BOOK
Electrocardiography of Complex Arrhythmias, An Issue of Cardiac Electrophysiology Clinics, E-Book
(2014)
Additional Information
Book Details
Abstract
This issue of Cardiac Electrophysiology Clinics examines electrocardiography of complex arrhythmias. Topics include concealed conduction, right and left atrial macroreentrant tachycardias, focal atrial fachycardias, AV nodal and AV reentrant tachycardia, wide complex tachycardias, ventricular tachycardia in CAD, ECG characteristics of outflow tract VT, fascicular tachycardias, VT in non-ischemic dilated cardiomyopathy, VT originating from unusual sites, incessant VT and VT storms, ECG characteristics of TdP, VT in ARVC, and ventricular arrhythmia in inherited channelopathies, arrrhythmias in complex congenital heart disease, AV conduction disease and block, electrocardiographic analysis of paced rhythms.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Electrocardiography ofComplex Arrhythmias | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Cardiac electrophysiology clinics\r | xii | ||
| Foreword | xiii | ||
| Not Such a Trivial Pursuit | xiii | ||
| Preface | xv | ||
| Electrocardiography of Complex Arrhythmias | xv | ||
| Reference | xv | ||
| Concealed Conduction and Allied Concepts | 377 | ||
| Key points | 377 | ||
| Introduction | 377 | ||
| Historical background | 377 | ||
| ECG and EP manifestations | 378 | ||
| Concealment During Antegrade Conduction of Impulses | 378 | ||
| Premature atrial complex | 378 | ||
| Regular high-rate atrial impulses | 378 | ||
| Irregular high-rate atrial impulses | 383 | ||
| ECG perspectives pertinent to atrial fibrillation | 384 | ||
| Concealment During Retrograde Conduction of Impulses | 384 | ||
| Premature ventricular impulse | 384 | ||
| Incremental ventricular pacing | 385 | ||
| CC During Collision of Antegrade and Retrograde Impulses | 387 | ||
| Transseptal CC | 387 | ||
| Perpetuation of CC by Virtue of the Linking Phenomenon | 388 | ||
| Aberrant Ventricular Conduction | 392 | ||
| Development | 392 | ||
| Maintenance | 394 | ||
| Resolution | 395 | ||
| DVR and CC | 396 | ||
| Impact of CC on Different Forms of Tachycardia | 399 | ||
| Reentrant tachycardias | 399 | ||
| Tachycardias with V greater than A | 402 | ||
| Pacemaker-mediated tachycardia | 408 | ||
| Summary | 412 | ||
| Acknowledgments | 412 | ||
| References | 413 | ||
| Electrocardiographic Characteristics of Ventricular Arrhythmia in Inherited Channelopathies | 419 | ||
| Key points | 419 | ||
| Introduction | 419 | ||
| Long-QT syndrome | 420 | ||
| Background | 420 | ||
| Genetics and Pathogenesis | 420 | ||
| Electrocardiographic Characteristics | 420 | ||
| Clinical Manifestation and Diagnosis | 422 | ||
| Management | 424 | ||
| Short-QT syndrome | 425 | ||
| Background | 425 | ||
| Genetics and Pathogenesis | 425 | ||
| ECG Characteristics | 425 | ||
| Clinical Manifestation and Diagnosis | 426 | ||
| Treatment | 426 | ||
| Brugada syndrome | 426 | ||
| Background | 426 | ||
| Genetics and Pathogenesis | 426 | ||
| ECG Characteristics | 426 | ||
| Clinical Manifestation and Diagnosis | 427 | ||
| Management | 427 | ||
| Catecholaminergic polymorphic ventricular tachycardia | 428 | ||
| Background | 428 | ||
| Genetics and Pathogenesis | 428 | ||
| ECG Characteristics | 428 | ||
| Clinical Presentation and Diagnosis | 429 | ||
| Management | 429 | ||
| References | 429 | ||
| Electrophysiological Basis of ECG Characteristics of Torsades de Pointes in Long QT Syndrome | 433 | ||
| Key points | 433 | ||
| Introduction | 433 | ||
| ECG characteristics of TdP | 434 | ||
| A paradigm of TdP from ion channels to ECG | 437 | ||
| The mechanism of twisting QRS morphology of TdP | 437 | ||
| Short-long cardiac sequence and the onset of TdP | 438 | ||
| QT/T-wave alternans and TdP | 440 | ||
| The mechanism of perpetuation of TdP: repetitive focal activity versus reentrant excitation | 441 | ||
