‐resolution map of a left atrial flutter. The patient...

Figure 42.3 Ablation site and PentaRay™ map with successful site of ablation fo...

Figure 42.4 CT image illustrating the pertinent anatomical features of the peri...

Figure 42.5 Patient presented with multiple ICD shocks due to a supraventricula...

Figure 42.6 The patient is a 5 year old who had atrial tachycardia (AT) on an E...

Figure 42.7 A 51‐year‐old male with a past medical history of hypertension and ...

Chapter 43

Figure 43.1 Left atrial appendage (LAA) morphologies by cardiac CT (

left

), MRI ...

Figure 43.2 Computed tomography‐based images of the LAA: (a) LAA with mild trab...

Figure 43.3 Forest plot of chicken‐wing versus non‐chicken‐wing LAA morphology ...

Figure 43.4 (a) Forest plot of chicken‐wing versus cauliflower LAA morphology a...

Figure 43.5 Algorithm to assess need for long‐term anticoagulation (AC) in pati...

Figure 43.6 Example illustrating the classification for the “take‐off” (a) of t...

Chapter 44

Figure 44.1 Catheter setup to assess the origin of atrial ectopic activity duri...

Figure 44.2 Premature atrial beat from the superior vena cava triggering atrial...

Figure 44.3 Premature atrial beat from interatrial septum: the circular mapping...

Figure 44.4 Premature atrial beat from the mid‐coronary sinus. ABL, ablation ca...

Figure 44.5 Premature atrial beat from the left atrial appendage triggering atr...

Figure 44.6 Lesion set of left atrial posterior wall isolation obtained through...

Figure 44.7 Positioning of the circular mapping catheter in the left atrial pos...

Figure 44.8 Left atrial posterior wall isolation: the circular mapping catheter...

Figure 44.9 Lesion set of left atrial posterior wall isolation obtained through...

Figure 44.10 Intracardiac echocardiography image of ablation in the left atrial...

Figure 44.11 Superior vena cava isolation: baseline, and after (with dissociate...

Figure 44.12 Intracardiac echocardiography image of the circular mapping cathet...

Figure 44.13 Superior vena cava isolation obtained with a segmental approach st...

Figure 44.14 Left persistent superior vena cava isolation. (a) Circular mapping...

Figure 44.15 Left atrial endocardial ablation to obtain coronary sinus isolatio...

Figure 44.16 Coronary sinus and left atrial appendage isolation (the left atria...

Figure 44.17 Intracardiac echocardiography image showing the circular mapping c...

Figure 44.18 Lesion set to obtain ligament of Marshall isolation from the left ...

Chapter 45

Figure 45.1 Electrical remodeling: relevant mechanisms contributing to the occu...

Figure 45.2 Representative example of inducible atrial fibrillation by burst pa...

Figure 45.3 Representative example of persisting sinus rhythm despite atrial bu...

Chapter 46

Figure 46.1 The three consecutive steps of the stepwise approach. *, The linear...

Figure 46.2 An example of the stepwise approach showing the electrograms of the...

Chapter 47

Figure 47.1 Location of ganglionated plexi (GP). The locations of the anterior ...

Figure 47.2 (a, b) GP are usually surrounded by complex fractionated atrial ele...

Figure 47.3 (a) A rotor identified by optical mapping. The local electrograms (...

Figure 47.4 AF nests: (a) electrograms and power spectrum of compact and fibril...

Figure 47.5 Baseline SUMO scans with three‐dimensional reconstruction of the le...

Chapter 48

Figure 48.1 Amount and distribution of fibrosis in atrial tissue samples from t...

Figure 48.2 Isochronal activation maps for control (CTL), rapid atrial pacing (...

Figure 48.3 Examples of static dominant frequency maps for each of the animal m...

Figure 48.4 Conduction patterns recorded with optical mapping during pacing at ...

Figure 48.5 Action potential duration and conduction velocity. (a) Representati...

Figure 48.6 Dominant frequency (row 1), activation patterns (row 2), APD

80

(row...

Figure 48.7 Summary data of the average left atrial cross‐sectional area for ea...

Figure 48.8 Representative color‐coded electroanatomical peak–peak bipoloar vol...

Figure 48.9 (a) Dominant frequency (DF) map in patient with paroxysmal AF (6 ho...

Figure 48.10 Localized electrical rotors (spiral waves) in human AF revealed by...

Chapter 49

Figure 49.1 Stepwise process of delayed enhancement‐MRI (DE‐MRI) image acquisit...

Figure 49.2 The four stages of left atrial tissue fibrosis based on DE‐MRI.

Figure 49.3 Cumulative incidence of arrhythmia recurrence according to baseline...

Figure 49.4 The incorporation of left atrial geometry created by three‐dimensio...

Figure 49.5 Post‐ablation DE‐MRI evaluation of scarring in the pulmonary vein a...

Figure 49.6 Calculation process of residual fibrosis. The pre‐ablation DE‐MRI (...

Figure 49.7 Personalized treatment of atrial fibrillation. DE‐MRI, delayed‐enha...

Figure 49.8 Scar recovery and scar progression after atrial fibrillation ablati...

