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Book Details
Abstract
Whether you are in the lab or the office, stay current in the ever-evolving field of electrophysiology with Catheter Ablation of Cardiac Arrhythmias. Organized by type of arrhythmia, this simple yet comprehensive medical reference book provides detailed information on anatomy, diagnoses, mapping/ablation, and troubleshooting. The book also extensively covers the updated, basic concepts of transcatheter energy applications and currently available mapping/imaging tools for ablation.
- Improve accuracy with assistance from advanced catheter mapping and navigation systems, and the use of intracardiac echocardiography to assist accurate diagnosis and ablation.
- Stay current on timely topics like contemporary cardiac mapping and imaging techniques, atrial tachycardia and flutter, atrial fibrillation, atrioventricular nodal reentrant tachycardia, tachycardias related to accessory atrioventricular connections, and ventricular tachycardia, transseptal catheterization, ablation for pediatric patients, and patient safety and complications.
- Get the most comprehensive and detailed coverage of arrhythmias and ablation technologies, highlighted by a systematic approach to troubleshooting specific problems encountered in the laboratory - complete with solutions.
- Find the critical answers you need quickly and easily thanks to a consistent, highly user-friendly chapter format.
- Master each approach with exceptional visual guidance from tables, illustrations, and high-quality figures.
- Stay up to date with enhanced and expanded chapters, as well as several hundred new figures, web-based videos, and updated references.
- Explore recent developments in the areas of atrial fibrillation and ventricular tachycardias.
- Learn from experts in the field with nearly half of the chapters composed by new authors.
- Improve content knowledge in relation to anatomy with new chapters focusing on hemodynamic support during VT ablation, rotor mapping in atrial fibrillation, and hybrid procedures.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| IFC_Expert Consult page | IFC1 | ||
| Catheter Ablation of Cardiac Arrhythmias | i | ||
| Copyright page | ii | ||
| Dedication | iii | ||
| Special Dedication to Third Edition— Mark A. Wood, MD | iv | ||
| Contributors | v | ||
| Preface | xi | ||
| Acknowledgments | xii | ||
| Table of Contents | xiii | ||
| Video Contents | xvi | ||
| 1 Fundamental Concepts of Transcatheter Energy Delivery | 1 | ||
| 1 Biophysics of Radiofrequency Lesion Formation | 3 | ||
| Key Points | 3 | ||
| Biophysics of Tissue Heating | 3 | ||
| Resistive Heating | 3 | ||
| Thermal Conduction | 4 | ||
| Sudden Impedance Rise | 6 | ||
| Convective Cooling | 7 | ||
| Catheter Contact Force and Orientation | 8 | ||
| Electrical Current Distribution | 8 | ||
| Dispersive Electrode | 9 | ||
| Edge Effect | 10 | ||
| Tissue Pathology and Pathophysiologic Response to RF Ablation | 11 | ||
| Gross Pathology and Histopathology of the Ablative Lesion | 11 | ||
| RF Lesion Ultrastructure | 12 | ||
| RF Ablation and Arterial Perfusion | 13 | ||
| Collateral Injury from Ablation | 14 | ||
| Cellular Mechanisms of Thermal Injury | 14 | ||
| Plasma Membrane | 14 | ||
| Cytoskeleton | 15 | ||
| Nucleus | 15 | ||
| Cellular Electrophysiology | 15 | ||
| Calcium Overload and Cellular Injury | 15 | ||
| Conduction Velocity | 16 | ||
| Determinants of Effective Lesion Formation | 17 | ||
| Targeting | 17 | ||
| Tissue Composition | 17 | ||
| Power | 17 | ||
| Electrode Temperature | 17 | ||
| Peak Tissue Temperature | 17 | ||
| Electrode Contact Pressure | 17 | ||
| Convective Cooling | 17 | ||
| Electrode Size | 18 | ||
| Duration of Energy Delivery | 18 | ||
| Ablation Circuit Impedance | 18 | ||
| Electrode Orientation | 18 | ||
| Electrode Geometry | 18 | ||
| Electrode Material | 19 | ||
| Characteristics of RF Energy | 19 | ||
| Conclusion | 19 | ||
| References | 19 | ||
| Videos | 21 | ||
| 2 Guiding Lesion Formation During Radiofrequency Energy Catheter Ablation | 22 | ||
| Key Points | 22 | ||