| Summary | 443 | ||
| References | 443 | ||
| Atrioventricular Conduction Disease and Block | 445 | ||
| Key points | 445 | ||
| Introduction | 445 | ||
| Electrocardiographic pattern | 445 | ||
| First-degree AV Block | 445 | ||
| Second-degree AV Block | 445 | ||
| Mobitz type I, second-degree AV block | 446 | ||
| Mobitz type II, second-degree AV block | 447 | ||
| 2:1 AV Block | 447 | ||
| High-degree AV Block | 447 | ||
| Third-degree AV Block and AV Dissociation | 448 | ||
| Paroxysmal AV Block | 448 | ||
| Vagotonic AV Block | 450 | ||
| Noninvasive and invasive testing | 450 | ||
| Causes of AV block | 451 | ||
| Acquired AV Block | 451 | ||
| Drugs | 451 | ||
| Iatrogenic | 453 | ||
| Ischemic | 454 | ||
| Degenerative | 454 | ||
| Systemic diseases | 454 | ||
| Hereditary AV Block and Channelopathies | 456 | ||
| Congenital AV Block | 456 | ||
| Management and treatment | 456 | ||
| Summary | 457 | ||
| References | 457 | ||
| Electrocardiographic Characteristics of Focal Atrial Tachycardias | 459 | ||
| Key points | 459 | ||
| Introduction and definition | 459 | ||
| Pathophysiology | 459 | ||
| ECG characteristics of focal AT | 460 | ||
| General principles surrounding the ECG in focal AT | 460 | ||
| ECG characteristics of right atrial sites of origin | 461 | ||
| Crista Terminalis | 461 | ||
| Tricuspid Annulus | 461 | ||
| Right Atrial Appendage | 462 | ||
| CS Ostium | 462 | ||
| Septal and Perinodal Region | 462 | ||
| ECG characteristics of left atrial sites of origin | 462 | ||
| Pulmonary Veins | 462 | ||
| Left Atrial Appendage | 462 | ||
| Mitral Annulus | 463 | ||
| Noncoronary Aortic Sinus of Valsalva | 463 | ||
| CS Body | 465 | ||
| Left Septal Region | 465 | ||
| Differential diagnosis | 465 | ||
| Pharmacologic management | 466 | ||
| Outcomes of EP study and ablation | 466 | ||
| Summary | 467 | ||
| References | 467 | ||
| Right and Left Atrial Macroreentrant Tachycardias | 469 | ||
| Key points | 469 | ||
| Electrophysiology study and ECG characteristics of macroreentrant tachycardias | 469 | ||
| Typical and Reverse Typical AFL | 469 | ||
| RA Upper Loop Reentry and Lower Loop Reentry | 470 | ||
| Left Atrial Macroreentrant Tachycardias | 472 | ||
| Mitral Annular AFL | 472 | ||
| LA Septal Flutter | 472 | ||
| Other LA Flutters | 474 | ||
| Differential diagnosis in 12-lead ECG | 475 | ||
| Management | 476 | ||
| Intervention outcome | 477 | ||
| Discussion | 479 | ||
| Distinguishing Typical AFL from Atypical AFL | 479 | ||
| Macroreentrant Atrial Tachycardias Following AF Ablation | 479 | ||
| Summary | 480 | ||
| References | 480 | ||
| Paroxysmal Supraventricular Tachycardias | 483 | ||
| Key points | 483 | ||
| Introduction | 483 | ||
| History of AVNRT | 483 | ||
| Clinical presentation | 484 | ||
| Electrocardiographic characteristics of AVNRT | 485 | ||
| Dual A-V nodal physiology | 486 | ||
| Types of AVNRT | 486 | ||
| Uncommon or atypical forms of AVNRT | 486 | ||
| Electrophysiologic characteristics of AVNRT | 486 | ||
| Investigation and differential diagnosis of AVNRT and AVRT in the electrophysiology laboratory | 489 | ||
| Timed Ventricular Premature Beats (Premature Ventricular Contractions) During SVT | 489 | ||
| P-wave morphology | 490 | ||
| Management of AVNRT | 490 | ||
| Management of patients with narrow complex tachycardia | 490 | ||
| Catheter ablation of AVNRT | 490 | ||
| Two approaches have been used for AVNRT ablation | 490 | ||
| Advantages of slow pathway ablation | 490 | ||
| End points of slow pathway ablation | 490 | ||
| Imaging during AVNRT ablation | 491 | ||
| Electrophysiologic effects of slow pathway ablation | 491 | ||
| Electrophysiologic effects of fast pathway ablation | 491 | ||
| Cryomapping and ablation of AVNRT | 492 | ||
| End points and outcomes of cryoablation in AVNRT | 492 | ||
| Subthreshold stimulation mapping of AVNRT | 492 | ||
