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Abstract
Cardiac Electrophysiology: From Cell to Bedside defines the entire state of current scientific and clinical knowledge in this subspecialty. In response to the many major recent developments in the field, Drs. Zipes and Jalife have completely updated this modern classic, making the 5th Edition the most significant revision yet. From our latest understanding of ion channels, molecular genetics, and cardiac electrical activity through newly recognized syndromes, unique needs of special patient populations, and new diagnostic and therapeutic options, you'll find all the state-of-the-art guidance you need to make informed, effective clinical decisions. What's more, a significantly restructured organization, a new full-color layout, and full-text online access make reference easier than ever.
- Integrates the latest scientific understanding of arrhythmias with the newest clinical applications, giving you an informed basis for choosing the right treatment and management options for each patient.
- Synthesizes the knowledge of preeminent authorities in cardiology, physiology, pharmacology, pediatrics, biophysics, pathology, cardiothoracic surgery, and biomedical engineering from around the world, giving you a well-rounded, expert grasp of every issue that affects your patient management.
- Contains 24 new chapters (listed below) as well as exhaustive updates throughout, to keep you current with new scientific knowledge, newly discovered arrhythmia syndromes, and new diagnostic and therapeutic techniques.
- Developmental Regulation of Cardiac Ion Channels
- Neural Mechanisms of Initiating and Maintaining Arrhythmias
- Single Nucleotide Polymorphisms and Acquired Cardiac Arrhythmias
- Inheritable Sodium Channel Diseases
- Inheritable Potassium Channel Diseases
- Inheritable Diseases of Intracellular Calcium Regulation
- Morphological Correlates of Atrial Arrhythmias
- Andersen-Tawil Syndrome
- Timothy Syndrome
- Progressive Cardiac Conduction Disease
- Sudden Infant Death Syndrome
- Arrhythmias in Patients with Neurologic Disorders
- Autonomic Testing
- Cardiac Resynchronization Therapy
- Energy Sources for Catheter Ablation
- Linear Lesions to Ablate Atrial Fibrillation
- Catheter Ablation of Ventricular Arrhythmias in Patients with Structural Heart Disease
- Catheter Ablation of Ventricular Arrhythmias in Patients without Structural Heart Disease
- Catheter Ablation in Patients with Congenital Heart Disease
- Features a completely new section on "Arrhythmias in Special Populations" that explores arrhythmias in athletes ... gender differences in arrhythmias ... arrhythmias in pediatric patients ... and sleep-disordered breathing and arrhythmias.
- Offers an attractive new full-color design featuring color photos, tables, flow charts, ECGs, and more, making clinically actionable information easy to find and absorb at a glance.
- Includes full-text online access via Expert Consult, making reference easier for busy practitioners.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Cardiac Electrophysiology | iii | ||
| Copyright page | iv | ||
| Contributors | v | ||
| Preface | xvii | ||
| Contents | xix | ||
| CHAPTER - Introduction: Progress in Antiarrhythmic Therapies | 1 | ||
| Background | 1 | ||
| Successful Therapeutics | 1 | ||