| General Principles of Power Titration | 22 | ||
| Assessment of Catheter–Tissue Contact | 22 | ||
| Power Titration for Ablation Efficacy | 23 | ||
| Power Titration for Ablation Safety | 24 | ||
| Coagulum Formation | 24 | ||
| Myocardial Boiling (Steam Pop) | 25 | ||
| Cardiac Perforation | 25 | ||
| Damage to Surrounding Structures | 26 | ||
| Methods of Titrating Energy Delivery with Conventional RF Ablation Catheters | 26 | ||
| Temperature-Titrated Energy Delivery | 26 | ||
| Impedance-Titrated Energy Delivery | 26 | ||
| Electrogram Amplitude-Titrated Energy Delivery | 27 | ||
| Titrating Energy Delivery by Electrophysiologic End Points | 28 | ||
| Titrating Energy Delivery with Large-Tip Catheters | 28 | ||
| Titrating Energy Delivery with Irrigated RF Ablation Catheters | 28 | ||
| Differences Between Irrigated and Conventional Ablation Catheters | 28 | ||
| Factors Affecting Lesion Size During Irrigated RF Ablation | 29 | ||
| Titrating Power During Irrigated RF Ablation | 29 | ||
| Titrating Energy Delivery in Other Anatomic Sites | 30 | ||
| Power Titration During Epicardial Ablation | 30 | ||
| Power Titration During Ablation Within the Coronary Sinus | 31 | ||
| Conclusion | 31 | ||
| References | 31 | ||
| Videos | 33 | ||
| 3 Irrigated- and Cooled-Tip Radiofrequency Catheter Ablation | 34 | ||
| Key Points | 34 | ||
| Biophysics of Cooled RF Ablation | 34 | ||
| Design of Irrigated- and Cooled-Tip RF Catheters | 35 | ||
| Results of Animal Studies | 37 | ||
| Clinical Studies | 41 | ||
| Cooled RF Ablation for Nonidiopathic VT | 41 | ||
| Cooled RF Ablation for Atrial Flutter | 42 | ||
| Cavotricuspid Isthmus–Dependent Atrial Flutter | 42 | ||
| Atypical Atrial Flutter | 42 | ||
| Cooled RF Ablation for AF | 42 | ||
| Cooled RF Ablation for Atrioventricular Reentrant Tachycardia | 43 | ||
| Safety Profile of Cooled-Tip versus Noncooled-Tip Ablation Catheters | 43 | ||
| Advancements in Cooled-Tip Catheter Technology: Different Approaches to Tip Irrigation | 43 | ||
| Limitations of Cooled-Tip Catheter Technology | 45 | ||
| Conclusions | 45 | ||
| References | 45 | ||
| 4 Catheter Cryoablation: | 48 | ||
| Key Points | 48 | ||
| History of Cryothermal Energy Use in Cardiovascular Medicine | 48 | ||
| Biophysics and Mechanisms of Cryothermal Energy Tissue Injury | 50 | ||
| Cryoablation Technical Aspects | 50 | ||
| Console and Catheters | 50 | ||
| Determinants of Cryoablation Lesion Size | 52 | ||
| Cryoablation Versus RF Ablation | 54 | ||
| Cryomapping and Cryoablation Delivery | 56 | ||
| Clinical Advantages of Cryothermal Energy for Catheter Ablation | 57 | ||
| Reversible Effects | 58 | ||
| Catheter Stability | 59 | ||
| Minimal Risk of Thromboembolism | 59 | ||
| Minimal Risk to Vascular Structures | 59 | ||
| Painless Ablation | 59 | ||
| Visualization by Ultrasound | 59 | ||
| Clinical Applications | 60 | ||
| AV Nodal Ablation | 61 | ||
| AVNRT | 61 | ||
| Septal and Para-Hisian Accessory Pathways | 62 | ||
| Atrial Flutter | 62 | ||
| Atrial Fibrillation | 62 | ||
| Ventricular Tachycardia | 63 | ||
| Cryoablation in the Children | 64 | ||
| References | 64 | ||
| 5 Alternative Energy Sources and Ablative Techniques: | 69 | ||
| Key Points | 69 | ||
| Introduction | 69 | ||
| Ultrasound | 70 | ||
| Basic Principles | 70 | ||
| Lessons from Experimental Studies | 70 | ||
| Phased-Array HIFU Systems | 71 | ||
| Ultrasound Balloon Catheters | 71 | ||
| HIFU for Other Applications | 72 | ||
| Collimated Ultrasound-Guided Imaging and Ablation | 73 | ||
| Laser | 73 | ||
| Basic Principles | 73 | ||
| Argon Laser | 75 | ||
| Nd–YAG Laser | 75 | ||
| Diode Laser | 75 | ||
| Applications for Linear Lesions | 75 | ||
| Laser BC Design | 76 | ||
| Microwave | 79 | ||
| Basic Principles | 79 | ||
| Microwave System Design | 80 | ||
| Data from In Vivo Experiments | 80 | ||
| Thigh Muscle Preparation | 80 | ||
| AV Nodal Ablation | 80 | ||
| Ablation of Ventricular Myocardium | 80 | ||
| Ablation of the Cavotricuspid Isthmus | 80 | ||
| Alternative Ablative Techniques | 81 | ||
| Conclusion | 81 | ||
| References | 81 | ||