| Complications of AVNRT ablation | 492 | ||
| AVRT | 492 | ||
| Clinical presentation | 492 | ||
| Tachycardias in WPW syndrome | 494 | ||
| Electrocardiographic characteristics of WPW syndrome and related tachycardias | 495 | ||
| Electrocardiographic features of OT | 496 | ||
| Effect of BBB During OT | 497 | ||
| Electrocardiographic features of preexcited tachycardias | 499 | ||
| Patients with multiple APs | 502 | ||
| Electrocardiographic clues to multiple APs | 503 | ||
| AF and atrial flutter in WPW syndrome | 503 | ||
| Other arrhythmias in AVRT | 504 | ||
| Mapping and ablation of APs | 504 | ||
| Summary | 508 | ||
| References | 508 | ||
| Wide Complex Tachycardia | 511 | ||
| Key points | 511 | ||
| Mechanism of WCT | 511 | ||
| VT | 512 | ||
| SVT-A | 512 | ||
| Antidromic AV Reentrant Tachycardia (ART) | 512 | ||
| Nonspecific Intraventricular Conduction Delays | 513 | ||
| Paced Ventricular Rhythm | 513 | ||
| ECG criteria for differential diagnosis of a WCT | 513 | ||
| QRS Duration | 513 | ||
| QRS Axis | 513 | ||
| QRS Concordance | 513 | ||
| Atrioventricular Relationship | 515 | ||
| Capture and Fusion QRS Complexes | 515 | ||
| QRS Morphology | 515 | ||
| Brugada Criteria | 516 | ||
| Lead aVR Criteria | 516 | ||
| ECG Criteria When Baseline ECG Is Available | 520 | ||
| Miscellaneous Criteria | 521 | ||
| Application of various ECG criteria | 521 | ||
| Management of WCT | 521 | ||
| Hemodynamically Unstable WCT | 521 | ||
| Summary | 522 | ||
| References | 523 | ||
| Ventricular Tachycardia in Coronary Artery Disease | 525 | ||
| Key points | 525 | ||
| Pathophysiology of scar-related ventricular tachycardia | 525 | ||
| General principles surrounding the ECG characteristics of VT | 526 | ||
| ECG characteristics of VT in coronary artery disease | 526 | ||
| Previous Inferior Infarction | 526 | ||
| Previous Anterior Infarction | 526 | ||
| Papillary Muscle Infarction | 527 | ||
| Epicardial VT | 527 | ||
| Bundle Branch Reentry VT | 527 | ||
| Differential diagnosis | 527 | ||
| Management | 531 | ||
| Electrophysiology study and catheter ablation | 531 | ||
| Outcomes of catheter ablation | 532 | ||
| Complications | 532 | ||
| Summary | 532 | ||
| References | 533 | ||
| Ventricular Tachycardia in Nonischemic Dilated Cardiomyopathy | 535 | ||
| Key points | 535 | ||
| Introduction | 535 | ||
| Pathology | 536 | ||
| ECG characteristics | 536 | ||
| ECG in SR | 537 | ||
| ECG During Ventricular Arrhythmia | 537 | ||
| Intracardiac EGM characteristics | 542 | ||
| Differences in Substrate Between ICMP and NICMP | 542 | ||
| Basal Perivalvular Location | 542 | ||
| Nonendocardial Substrate | 543 | ||
| Intramural and Periaortic Substrate | 547 | ||
| Unipolar EGM and Irreversibility of NICMP | 548 | ||
| Summary | 549 | ||
| References | 549 | ||
| Electrocardiogram Characteristics of Outflow Tract Ventricular Tachycardia | 553 | ||
| Key points | 553 | ||
| Introduction | 553 | ||
| Pathophysiology | 553 | ||
| Clinical Presentation | 553 | ||
| Distribution | 554 | ||
| ECG characteristics of outflow tract VT | 554 | ||
| RVOT Versus LVOT | 554 | ||
| Localization of Outflow Tract Tachycardia Arising from Superior RVOT | 555 | ||
| Localization of Outflow Tract Tachycardia Arising from the Basal Left Ventricle | 556 | ||
| Localization of Outflow Tract Tachycardia Arising from Aortic Cusps and Surrounding Epicardium | 556 | ||
| Localization algorithm | 558 | ||
| Limitations and additional considerations | 558 | ||
| Lead Placement | 558 | ||
| VT Originating from the Body of the Right Ventricle | 559 | ||
| Mapping and ablation | 561 | ||
| Summary | 564 | ||
| References | 564 | ||
| Fascicular Tachycardia | 567 | ||
| Key points | 567 | ||
| ECG characteristics of fascicular arrhythmias | 567 | ||
| Management | 571 | ||
| Medical Treatment | 571 | ||
| Catheter Ablation | 571 | ||
| Summary | 578 | ||
| References | 578 | ||
