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Electrophysiological Maneuvers for Arrhythmia Analysis

Electrophysiological Maneuvers for Arrhythmia Analysis

George Klein | Lorne Gula | Peter Leong-Sit

(2014)

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Book Details

Abstract

• From senior electrophysiologist and world-class educator George Klein, a fully illustrated guide with over 100 intracardiac tracings and figures that allow the physician to approach electrophysiologic problems effectively and systematically. • The book is especially focused on electrophysiological maneuvers and provides a clear and understandable guide to their proper selection and interpretation using abundant clinical examples. • Defines the integral role for "traditional" electrogram (EGM) analysis in order to understand the mechanism of a tachycardia. It goes without saying that a correct arrhythmia diagnosis is a prerequisite to catheter ablation regardless of the presence of sophisticated mapping and imaging technologies. Electrophysiological maneuvers are fundamental to this process, and proper selection and interpretation of maneuvers constitute a core skill of the electrophysiologist. In this volume, we make the case that most maneuvers are fundamentally similar in principle and can be understood by appreciating a few basic physiological and anatomical principles. The art lies not in a comprehensive knowledge by rote of every maneuver or its application, but rather a systematic approach using common principles. We illustrate this by showing abundant examples and emphasizing the "game plan," including checklists that can be applied to virtually any maneuver. —George J. Klein
In my opinion, this book should be on the shelf of every electrophysiologist trainee as well as every clinical cardiac electrophysiologist. It is a classic, like its editor. Dr. Klein deserves high praise for organizing his and his colleagues’ clinical experiences and thought processes into a concise, practical text that should be part of all training programs in electrophysiology. —From the foreword by Mark E. Josephson, MD This book comprehensively discusses the principles behind electrophysiology studies. The importance of understanding cardiac anatomy, the physiology behind the maneuvers, the study of arrhythmias, and the benefits as well as the shortcomings of specific maneuvers are well elucidated. -Doody Revew (Saima Karim, DO)

Table of Contents

Section Title Page Action Price
Cover i
Title Page iii
Copyright iv
Contents v
Contributors vii
Foreword ix
Preface xi
Abbreviations xiii
Chapter 1: Principles of the EP Maneuver 1
The Importance of “Geography” 3
Fusion and Reset: A Key Concept 5
The Relationship between the His Refractory PVC during Supraventricular Tachycardia(SVT) and Entrainment of SVT from the Ventricle 13
Suggested Readings 19
Chapter 2: Maneuvers during Sinus or Paced Rhythm 21
Para-Hisian Pacing 25
Assessing a Line of Block 40
Assessing a Line of Block: Tricuspid-Caval Isthmus 42
Assessing a Line of Block: Left Atrial Roof Line 45
Assessing a Line of Block: Mitral Isthmus Line 51
Verifying PV Isolation 57
Mapping Gaps in Conduction 60
Differential Pacing to Identify Near- vs. Far-Field EGMs 64
Challenges Confirming Exit Block from the PV 70
Suggested Readings 73
Chapter 3: Extrastimuli during Tachycardia 75
Relationship of Extrastimuli to Entrainment 76
Diagnostic Utility of Programmed PVC, PAC: Specific Examples 80
Suggested Readings 112
Chapter 4: Overdrive Pacing and Entrainment: SVT 113
Avoidance of Common Mistakes: The Entrainment Checklist 114
Practical Usage of Overdrive Pacing/Entrainment 116
Suggested Readings 136
Chapter 5: Overdrive Pacing and Entrainment: VT, AF and Flutter 137
Ventricular Tachycardia 139
Atrial Tachycardia 160
Suggested Readings 170
Chapter 6: Nonstimulation Based Maneuvers 171
Isoproterenol 172
Adenosine 173
Confirming Existence of a Tachycardia Substrate 174
Wide QRS Complex Tachycardia Diagnosis 177
SVT Responses to Adenosine 180
Differentiating AVNRT from JT 188
Adenosine and Recovery of Conduction 190
Miscellaneous Nonpacing Maneuvers 192
Suggested Readings 192
Index 193
Back Cover 197