| 6 Cardiac Anatomy for Catheter Mapping and Ablation of Arrhythmias | 85 | ||
| Key Points | 85 | ||
| Basic Orientation and Terminology | 86 | ||
| Imaging Modalities for Mapping and Ablation | 86 | ||
| Echocardiography | 87 | ||
| Structural Anatomy of the Left and Right Atria | 88 | ||
| Right Atrium | 88 | ||
| Crista Terminalis | 88 | ||
| Clinical Correlation. | 88 | ||
| Eustachian Ridge | 89 | ||
| 2 Cardiac Mapping and Imaging | 107 | ||
| 7 Fundamentals of Intracardiac Mapping | 109 | ||
| Key Points | 109 | ||
| Underlying Basis for the Extracellular Electrogram | 109 | ||
| Electrogram Recording: Amplification, Filtering, and Digitization of Signals | 110 | ||
| Unipolar and Bipolar Signals | 110 | ||
| Recording Artifacts | 111 | ||
| Characteristics of Intracardiac Signals: Normal Heart | 113 | ||
| Electrical Abnormalities in the Absence of Structural Heart Disease | 113 | ||
| Electrogram Abnormalities in the Presence of Structural Heart Disease | 113 | ||
| Endocardial Mapping Techniques | 117 | ||
| Activation Sequence Mapping | 117 | ||
| Mid-Diastolic Potentials | 117 | ||
| Unipolar Potential Mapping | 118 | ||
| Pace Mapping | 119 | ||
| Entrainment Mapping | 121 | ||
| Miscellaneous Pacing Maneuvers | 124 | ||
| Response to Atrial or Ventricular Pacing | 124 | ||
| Premature Ventricular Contractions During Narrow-Complex Tachycardia | 125 | ||
| Premature Atrial Contractions During Narrow- and Wide-Complex Tachycardia | 126 | ||
| Termination of Tachycardia During Pacing Maneuvers | 126 | ||
| Electrogram Morphology in Response to Pacing | 127 | ||
| Activation Sequence During Pacing Maneuvers | 128 | ||
| Para-Hisian Pacing | 128 | ||
| References | 133 | ||
| 8 Advanced Catheter Three-Dimensional Mapping Systems | 135 | ||
| Key Points | 135 | ||
| General Principles | 135 | ||
| Local Activation Time | 136 | ||
| Activation Mapping | 136 | ||
| Mapping Focal Arrhythmias | 137 | ||
| Mapping Macroreentrant Arrhythmias | 139 | ||
| Voltage Mapping | 140 | ||
| Anatomic Geometries | 142 | ||
| CT/MRI Image Integration | 144 | ||
| Intracardiac Echocardiography Image Integration | 145 | ||
| Complex Fractionated Atrial EGM Mapping | 145 | ||
| Specific Types of 3D Mapping Systems | 146 | ||
| Magnetic-Based Mapping System | 146 | ||
| Impedance-Based Mapping Technology | 148 | ||
| Hybrid Magnetic/Impedance-Based Mapping System | 149 | ||
| Noncontact Mapping | 150 | ||
| Summary | 150 | ||
| References | 151 | ||
| Videos | 152 | ||
| 9 Remote Catheter Navigation Systems | 153 | ||
| Key Points | 153 | ||
| Catheter Robotics | 153 | ||
| Hansen Medical | 154 | ||
| Stereotaxis | 154 | ||
| Magnetecs | 156 | ||
| Advantages and Disadvantages of Using Remote Catheter Navigation | 156 | ||
| User Interface | 158 | ||
| Integration with the 3D Mapping System | 158 | ||
| Cost Issue | 159 | ||
| Clinical Applications | 159 | ||
| Summary | 160 | ||
| References | 161 | ||
| Videos | 161 | ||
| 10 Role of Intracardiac Echocardiography in Clinical and Experimental Electrophysiology | 162 | ||
| Key Points | 162 | ||
| ICE Catheter Design | 163 | ||
| Identification of Atrial Endocardial Structures | 164 | ||
| Guidance of RFA Catheter | 165 | ||
| Monitoring and Quantification of RFA Lesions | 165 | ||
| Role in AF Ablation Procedures | 165 | ||
| Accurate Positioning of the Catheters at the Venous Ostium | 166 | ||
| Titrating Energy Delivery | 167 | ||
| Early Detection of Thrombus Formation | 169 | ||
| Postablation ICE Imaging: Can PV Stenosis Be predicted? | 169 | ||
| Avoidance of Atrioesophageal Fistula | 169 | ||
| Phased-Array ICE and Ablation of AFL | 170 | ||
| ICE-Guided Ablation in the Left Ventricle | 171 | ||
| Transseptal Puncture | 173 | ||
| Echocardiographic Evaluation of Atrial Mechanical Function | 173 | ||
| Suggested Imaging Protocol for Phased-Array ICE | 174 | ||
| Other and Novel Uses of ICE | 175 | ||
| Summary | 175 | ||
| References | 176 | ||
| 3 Catheter Ablation of Atrial Tachycardias and Flutter | 181 | ||
| 11 Ablation of Focal Atrial Tachycardias | 183 | ||
| Key Points | 183 | ||
| Anatomic Distribution of AT Foci | 184 | ||