| Proving Therapeutic Efficacy | 3 | ||
| Implementing Successful Therapy | 5 | ||
| Conclusions | 6 | ||
| References | 6 | ||
| PART I - Structural and Molecular Bases of Ion Channel Function | 9 | ||
| CHAPTER 1 - Voltage-Gated Sodium Channels and Electrical Excitability of the Heart | 9 | ||
| Subunit Structure of Sodium Channels | 9 | ||
| Three-Dimensional Structure of Sodium Channels | 9 | ||
| Sodium Channel Function | 10 | ||
| Sodium Channel Genes | 13 | ||
| Molecular Pharmacology of Sodium Channels | 14 | ||
| Expression, Localization, and Function of Sodium Channel Subtypes | 14 | ||
| References | 16 | ||
| CHAPTER 2 - Cardiac Calcium Channels | 19 | ||
| Calcium Channel Types | 19 | ||
| Molecular Characterization of Calcium Channels | 21 | ||
| Calcium Channel Selectivity and Permeation | 22 | ||
| Calcium Channel Gating | 23 | ||
| Amount of Ca2+ Entry through Calcium Channels | 25 | ||
| References | 26 | ||
| CHAPTER 3 - Voltage-Regulated Potassium Channels | 29 | ||
| Biophysical Properties of Voltage-Gated Potassium Channels | 29 | ||
| Subunits of Voltage-Gated Potassium Channels | 32 | ||
| Transient Outward Currents | 35 | ||
| Delayed Rectifiers | 37 | ||
| Voltage-Regulated Inward Rectifier | 38 | ||
| Background Potassium Currents | 39 | ||
| Voltage-Regulated Potassium Channels in Cardiac Disease | 39 | ||
| References | 40 | ||
| CHAPTER 4 - Intracellular Signaling and Regulation of Cardiac Ion Channels | 43 | ||
| Signaling Overview | 43 | ||
| Signaling Regulation for Disease | 43 | ||
| Local Myocyte Signaling Regulates Global Cardiac Function | 43 | ||
| Cardiomyocyte Local Membrane Organization: Form Fits Function | 43 | ||
| Calmodulin-Dependent Protein Kinase II Targets CaV1.2 by Way of an Adapter Sequence Embedded in β Subunits | 46 | ||
| References | 47 | ||
| CHAPTER 5 - Membrane Pumps and Exchangers | 51 | ||
| Overview of Membrane Pumps and Exchangers | 51 | ||
| Na+,K+-ATPase | 51 | ||
| Sarcolemmal Ca2+-ATPase | 54 | ||
| Na+-H+ Exchange | 54 | ||
| Na+-Ca2+ Exchange | 55 | ||
| Outlook and Future Directions | 58 | ||
| References | 59 | ||
| CHAPTER 6 - Sarcoplasmic Reticulum Ion Channels | 65 | ||
| The Sarcoplasmic Reticulum | 65 | ||
| The Sarcoplasmic Reticulum Calcium Release Channel (Ryanodine Receptor-2) | 66 | ||
| Monovalent Cation Channels | 71 | ||
| Chloride Channels | 72 | ||
| The Trimeric Intracellular Cation Channel | 72 | ||
| Conclusion and Outlook | 72 | ||
| References | 72 | ||
| CHAPTER 7 - Hyperpolarization-Activated, Cyclic Nucleotide-Gated (HCN) Channels: From Genes to Function | 77 | ||
| Molecular Identification of HCN Channels | 77 | ||
| Structure-Function Relations of HCN Channels | 77 | ||
| Other Cellular Factors Modulating HCN Channels | 78 | ||
| Channel Complex Formation | 79 | ||
| HCN Channel Expression in Heart | 79 | ||
| Cardiac HCN Channels and Native If | 79 | ||
| If Blockers as Bradycardic Drugs | 79 | ||
| Deletion of HCN Channels in Mice | 80 | ||
| Physiologic Role of HCN Channels in Humans | 81 | ||
| References | 82 | ||
| CHAPTER 8 - Molecular Organization and Regulation of the Cardiac Gap Junction Channel Connexin 43 | 85 | ||
| The Cardiac Intercalated Disk: Structure and Function | 85 | ||
| The Intercalated Disk as a Functional Unit | 86 | ||