Chapter 50

Figure 50.1 The pathophysiological triangle in atrial fibrillation.

Figure 50.2 Electroanatomical voltage mapping and electrogram morphology as s...

Figure 50.3 Different expression of left atrial fibrosis on electroanatomical...

Figure 50.4 Box isolation of fibrotic areas (BIFA) in a patient with paroxysm...

Figure 50.5 Box isolation of fibrotic areas (BIFA) or sole pulmonary vein iso...

Chapter 51

Figure 51.1 Critical anatomical structures in relation to the left atrial app...

Figure 51.2 Comparison of a three‐dimensional anatomical map with a circular ...

Figure 51.3 Activation mapping in a patient with a tachycardia cycle length o...

Figure 51.4 Ablation set for isolation of the left atrial appendage. Carto 3 ...

Figure 51.5 Atrial tachycardia mapped to the left atrial appendage. (a) AP vi...

Chapter 52

Figure 52.1 Intracardiac electrogram showing coronary sinus (CS) catheter (10...

Figure 52.2 Dissociated firing (blue arrow) noted after isolation of the left...

Figure 52.3 Examples of electrograms from the revised grading system. Electro...

Chapter 53

Figure 53.1 The concept of phase‐space plot and the relationship to acquired ...

Figure 53.2 Illustration of phase representation of signals using the Hilbert...

Figure 53.3 Rotors driving AF in panoramic FIRM mapping in humans. (a) LA rot...

Figure 53.4 Phase maps and analysis of ECGI data. (a) One of the two consecut...

Figure 53.5 Body surface dominant frequency (DF) and phase mapping. (a) Sampl...

Chapter 55

Figure 55.1 Determining which component of a complex electrogram was captured...

Figure 55.2 A simple reentrant circuit of atrial tachycardia and results of p...

Figure 55.3 Unreliable PPI measurement due to unrepresentative return cycle. ...

Figure 55.4 Method of building entrainment map on an electroanatomical mappin...

Figure 55.5 Entrainment map of left atrium in same patient as in Figure 55.4....

Figure 55.6 Entrainment from a site in the diastolic corridor. Stimulation is...

Figure 55.7 Entrainment from an inner loop site. As in Figure 55.6, the PPI m...

Figure 55.8 Use of entrainment to determine whether a site is activated early...

Figure 55.9 Entrainment from a bystander site near the main diastolic corrido...

Figure 55.10 Dual‐loop atrial tachycardia diagnosis. Overdrive pacing (250 ms...

Figure 55.11 Termination of tachycardia without propagation during overdrive ...

Figure 55.12 Change in tachycardia following pacing. At left, a rapid atrial ...

Chapter 56

Figure 56.1 Atrial reentry following prior pulmonary vein isolation for treat...

Figure 56.2 Reentry circuit diagrams. At left, reentry (

colored arrows

) in an...

Figure 56.3 Bystander site in postinfarct VT. Stimulation is performed from t...

Figure 56.4 Unreliable PPI in irregular VT. Overdrive pacing is performed dur...

Figure 56.5 Proximal electrogram as a surrogate for distal. Overdrive pacing ...

Figure 56.6 Uninterpretable PPI during atrial tachycardia (AT). Overdrive pac...

Figure 56.7 Uncertainty about which electrogram component to measure for PPI ...

Figure 56.8 Lack of capture and PPI assessment. Overdrive pacing during VT is...

Figure 56.9 Varying PPI in focal AT. The last two cycles of pacing near a rig...

Figure 56.10 Decremental conduction as a cause of long PPI. At left, a middia...

Figure 56.11 Erroneously short PPI. Overdrive pacing during VT is shown, with...

Figure 56.12 Reasons for apparent short PPI: far‐field capture. In (a) at lef...

Chapter 57

Figure 57.1 Accessory pathway schematic showing preexcitation and induction o...

Figure 57.2 Schematic diagram of a typical left‐sided accessory pathway. Atri...

Figure 57.3 Normal mitral and tricuspid annulus anatomy. (a) Anatomical secti...

Figure 57.4 Histological sections showing accessory pathways. (a) Histologica...

Figure 57.5 “Slanted” (oblique) accessory pathway. The histological sections ...

Figure 57.6 Histological section showing a right posteroseptal accessory path...

Figure 57.7 Algorithm for ECG localization of accessory pathway by preexcitat...

Figure 57.8 Confirmation and validation of accessory pathway potentials. Atri...

Figure 57.9 Electrogram characteristics and ablation success. Success of any ...

Figure 57.10 Differential pacing to separate the local A, AP potential, and V...

Figure 57.11 Orientation of oblique course of accessory pathways. Results rep...

Figure 57.12 Anatomy of triangle of Koch. (a) A right anterior oblique angle ...

Figure 57.13 Anatomy of posterior septal space. This shows a dissection of th...

Figure 57.14 Schematic of CS‐associated (epicardial) posteroseptal accessory ...

Figure 57.15 Fluoroscopic views and electrograms recorded for mapping of CS‐a...

Figure 57.16 Atriofascicular pathway schematic. Note the AV node‐like structu...