| CT | 184 | ||
| CS Ostium and CS Musculature | 184 | ||
| Midline Atrial Structures: Perinodal, Para-Hisian, Atrial Septal (Left or Right), and Noncoronary Cusp | 185 | ||
| PVs | 185 | ||
| Tricuspid and MA | 185 | ||
| RAA and LAA | 185 | ||
| Pathophysiology | 186 | ||
| Multiple Focal ATs | 186 | ||
| TCM and AT | 187 | ||
| Diagnosis (and Differential Diagnosis) | 187 | ||
| Inappropriate Sinus Tachycardia Versus Focal AT | 187 | ||
| AT Versus Atrioventricular Nodal Reentrant Tachycardia/Atrioventricular Reentrant Tachycardia | 187 | ||
| Focal AT Versus Macroreentrant AT | 189 | ||
| Mapping and Ablation | 189 | ||
| Mapping I: PWM | 189 | ||
| Right or LA Site of Origin | 190 | ||
| P Wave According to Anatomic Site of Origin: CT | 191 | ||
| TA and RAA | 191 | ||
| CS: Ostium and Midbody | 191 | ||
| Perinodal Region, Interatrial Septum | 192 | ||
| Aortomitral Continuity and Noncoronary Cusp AT | 193 | ||
| PVs and LAA | 193 | ||
| Mapping II: Endocardial Activation Mapping | 194 | ||
| Anatomic Relationships and Mapping ATs | 195 | ||
| RA Versus LA: Endocardial Mapping | 195 | ||
| 3D Mapping | 196 | ||
| Entrainment | 196 | ||
| Characteristics of the Ablation Signal | 196 | ||
| Ablation Results | 197 | ||
| TroubleShooting a Difficult Case: An Illustrative Case Presentation | 197 | ||
| Procedure 1 | 197 | ||
| Procedure 2 | 198 | ||
| Discussion | 198 | ||
| Conclusions | 199 | ||
| References | 200 | ||
| 12 Ablation of Cavotricuspid Isthmus–Dependent Atrial Flutters | 203 | ||
| Key Points | 203 | ||
| AFL Terminology | 203 | ||
| Anatomy and Pathophysiology | 204 | ||
| Diagnosis | 207 | ||
| Surface Electrocardiography | 207 | ||
| Electrophysiologic Diagnosis | 207 | ||
| Ablation | 211 | ||
| Overcoming Difficult CTI Anatomy | 214 | ||
| End Points for Ablation | 215 | ||
| Simplified Approach to Ablation of CTI-dependent (Typical and Reverse Typical) AFL | 224 | ||
| Outcomes and Complications | 224 | ||
| Troubleshooting the Difficult Case | 227 | ||
| References | 229 | ||
| 13 Ablation of Nonisthmus-Dependent Flutters and Atrial Macroreentry | 232 | ||
| Key Points | 232 | ||
| Anatomy | 232 | ||
| Pathophysiology | 232 | ||
| Diagnosis | 233 | ||
| Macroreentrant Versus Focal AT | 233 | ||
| Localization of Reentry to the RA or LA | 234 | ||
| Mapping | 236 | ||
| Activation Mapping | 236 | ||
| Entrainment Mapping | 236 | ||
| Electroanatomic Mapping | 237 | ||
| Ablation | 241 | ||
| Specific Forms of Atypical Flutter (see Table 13-1) | 242 | ||
| Lower Loop Reentry | 242 | ||
| Upper Loop Reentry | 243 | ||
| RA Free-Wall Macroreentry | 244 | ||
| Dual-Loop RA Macroreentry | 244 | ||
| LA Macroreentry | 245 | ||
| Left Septal Macroreentry | 246 | ||
| Macroreentrant ATs After Mitral Valve Surgery | 247 | ||
| ATs After Catheter Ablation for AF | 248 | ||
| ATs After Maze Surgery | 248 | ||
| ATs After Orthotopic Cardiac Transplantation | 249 | ||
| References | 250 | ||
| 14 Ablation of Postoperative Atrial Tachycardia in Congenital Heart Disease | 252 | ||
| Key Points | 252 | ||
| Pathophysiology and Anatomy | 253 | ||
| Epidemiology and Natural History | 253 | ||
| Mechanisms of IART | 254 | ||
| Animal Models of IART | 254 | ||
| Clinical Presentation of IART | 255 | ||
| Electrocardiographic Manifestations of IARTs | 255 | ||
| Anatomic Complexity of Arrhythmia Phenotypes in CHD | 255 | ||
| Surgical Anatomy of Repairs | 256 | ||
| Studies of Clinical Mechanism | 256 | ||
| Prevalence/Significance of Atrial Fibrillation | 257 | ||
| Nonablative Management of IART | 258 | ||
| General Considerations | 258 | ||
| Cardioversion | 258 | ||
| Importance of Anticoagulation | 258 | ||
| Use of Antiarrhythmic Drugs in IART | 258 | ||
| Pacing Therapy for IART | 259 | ||
| Ablative Therapy of IART | 259 | ||
| General Considerations for Catheter Ablation in CHD Patients | 259 | ||
| Mapping and Ablation of IART in CHD | 259 | ||
| Activation Mapping | 260 | ||
| Voltage Mapping | 261 | ||
| Entrainment Mapping | 261 | ||
| Utilization of Multimodal Imaging: Three-Dimensional Mapping and Intracardiac Echo | 262 | ||