| Molecular Structure of Connexin 43 | 87 | ||
| Connexin Structure during Gap Junction Regulation | 89 | ||
| Conclusions and Future Directions | 91 | ||
| References | 91 | ||
| PART II - Biophysics of Cardiac Ion Channel Function | 93 | ||
| CHAPTER 9 - Biophysics of Normal and Abnormal Cardiac Sodium Channel FunctionSalary support was provided by the National Institutes of Health (Grant R01 GM56307) and The James Tayloe Gwathmey Physician-Scientist Chair. | 93 | ||
| FAST GATING PROCESSES: A SYMPHONY OF STRUCTURE AND FUNCTION | 93 | ||
| Slow Inactivation: A Concerted Rearrangement in the Pore | 95 | ||
| Long QT Syndrome Mutations: Gating Mutations That Enhance Sodium Current | 96 | ||
| Brugada Syndrome: Gating Mutations That Reduce Sodium Current | 97 | ||
| Cardiac Conduction Disease: A Biophysical Compromise? | 98 | ||
| New Motifs and Modulators for Structure and Function | 98 | ||
| Inherited Cardiac Arrhythmias Inform Antiarrhythmic Pharmacologic Mechanisms | 100 | ||
| Slow Inactivation and the P Segments: A Mechanism for Local Anesthetic Use Dependence? | 100 | ||
| The Future: A Dynamic Cardiac Sodium Channel Structure | 101 | ||
| References | 102 | ||
| CHAPTER 10 - Gating of Cardiac Delayed Rectifier Potassium Channels | 105 | ||
| Overview of Potassium Channel Activity | 105 | ||
| Molecular Basis of Single Channels | 105 | ||
| Structural Features of Voltage-Gated Potassium Channels | 107 | ||
| Gating Mechanisms | 109 | ||
| References | 111 | ||
| CHAPTER 11 - Cardiac Stretch-Activated Channels and Mechano-Electric Transduction\r | 115 | ||
| Background | 115 | ||
| Functional Relevance of Cardiac Mechano-Electric Transduction | 115 | ||
| Cardiac Stretch-Activated Ion Channels | 119 | ||
| Manifestations of Cardiac SAC Activation | 120 | ||
| Conclusions and Outlook | 123 | ||
| Acknowledgment | 123 | ||
| References | 124 | ||
| CHAPTER 12 - The Sinoatrial Node: Its Complex Structure and Unique Ion Channel Gene Program | 127 | ||
| Development, Structure, and Function of the Sinoatrial Node | 127 | ||
| Ionic Currents and Ion Channels in the Sinoatrial Node | 127 | ||
| Plasticity of Ion Channel Expression in the Sinoatrial Node | 134 | ||
| Ion Channels in the Sinoatrial Node Are under the Control of Tbx3 | 136 | ||
| Interfacing the Sinoatrial Node with the Atrial Muscle | 136 | ||
| Conclusions | 137 | ||
| Acknowledgments | 137 | ||
| References | 137 | ||
| CHAPTER 13 - Biophysical Properties of Inwardly Rectifying Potassium Channels | 139 | ||
| Background | 139 | ||
| Cardiac Inward Rectifier Potassium Currents | 139 | ||
| Subunit Structure and Molecular Properties of Inward Rectifier Potassium Channels | 140 | ||
| Mechanisms of Rectification in Inward Rectifier Potassium Channels | 143 | ||
| Conclusions and Outlook | 146 | ||
| References | 146 | ||
| CHAPTER 14 - Biophysical Properties of Gap Junctions | 149 | ||
| Background | 149 | ||
| Homomeric-Homotypic Channels | 149 | ||
| Standard Gating Concept | 152 | ||
| Mixed Channels | 152 | ||
| Gap Junctions and Impulse Propagation | 154 | ||
| References | 154 | ||
| PART III - Intermolecular Interactions and Pharmacology of Cardiac Ion Channels | 157 | ||
| CHAPTER 15 - Developmental Regulation of Cardiac Ion Channels | 157 | ||
| Changes in Cellular Morphology and Ultrastructure | 157 | ||
