Understanding Intracardiac EGMs E-Book

Fred M. Kusumoto

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

Seitenzahl: 505

Veröffentlichungsjahr: 2015

Beschreibung

Dr Kusumoto’s unique new book takes a step-wise, patient-centered approach to guide readers through the thought process required during an electrophysiology study and the development of new findings.

• Follows a case based step-wise approach focused on the EP lab that allows readers to follow along with the thought process behind how experienced electrophysiologists first diagnose, then prepare, treat and manage patients with common rhythmic abnormalities, including atrial fibrillation
• Written by award-winning Mayo Clinic Physician-educator Dr. Fred Kusumoto
• Ideal for fellows, new EPs, nursing and technical staff in the EP lab
• Includes clinical questions to help readers test their understanding of the steps and concepts covered in the book and prepare for certification exams

Leseprobe

Table of Contents

Cover

Dedication

Title Page

Copyright

Preface

Glossary

Chapter 1: Basic electrophysiology

Mechanistic tachycardia classification

Anatomic tachycardia classification

Electophysiology basics

Chapter 2: Supraventricular tachycardia case 1

Evaluation of baseline electrograms

Pacing protocols

Initiation of tachycardia and evaluation

Ablation of typical AVNRT

Chapter 3: Supraventricular tachycardia case 2

Chapter 4: Supraventricular tachycardia case 3

Chapter 5: Supraventricular tachycardia case 4

Chapter 6: Supraventricular tachycardia case 5

Chapter 7: Supraventricular tachycardia case 6: baseline preexcitation

Chapter 8: Supraventricular tachycardia case 7: baseline preexcitation

Chapter 9: Supraventricular tachycardia case 8

Chapter 10: Supraventricular tachycardia case 9

Chapter 11: Supraventricular tachycardia cases 10 and 11

Chapter 12: Supraventricular tachycardia case 12

Chapter 13: Supraventricular tachycardia case 13

Chapter 14: Supraventricular tachycardia case 14: atrial fibrillation

Chapter 15: Supraventricular tachycardia case 15: atrial tachycardia after atrial fibrillation ablation

Chapter 16: Supraventricular tachycardia case 16: atrial tachycardia after atrial fibrillation ablation

Chapter 17: Supraventricular tachycardia case 17: atrial tachycardia after atrial fibrillation ablation

Chapter 18: Supraventricular tachycardia case 18: atrial tachycardia after atrial fibrillation ablation

Chapter 19: Supraventricular tachycardia case 19: atrial tachycardia after atrial fibrillation ablation

Chapter 20: Wide complex tachycardia case 1

Chapter 21: Wide complex tachycardia case 2

Chapter 22: Wide complex tachycardia case 3: premature ventricular contractions

Chapter 23: Wide complex tachycardia case 4

Chapter 24: Wide complex tachycardia case 5

Chapter 25: Wide complex tachycardia case 6

Chapter 26: Syncope

Bradycardia

Tachycardia

CHAPTER 27: Multiple choice questions and answers

Appendix

Index

End User License Agreement

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Guide

Cover

Table of Contents

Preface

Begin Reading

List of Illustrations

Chapter 1: Basic electrophysiology

Figure 1.1 For most types of reentry, two separate pathways have different electrophysiologic properties, and with a carefully timed impulse, depolarization can occur in one pathway and “turn around” to depolarize the parallel pathway. The most well-described and the best clinical example of this is a patient with an accessory pathway (a). Normally, the AV node forms the only electrical connection between the atria and the ventricles, but in patients with an accessory pathway, the second electrical connection between the atria and ventricles can allow a reentrant circuit to develop. Another common scenario for reentrant arrhythmias is ventricular tachycardia in the setting of a prior myocardial infarction (b). In this case, a “patchy” myocardial scar forms an alternate pathway along with normal myocardium to activate one side of a scar to the other side of the scar.

Figure 1.2 Initiation of typical atrial flutter. (a): In sinus rhythm (*), atrial depolarization proceeds down the lateral wall of the right atrium (RA) and superiorly toward the septum. (b): With a premature atrial contraction from the left atrium (*), inferior atrial depolarization blocks in the cavotricuspid isthmus (CTI), but the wave of depolarization travels superiorly to activate the superior and lateral portions of the right atrium and enters the CTI from the other direction. (c): Slow conduction through the CTI initiates atrial flutter.

Figure 1.3 Anatomic classification of tachycardias

Figure 1.4 Patient with an automatic tachycardia from the AV node region observed in the first few hours after aortic valve surgery. This arrhythmia, called nonparoxysmal junctional tachycardia (NPJT), usually resolves after 1 or 2 days. Intermittent intrinsic AV conduction can sometimes be observed when a properly timed P wave results in an early QRS complex or a subtle change in the QRS morphology (*).

Figure 1.5 Basic catheter positions for electrophysiology study in the right anterior oblique (RAO) and the left anterior oblique (LAO) projections. Quadripolar catheters are located in the right atrium (RA), His bundle region (His) straddling the tricuspid valve, and the right ventricle (RV). A decapolar catheter is placed in the coronary sinus (CS). For orientation, the approximate locations of the mitral valve (MV), tricuspid valve (TV), inferior vena cava (IVC), and superior vena cava (SVC) are shown (

Figure 1.6 Flow sheet for the evaluation of electrograms during a typical electrophysiology study.

Figure 1.7 Electrograms recorded from catheter positions in Figure 1.5. The AV relationship is 1:1 with atrial activation (both P waves and atrial EGMs) preceding or “driving” ventricular activation (both QRS complexes and ventricular EGMs). Atrial activation is seen first in the high right atrium (HRA), followed by the His bundle, and last in the coronary sinus (vertical arrows). A His bundle deflection (H) and a right bundle (RB) potential can be seen during the isoelectric period of the PR interval. AV conduction is usually divided into two parts: the AH interval (first septal atrial activation to the His deflection) that represents conduction through the AV node and the HV interval (His deflection to first ventricular depolarization) that represents His bundle, bundle branch, and Purkinje fiber depolarization. Ventricular (V) activation is seen first in catheters located in the septum (His and RV) and later in the coronary sinus.