| Irrigated Ablation | 264 | ||
| Vascular Access and Transseptal Puncture | 265 | ||
| Reported Outcomes of Ablation of IART in CHD | 266 | ||
| Ablation of AF in CHD | 267 | ||
| Surgical Therapy of ATs in CHD | 268 | ||
| Conclusions | 268 | ||
| Disclosure | 269 | ||
| References | 269 | ||
| Videos | 272 | ||
| 4 Catheter Ablation of Atrial Fibrillation | 273 | ||
| 15 Pulmonary Vein Isolation for Atrial Fibrillation | 275 | ||
| Key Points | 275 | ||
| 1. Patient Selection and Preprocedural Considerations | 275 | ||
| 1.1. Indications for PVI | 275 | ||
| 1.2. Antiarrhythmic Drugs | 276 | ||
| 1.3. Anticoagulation Status | 276 | ||
| 1.4. Anesthesia Protocol | 277 | ||
| 2. Techniques and Results of PVI | 277 | ||
| 3. Mechanisms of Arrhythmia Recurrence after PVI | 280 | ||
| 4. Postprocedural Care and Follow-Up | 281 | ||
| 5. Remote Navigation Technologies for PVI | 281 | ||
| 6. Balloon-Based Technologies for PVI | 283 | ||
| 6.1. Cryoballoon Ablation | 283 | ||
| 6.2. Laser-Balloon Ablation | 284 | ||
| 7. Multielectrode Ablation Catheters | 284 | ||
| 8. Force-Sensing Technologies | 284 | ||
| 9. Conclusions | 285 | ||
| References | 285 | ||
| 16 Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from the Nonpulmonary Vein Areas | 288 | ||
| Key Points | 288 | ||
| Characteristics of AF Originating from Non-PV Areas | 288 | ||
| Incidence of Non-PV AF Initiators | 288 | ||
| Pathophysiology of Non-PV AF Initiators | 288 | ||
| Diagnosis of Non-PV AF Initiators | 290 | ||
| Provocative Maneuvers | 290 | ||
| Mapping Techniques | 290 | ||
| Predicting the Location of AF Initiators | 290 | ||
| AF Initiators from the RA. | 291 | ||
| AF Initiators from the LA. | 291 | ||
| Assessing the Geometry Around the Atrial–Venous Junctions | 294 | ||
| Ablation Techniques | 294 | ||
| SVC | 295 | ||
| Crista Terminalis | 295 | ||
| CS | 297 | ||
| LA Wall | 297 | ||
| Ligament of Marshall | 297 | ||
| Efficacy and Safety | 297 | ||
| Ablation Results and Recurrences | 297 | ||
| Avoiding Complications | 301 | ||
| Conclusions | 302 | ||
| References | 302 | ||
| Video | 304 | ||
| 17 Substrate-Based Ablation for Atrial Fibrillation | 305 | ||
| Key Points | 305 | ||
| Mechanisms of Atrial Fibrillation and Rationale for Substrate Ablation | 305 | ||
| Antral PVI | 306 | ||
| Pathophysiology | 306 | ||
| Mapping and Ablation | 306 | ||
| Outcomes | 306 | ||
| Problems and Limitations | 306 | ||
| Linear Ablation | 307 | ||
| Pathophysiology | 307 | ||
| Mapping and Ablation | 308 | ||
| Left Atrial Roofline | 308 | ||
| Assessment of Conduction Block. | 309 | ||
| Mitral Isthmus Line | 309 | ||
| 5 Catheter Ablation of Atrioventricular Nodal Reentry Tachycardia and the Atrioventricular Junction | 367 | ||
| 21 Ablation of Atrioventricular Junctional Tachycardias: | 369 | ||
| Key Points | 369 | ||
| Anatomy of the AV Node and Its Inputs | 372 | ||
| Pathophysiology | 373 | ||
| Diagnosis | 376 | ||
| Slow–Fast Variant | 377 | ||
| Slow–Slow Variant | 381 | ||
| Fast–Slow Variant | 383 | ||
| Left-Sided Variant | 384 | ||
| Differential Diagnosis | 384 | ||
| AV Nodal Reentry and Atypical Presentations | 386 | ||
| AV Nodal Reentry and Other Arrhythmias | 387 | ||
| JT | 387 | ||
| Ablation | 390 | ||
| Slow–Fast Variant | 390 | ||
| Anatomic Approach | 390 | ||
| Electrogram-Guided Approach | 392 | ||
| Application of RF Current | 392 | ||
| Cryoablation | 393 | ||
| Slow–Slow and Fast–Slow Variants | 394 | ||
| Left-Sided Variant | 396 | ||
| Catheter Ablation of the Slow AV Nodal Pathway Using Externally Irrigated-Tip Electrodes | 396 | ||
| End Points for Ablation | 399 | ||
| Preventing AV Block During Catheter Ablation | 399 | ||
| Efficacy of AV Nodal Modification | 399 | ||
| Fast-Pathway Ablation | 401 | ||
| Ablation of AV Nodal Reentry in Patients with Impaired AV Conduction | 401 | ||
| Complications | 403 | ||
| Troubleshooting the Difficult Case | 403 | ||
| Ablation of JT | 404 | ||
| References | 404 | ||
| 22 Atrioventricular Junction Ablation and Modification for Heart-Rate Control of Atrial Fibrillation | 409 | ||