| The Action Potential, ‘‘Resting’’ Membrane Potential, and Intracellular Ion Activities | 157 | ||
| Membrane Currents Responsible for the Cardiac Action Potential | 158 | ||
| Intracellular Calcium Homeostasis | 162 | ||
| Ion Channel Expression in the Early Fetus | 164 | ||
| Perspectives and Future Directions | 164 | ||
| References | 166 | ||
| CHAPTER 16 - Pharmacology of the Cardiac Sodium Channel | 169 | ||
| Sodium Channels | 169 | ||
| Inhibition of Sodium Channels | 169 | ||
| Classification of Antiarrhythmic Drugs | 171 | ||
| Molecular Mechanisms for Use-Dependent Block | 171 | ||
| Molecular Biology of Drug Interaction Sites | 172 | ||
| Block of Late Sodium Channels | 172 | ||
| Drug Effects on Channel Trafficking: Novel Antiarrhythmic Drug Effects | 173 | ||
| Specificity of Sodium Channel-Blocking Drugs | 173 | ||
| References | 173 | ||
| CHAPTER 17 - Pharmacology of L-type and T-type Calcium Channels in the Heart | 175 | ||
| Overview of L-type and T-type Calcium Channels | 175 | ||
| Structure and Function of the L-type Calcium Channel | 176 | ||
| Modulation of the L-type Calcium Channel by Drugs | 177 | ||
| Regulation of the L-type Calcium Channel by Protein Kinases and Phosphatases | 180 | ||
| Pharmacology of the T-type Calcium Channel in the Heart | 183 | ||
| References | 184 | ||
| CHAPTER 18 - KCNQ1/KCNE1 Macromolecular Signaling Complex: Channel Microdomains and Human Disease | 187 | ||
| Background | 187 | ||
| β-Adrenergic Receptor Signaling: Coordination of Localized Regulation of Channel Proteins by A Kinase-Anchoring Proteins | 187 | ||
| Pathologic Consequences of Disruption of the IKs/Yotiao Complex | 188 | ||
| Uncoupling of IKs Channels from Sympathetic Nervous System-Mediated Regulation: Novel Mechanisms of Arrhythmia | 191 | ||
| References | 192 | ||
| CHAPTER 19 - Drug-Induced Channelopathies | 195 | ||
| Introduction | 195 | ||
| Drug-Induced Long QT Syndrome | 195 | ||
| Mechanism of Drug-Induced QT Interval Prolongation and Torsade de Pointes | 196 | ||
| Drugs Affecting Multiple Ion Channels | 198 | ||
| Influence of Genetics on Drug-Induced QT Interval Prolongation | 201 | ||
| References | 201 | ||
| CHAPTER 20 - Connexins as Potential Targets for Cardiovascular Pharmacology | 205 | ||
| Background | 205 | ||
| Chemical Agents That Induce Gap Junction Closure | 205 | ||
| Molecular Approaches to Reduction of Cell-Cell Coupling | 206 | ||
| Peptide-Based Strategies for Reduction of Gap Junction-Mediated Intercellular Communication | 207 | ||
| Agents That Increase Gap Junction Coupling | 208 | ||
| Peptide-Based Strategies to Increase or Preserve Gap Junctional Communication | 208 | ||
| Summary and Conclusions | 211 | ||
| References | 211 | ||
| PART IV - Cell Biology of Cardiac Impulse Initiation and Propagation | 215 | ||
| CHAPTER 21 - Fibrosis and Fibroblast Infiltration: An Active Structural Substrate for Altered Propagation and Spontaneous Tachyarrhythmias | 215 | ||
| Cardiac Fibrosis and Fibroblasts as Electrical Insulators | 215 | ||
| Cardiac Activity Modulation by Heterocellular Electrotonic Coupling | 216 | ||
| Summary | 220 | ||
| References | 220 | ||
| CHAPTER 22 - Biologic Pacing | 223 | ||
| The Natural Pacemaker | 223 | ||
| Strategies for Building Biologic Pacemakers | 225 | ||
| Challenges | 228 | ||
| Conclusions | 231 | ||