| Ventricular Tachycardia Originating from Unusual Sites | 581 | ||
| Key points | 581 | ||
| Introduction | 581 | ||
| Right ventricle | 581 | ||
| Tricuspid Annulus | 581 | ||
| Papillary Muscles of the Right Ventricle | 583 | ||
| Left ventricle | 585 | ||
| Mitral Annulus | 585 | ||
| Papillary Muscles of the Left Ventricle | 586 | ||
| Anterolateral Papillary Muscle | 586 | ||
| Posteromedial Papillary Muscle | 586 | ||
| Cardiac venous system | 588 | ||
| Summary | 591 | ||
| References | 591 | ||
| Electrocardiographic Characteristics of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia | 595 | ||
| Key points | 595 | ||
| Background | 595 | ||
| Clinical manifestations and epidemiology of ventricular arrhythmias | 596 | ||
| Electrocardiographic differentiation between ARVD/C and right ventricular outflow tract–VT | 597 | ||
| Sinus rhythm | 597 | ||
| Ventricular arrhythmias | 598 | ||
| Single Versus Multiple Forms | 598 | ||
| VT/PVC Morphology | 598 | ||
| Pathophysiology of VT morphology | 599 | ||
| Differentiation between ARVD/C and cardiac sarcoid | 599 | ||
| Summary | 599 | ||
| References | 599 | ||
| Electrocardiographic Recognition of Epicardial Arrhythmias | 603 | ||
| Key points | 603 | ||
| Introduction | 603 | ||
| Ventricular arrhythmias | 604 | ||
| Pseudo-δ Wave | 604 | ||
| Intrinsicoid Deflection Time | 604 | ||
| The Shortest RS Complex | 605 | ||
| QRS Complex Duration | 605 | ||
| MDI | 607 | ||
| Q Wave Status in Lead I and Inferior Leads | 607 | ||
| Precordial Pattern Break | 608 | ||
| Nonischemic Cardiomyopathy Epicardial VT Algorithm | 608 | ||
| Ischemic Cardiomyopathy Epicardial VT Criteria | 608 | ||
| Normal Sinus Rhythm Findings Suggestive of Basal Lateral Scar | 608 | ||
| Decision Algorithm for Epicardial Mapping and Ablation in VT | 609 | ||
| Accessory pathways | 610 | ||
| Posterior Septal Pathways | 610 | ||
| Right Free Wall Pathways | 610 | ||
| Summary | 610 | ||
| References | 610 | ||
| Incessant Ventricular Tachycardia and Fibrillation | 613 | ||
| Key points | 613 | ||
| Introduction | 613 | ||
| Specific contributing factors in electrical storm | 613 | ||
| Electrolyte Imbalance | 614 | ||
| Myocardial Ischemia and Infarction | 614 | ||
| Drug-induced Proarrhythmia | 614 | ||
| VT Storm in Patients with ICDs | 614 | ||
| VT Storm in Inherited Channelopathies | 614 | ||
| Electrical Storm in Patients with Congestive Heart Failure | 614 | ||
| ECG markers of VT storm | 615 | ||
| Infarction electrical storm management | 619 | ||
| Summary | 620 | ||
| References | 620 | ||
| Arrhythmias in Complex Congenital Heart Disease | 623 | ||
| Key points | 623 | ||
| Introduction | 623 | ||
| Case I | 624 | ||
| Case II | 624 | ||
| Case III | 627 | ||
| Case IV | 627 | ||
| Case V | 630 | ||
| Case VI | 631 | ||
| Summary | 632 | ||
| Acknowledgments | 632 | ||
| References | 632 | ||
| Electrocardiographic Analysis of Paced Rhythms | 635 | ||
| Key points | 635 | ||
| Electrograms from implanted devices | 635 | ||
| Unipolar and Bipolar Electrograms | 635 | ||
| Effect of ventricular pacing site on ECG | 636 | ||
| His Bundle and Para-Hisian Pacing | 636 | ||
| BiV Pacing | 636 | ||
| Electrocardiographic characteristics of BiV responders | 638 | ||
| DDD pacing algorithms | 640 | ||
| Ventricular Pacing Avoidance Algorithms | 640 | ||
| Autocapture | 640 | ||
| Ventricular Safety Pacing | 641 | ||
| Atrial Fibrillation Suppression Algorithms | 641 | ||
| Rate Drop Response | 642 | ||
| Rate Smoothing | 643 | ||
| Noncompetitive Atrial Pacing | 643 | ||
| Fusion and Pseudofusion | 644 | ||
| Pacemaker-mediated arrhythmias | 644 | ||
| Repetitive Nonreentrant VA Synchronous Rhythm | 645 | ||
| Device-induced proarrhythmia | 646 | ||
| Pacemaker-Facilitated VT/VF | 646 | ||
| Diagnosis of Arrhythmias by Device Electrograms | 647 | ||
| Summary | 648 | ||
| References | 648 | ||
| Index | 651 |