| Key Points | 409 | ||
| Complete AV Junction Ablation | 409 | ||
| Mapping and Ablation | 410 | ||
| AV Junction Ablation in Patients Undergoing CRT Device Implantation | 412 | ||
| AV Junction Ablation Plus Pacing Versus Primary Catheter Ablation in Drug-Refractory AF | 413 | ||
| Outcomes | 414 | ||
| Troubleshooting the Difficult Case | 414 | ||
| AV Junction Modification | 414 | ||
| References | 416 | ||
| Video | 417 | ||
| 6 Catheter Ablation of Accessory Atrioventricular Connections | 419 | ||
| 23 Ablation of Free-Wall Accessory Pathways | 421 | ||
| Key Points | 421 | ||
| Anatomy | 421 | ||
| Pathophysiology | 424 | ||
| Diagnosis | 424 | ||
| Differential Diagnosis | 427 | ||
| Mapping | 427 | ||
| Left Free-Wall APs | 428 | ||
| Right Free-Wall APs | 433 | ||
| Ablation | 434 | ||
| Clinical Results | 438 | ||
| Left Free-Wall APs | 438 | ||
| Complications | 441 | ||
| Troubleshooting the Difficult Case | 441 | ||
| References | 444 | ||
| Videos | 446 | ||
| 24 Ablation of Posteroseptal Accessory Pathways | 447 | ||
| Key Points | 447 | ||
| Anatomy | 447 | ||
| Pathophysiology | 449 | ||
| Diagnosis and Differential Diagnosis | 449 | ||
| Mapping | 451 | ||
| Ablation | 456 | ||
| Troubleshooting the Difficult Case | 458 | ||
| References | 459 | ||
| Videos | 460 | ||
| 25 Ablation of Superoparaseptal (Anteroseptal) and Midseptal Accessory Pathways | 461 | ||
| Key Points | 461 | ||
| Anatomy and Nomenclature | 462 | ||
| Diagnosis and Differential Diagnosis | 462 | ||
| Superoparaseptal APs | 462 | ||
| Midseptal APs | 462 | ||
| Electrophysiologic Testing | 463 | ||
| Mapping and Ablation Techniques | 464 | ||
| Superoparaseptal APs | 464 | ||
| Troubleshooting the Difficult Cases | 468 | ||
| Midseptal APs | 472 | ||
| Summary | 473 | ||
| References | 473 | ||
| 26 Ablation of Atriofascicular Accessory Pathways and Variants | 474 | ||
| Key Points | 474 | ||
| Atriofascicular Accessory Pathways | 474 | ||
| Anatomy | 474 | ||
| Pathophysiology | 475 | ||
| Diagnosis | 475 | ||
| 12-Lead Electrocardiogram | 475 | ||
| Intracardiac Electrograms | 476 | ||
| During Sinus Rhythm | 476 | ||
| Induction of Antidromic AV Reentrant Tachycardia | 476 | ||
| Electrophysiology Evaluation Tachycardia | 479 | ||
| 1 : 2 Atrial to Ventricular Conduction over an Atriofascicular Pathway | 481 | ||
| Differential Diagnosis | 481 | ||
| 1. SVT with LBBB Aberrancy | 481 | ||
| 2. VT | 481 | ||
| 3. Wolff–Parkinson–White Configuration | 481 | ||
| 4. Decremental AV Pathways | 482 | ||
| 5. Nodoventricular/Nodofascicular Pathways | 482 | ||
| Fasciculoventricular Bypass Tracts | 483 | ||
| AV Nodal Reentry Tachycardia Coexisting with Atriofascicular Bypass Tract | 483 | ||
| Mapping | 485 | ||
| 1. Mapping of Accessory Pathway Along the Tricuspid Annulus | 485 | ||
| Identification of the M (Mahaim) Potential | 485 | ||
| Catheter-Induced Mechanical Conduction Block | 485 | ||
| 2. Identification of the Atrial Insertion | 486 | ||
| Shortest Stimulus to the Fully Preexcited Ventricular Electrogram | 486 | ||
| Atrial Extrastimulus During Antidromic Tachycardia | 486 | ||
| 3. Identification of the Ventricular Insertion | 486 | ||
| Ablation | 487 | ||
| Troubleshooting the Difficult Case | 488 | ||
| Catheter Stability and Tissue Contact | 488 | ||
| Difficulty in Identifying the M Potential | 489 | ||
| Loss of Accessory Pathway Conduction due to Mechanical Trauma | 489 | ||
| Atriofascicular Pathway Variants | 489 | ||
| AV Pathways with Decremental Conduction | 489 | ||
| Short Decremental AV Pathways | 489 | ||
| Long Decremental AV Pathways | 489 | ||
| Left-Sided Decremental Accessory Pathways | 490 | ||
| Nodoventricular and Nodofascicular Accessory Pathways | 490 | ||
| Mapping and Ablation | 493 | ||
| Fasciculoventricular Accessory Pathways | 493 | ||
| References | 494 | ||
| 27 Special Problems in Ablation of Accessory Pathways | 496 | ||
| Key Points | 496 | ||
| General Considerations | 496 | ||
| Inability to Heat | 496 | ||
| Misdiagnosis | 497 | ||
| Problems Related to Catheter Manipulation | 498 | ||
| Inaccurate Pathway Localization | 498 | ||
