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Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows

Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows

Paul D. Purves | George J. Klein | Peter Leong-Sit

(2011)

Abstract

Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows fulfills the need of allied health personnel and new fellows for a practical, hands-on pictorial guide that clearly illustrates the essential concepts of clinical cardiac electrophysiology. More than 70 high-quality tracings, diagrams, fluoroscopic images, and electroanatomic maps accompanied by detailed discussions of each image offer a fundamental understanding of cardiac electrophysiology equipment, principles, and procedures: • Catheter placement, hardware connections, and intracardiac signals • Normal electrogram sequences associated with sinus rhythm • Methodologies used to uncover the mechanisms of common clinical tachycardias In addition, commentaries provided throughout the book introduce more advanced principles for readers who want to delve further into the EP study. Authored by a team of experts, Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows is an invaluable resource for a complex technology, providing superb guidance in acclimating new trainees and personnel to the EP laboratory and empowering them with the knowledge and skills needed to practice clinical electrophysiology.
This would be very useful as a training manual or reference for beginning practitioners. I anticipate that it would be kept in an electrophysiology lab so that staff could refer to the illustrations and descriptions. - Doody Review (Elaine Hannigan, RN, MSN) - (Paul Purves is a unique EP technologist who has coupled his technical expertise and knowledge of EP with a passion for understanding the underpinnings of the study, and teaches what he knows to other technologists, nurses, and indeed physicians. He is a gifted teacher who has coordinated and assembled the “collective wisdom” of our team into this reader-friendly and unique visual guide to performing and understanding the arrhythmia study. It surpasses the needs of a simple introduction and will be useful to all levels of trainee who want to understand what is really “going on” and move to the next level. -George J. Klein, MD, FRCP(C)

Table of Contents

Section Title Page Action Price
Cover\r Cover
Cardiac Electrophysiology iii
Copyright iv
Contents v
About the Authors ix
Foreword xi
Preface xiii
Acknowledgments xv
Abbreviations xvii
Glossary xix
Before We Begin an SVT Study 1
Unit 1:\rThe Basics 4
1. Catheter Placement 6
2. The Computer System 8
3. Signal Processing 10
4. Signal Sequence in Sinus Rhythm 12
5. Basic Conduction Intervals 14
6. Tissue Conduction 16
7. Supraventricular Tachycardia Diagnostic Study 18
Incremental Ventricular Pacing 18
Retrograde Wenckebach 20
Ventricular Extra-stimulus Pacing 22
Retrograde V-A Block 24
Ventricular Effective Refractory Period 26
Atrial Extra-stimulus Pacing 28
Atrioventricular Block 30
Atrial Effective Refractory Period 32
Incremental Atrial Pacing 34
Unit 2: Common Clinical Tachycardias 36
8. AV Nodal Reentrant Tachycardia 38
Typical AVNRT Pathways 38
Jump 40
AV Nodal Echo 42
Onset of Tachycardia 44
9. Atrioventricular Reentrant Tachycardia 46
Wolff-Parkinson-White 46
Accessory Pathway Locations 48
Accessory Pathway Echo 50
AVRT Initiation 52
Effective Refractory Period of an Accessory Pathway 58
Ablation of Accessory Pathways 60
10. Focal Atrial Tachycardia 62
11. Atrial Flutter 64
Typical Catheter Placement 64
Cavo-tricuspid Isthmus Ablation 66
Split A’s 68
12. Atrial Fibrillation 70
Basic Diagnosis 70
Near-Field Versus\rFar-Field Electrograms 72
Entrance Block 74
Exit Block 76
Pulmonary Vein Fibrillation 78
Independent Pulmonary Vein Activity 80
13. Ventricular Tachycardia 82
Basic Diagnosis 82
Activation Mapping 84
Pace Mapping 86
Entrainment Mapping 88
Scar-dependent Ventricular Tachycardia 90
Voltage Mapping 92
Substrate Modification 94
Unit 3:\rAdvanced Concepts 96
14. Mechanisms of Tachycardia 98
15. Bipolar Versus Unipolar Electrograms 100
16. Latency 102
17. Gap Phenomenon 104
18. PVCs into AVNRT 106
19. PVCs into AVRT 108
20. Entrainment Pacing 110
21. Para-Hisian Pacing 112
Unit 4: Advanced Tracings 118
22. An Irregular Rhythm 120
23. Why Does\rthe A-H Interval Vary? 122
24. Distinguishing A from V 126
25. An Unexpected QRS 128
26. Unusual Onset of Tachycardia 130
27. Diagnostic Dilemma 132
28. A Dangling Potential 136
29. After Pulmonary Vein Ablation 138