| Other Factors | 498 | ||
| Specific Challenges | 498 | ||
| Ablation of Epicardial APs | 498 | ||
| CS and Epicardial APs | 498 | ||
| Atrial Appendage-to-Ventricular APs | 501 | ||
| Ablation of APs Associated with Structural Cardiac Abnormalities | 502 | ||
| Ebstein Anomaly | 503 | ||
| Persistent LSVC | 503 | ||
| Ablation of Pathways with Atypical Configuration | 504 | ||
| Multiple APs | 504 | ||
| Oblique APs | 506 | ||
| Atypical APs | 507 | ||
| New Technologies | 509 | ||
| Saline-Cooled RF Ablation | 509 | ||
| Cryothermal Ablation | 510 | ||
| Impact of Location on Ablation of APs | 510 | ||
| Approach to the Patient Requiring Repeat Ablation | 512 | ||
| References | 513 | ||
| 7 Catheter Ablation of Ventricular Tachycardia | 517 | ||
| 28 Ablation of Ventricular Outflow Tract Tachycardias | 519 | ||
| Key Points | 519 | ||
| Mechanism | 519 | ||
| Clinical Presentation | 520 | ||
| Anatomic Substrate | 520 | ||
| Anatomy of the Outflow Tracts | 521 | ||
| Diagnosis | 523 | ||
| Electrocardiographic Patterns and Anatomic Localization | 523 | ||
| Clinical Arrhythmias from RVOT | 523 | ||
| Clinical Arrhythmias from Basal LV | 527 | ||
| Clinical Arrhythmias from the Aortic Cusps | 528 | ||
| Epicardial Idiopathic Outflow Tract VTs | 529 | ||
| Differentiating RVOT from Aortic Cusps Site of Origin | 530 | ||
| Amplitude and Duration | 531 | ||
| Precordial Transition | 531 | ||
| Treatment of Outflow Tract Ventricular Arrhythmias | 532 | ||
| Mapping of Ventricular Outflow Tract Tachycardias | 533 | ||
| Ablation | 535 | ||
| Clinical Outcomes and Complications | 536 | ||
| Troubleshooting the Difficult Case | 536 | ||
| Conclusion | 538 | ||
| References | 538 | ||
| 29 Ablation of Idiopathic Left and Right Ventricular and Fascicular Tachycardias | 540 | ||
| Key Points | 540 | ||
| Mitral Annular VT | 541 | ||
| Pathophysiology | 541 | ||
| Classification | 541 | ||
| Mechanism | 541 | ||
| Diagnostic criteria | 541 | ||
| Surface Electrocardiogram | 541 | ||
| Intracardiac Recordings, Mapping, and Ablation | 542 | ||
| Success and Recurrence Rates | 542 | ||
| Tricuspid Annular VT | 542 | ||
| Pathophysiology | 543 | ||
| Classification | 543 | ||
| Mechanism | 543 | ||
| Diagnostic Criteria | 543 | ||
| Surface ECG | 543 | ||
| Intracardiac Recordings, Mapping, and Ablation | 547 | ||
| Success and Recurrence Rates | 547 | ||
| Complications | 548 | ||
| Papillary Muscle VT | 548 | ||
| Pathophysiology | 548 | ||
| Classification | 548 | ||
| Mechanism | 548 | ||
| Diagnostic Criteria | 548 | ||
| Surface ECG | 548 | ||
| 8 Miscellaneous Topics | 683 | ||
| 35 Complications Associated with Radiofrequency Catheter Ablation of Arrhythmias | 685 | ||
| Key Points | 685 | ||
| Types and Classification of Complications | 685 | ||
| General Complications | 686 | ||
| Vascular Access Complications | 686 | ||
| Pericardial Effusion and Cardiac Tamponade | 687 | ||
| Mechanism of Cardiac Tamponade | 687 | ||
| Potential Risk of a Cardiac Perforation Relevant to the Cardiac Anatomy | 687 | ||
| Detection of a Pericardial Effusion and Cardiac Tamponade | 688 | ||
| Specific Considerations | 689 | ||
| Management of Cardiac Tamponade | 689 | ||
| Thromboembolism | 690 | ||
| Air Embolism | 691 | ||
| Atrioventricular Block | 691 | ||
| Pericarditis | 692 | ||
| Radiation Exposure | 692 | ||
| Specific Complications | 692 | ||
| AV Junction Ablation | 692 | ||
| AF | 692 | ||
| Complications During Catheter and Sheath Manipulation | 692 | ||
| Collateral Damage to Adjacent Structures During Energy Delivery | 693 | ||
| PV Stenosis | 693 | ||
| Esophageal Injury and Atrioesophageal Fistulae | 694 | ||
| Injury to the Vagus Nerve | 695 | ||
| Phrenic Nerve Injury | 695 | ||
| Other Unintended Effects of the RF Delivery | 695 | ||
| Iatrogenic Tachycardias | 695 | ||
| VT | 695 | ||
| Coronary Artery Injury | 695 | ||
| Heart Failure | 696 | ||
| Epicardial Catheter Ablation | 696 | ||
| Complications Related to the Pericardial Access | 696 | ||
| Complications During Mapping and Ablation | 697 | ||
| Pericardial Effusion | 697 | ||
| Damage to the Epicardial Vessels | 697 | ||
| Phrenic Nerve Injury | 697 | ||
| Damage to the Esophagus, Vagus Nerve, and Lungs | 698 | ||
| Postprocedural Complications | 698 | ||
| Pericarditis | 698 | ||
| Pleuritis | 698 | ||
| Inappropriate Sinus Tachycardia | 698 | ||
| Conclusions | 698 | ||
| References | 698 | ||
| Video | 701 | ||
| 36 Atrial Transseptal Catheterization | 702 | ||
| Key Points | 702 | ||
| ANATOMIC Considerations for TSC | 702 | ||
| Indications for Atrial TSC | 704 | ||
| Intraprocedural Patient Management: Sedation, Anticoagulation Status | 704 | ||
| Techniques and Tools for TSC | 706 | ||
| General Considerations | 706 | ||
| Fluoroscopy-Guided TSC | 707 | ||
| ICE-Guided TSC | 708 | ||
| Other Techniques and Imaging Modalities | 709 | ||
| Approach to the Difficult TSC | 710 | ||
| Anatomic Variants of the IAS | 710 | ||
| TSC in the Presence of an IAS Closure Device | 712 | ||
| The Superior Approach to TSC | 713 | ||
| Available Tools to Reduce Complications | 713 | ||
| Conclusions | 716 | ||
| References | 716 | ||
| Videos | 717 | ||
| 37 Special Considerations for Ablation in Pediatric Patients | 718 | ||
| Key Points | 718 | ||
| Are Children Just Little Adults? | 719 | ||
| Arrhythmia Mechanisms | 719 | ||
| The Decision to Ablate: Safety Versus Efficacy | 720 | ||
| Use of Cryoablation in Children | 720 | ||
| Alternative Presentations or Management of Arrhythmias Commonly Observed in Adults | 721 | ||
| AVNRT in Children | 721 | ||
| Medical Management | 721 | ||
| AV Node Physiology in Children | 721 | ||
| Decision to Ablate and Safety Issues | 721 | ||
| AV Block. | 721 | ||
| Coronary Artery Damage: General Considerations for AVNRT and AP Ablation. | 722 | ||
| Ablation Energy: Cryo Versus RF. | 723 | ||
| AVNRT in Children: Summary and Recommendations. | 723 | ||
| Preexcitation Syndromes in Infants | 723 | ||
| Preexcitation Syndromes in Patients with Structural Congenital Heart Disease | 724 | ||
| Anatomy | 724 | ||
| Pathophysiology | 724 | ||
| Mapping and Ablation in Patients with Ebstein’s Anomaly | 725 | ||
| AV Discordance | 726 | ||
| Double AV Nodes | 727 | ||
| Patient Size and Structural Disease | 728 | ||
| Recurrence Risk | 729 | ||
| Summary | 729 | ||
| Atrial Flutter or Fibrillation in the Absence of Other Heart Diseases | 730 | ||
| Atrial and Ventricular Tachycardias in Patients with Congenital Heart Disease | 731 | ||
| Arrhythmias Unique to the Pediatric Patient | 731 | ||
| Incessant EAT in Children | 731 | ||
| Mechanism | 732 | ||
| Therapy | 732 | ||
| Mapping | 734 | ||
| Ablation | 735 | ||
| Complications | 736 | ||
| JET | 736 | ||
| Therapy | 737 | ||
| Mapping and Ablation | 737 | ||
| PJRT | 738 | ||
| Therapy | 738 | ||
| Mapping and Ablation | 738 | ||
| Complications and Recommendations | 739 | ||
| Other General Considerations in Pediatric Patients | 741 | ||
| Complications | 741 | ||
| Sedation and Anesthesia | 741 | ||
| Fluoroscopic Exposure | 741 | ||
| Ablation on Extracorporeal Membrane Oxygenation | 742 | ||
| Epicardial Ablation Techniques | 742 | ||
| Summary | 742 | ||
| References | 742 | ||
| 38 Catheter Ablation of Scar-Related Ventricular Tachycardia with Percutaneous Hemodynamic Support | 749 | ||
| Key Points | 749 | ||
| Options for Intraprocedural Cardiac Mechanical Support | 750 | ||
| Hemodynamic Support during VT Ablation | 752 | ||
| Hemodynamic Assessment During Ablation | 754 | ||
| Outcome of VT Ablation with Mechanical Support | 755 | ||
| Safety of pLVAD-Supported VT Ablation | 756 | ||
| Electromagnetic Interference | 756 | ||
| Patient Selection | 756 | ||
| pLVAD Implantation Technique | 757 | ||
| Anticoagulation Considerations | 757 | ||
| Conclusion | 757 | ||
| References | 758 | ||
| Index | 759 | ||
| A | 759 | ||
| B | 761 | ||
| C | 762 | ||
| D | 764 | ||
| E | 765 | ||
| F | 766 | ||
| G | 766 | ||
| H | 766 | ||
| I | 766 | ||
| J | 767 | ||
| L | 767 | ||
| M | 768 | ||
| N | 769 | ||
| O | 769 | ||
| P | 770 | ||
| R | 771 | ||
| S | 772 | ||
| T | 773 | ||
| U | 774 | ||
| V | 774 | ||
| W | 775 | ||
| IBC_Clinical Key ad | IBC1 |