| References | 232 | ||
| CHAPTER 23 - A New Functional Paradigm for the Heart’s Pacemaker: Mutual Entrainment of Intracellular Calcium Clocks and Surface Membrane Ion Channel Clocks | 235 | ||
| Evolution of Cardiac Pacemaker Cell Dogma | 236 | ||
| Discovery of an Intracellular Calcium Clock and Its Interactions with the Membrane Clock | 238 | ||
| The Plot Thickens: Intracellular Ca2+ Involvement in Normal Pacemaker Function | 238 | ||
| A New Pacemaker Theory Based on Integrated Function of an Intracellular Calcium Clock and Membrane Ion Channel Clock: Experimental Evidence | 239 | ||
| Integration of Intracellular and Membrane Processes Manifested by Natural Pacemaker Cells Is Required for Robust Function of Engineered Biologic Pacemakers | 243 | ||
| Numeric Validation of the Interpretation of Experimental Evidence That Normal Automaticity Is Generated by Integrated Function of the Intracellular Calcium Clock and Membrane Ion Channel Clock | 243 | ||
| An Additional Level of Complexity of Cardiac Pacemaker Function Arises within the Sinoatrial Nodal Tissue | 244 | ||
| Summary | 245 | ||
| References | 245 | ||
| CHAPTER 24 - Mechanisms of Atrioventricular Nodal Excitability and Propagation | 249 | ||
| Structure and Function of the Atrioventricular Junction | 249 | ||
| Molecular Heterogeneity in the Atrioventricular Junction | 250 | ||
| Cell-to-Cell Coupling in the Atrioventricular Junction | 252 | ||
| Functional Heterogeneity of the Atrioventricular Junction | 252 | ||
| Mechanisms of Atrioventricular Conduction | 253 | ||
| Conclusions | 257 | ||
| References | 257 | ||
| CHAPTER 25 - Intercellular Communication and Impulse Propagation | 259 | ||
| The Role of Cell-to-Cell Coupling in Uniform Propagation | 259 | ||
| The Role of Cell-to-Cell Uncoupling in Slow Conduction | 260 | ||
| Field Effect Propagation of the Cardiac Impulse | 262 | ||
| Uniform versus Nonuniform Cell-to-Cell Coupling | 263 | ||
| The Role of Coexpression of Connexins43, 45, and 40 in Ventricular and Atrial Propagation | 265 | ||
| Summary | 266 | ||
| References | 266 | ||
| CHAPTER 26 - Cardiac Myofibroblasts and Arrhythmogenesis | 269 | ||
| Fibroblasts and Myofibroblasts in the Working Myocardium | 269 | ||
| Connexin Expression by Myofibroblasts | 270 | ||
| Myofibroblasts Reestablish Conduction in Severed Cardiac Tissue | 271 | ||
| Myofibroblasts Slow Impulse Conduction | 272 | ||
| Myofibroblasts Elicit Ectopic Activity | 273 | ||
| Implications, Open Questions, and Perspectives | 275 | ||
| Summary | 276 | ||
| References | 276 | ||
| CHAPTER 27 - Cardiac Alternans as a Pathophysiologic Mechanism of Arrhythmias | 279 | ||
| Clinical Significance of T Wave Alternans | 279 | ||
| Mechanisms of Cardiac Alternans | 280 | ||
| Mechanisms Linking Alternans to Arrhythmogenesis | 283 | ||
| Mechanisms of Discordant Alternans between Cells | 284 | ||
| Mechanisms of Alternans in Cardiac Disease | 286 | ||
| Conclusions | 287 | ||
| References | 287 | ||
| CHAPTER 28 - Heterogeneous Expression of Repolarizing Potassium Currents in the Mammalian Myocardium | 293 | ||
| Diversity of Myocardial Voltage-Gated K+ (Kv) Currents | 296 | ||
| Other Myocardial K+ Currents Contributing to Repolarization | 298 | ||
| Molecular Diversity of Voltage-Gated K+ (Kv) Channel Pore-Forming α Subunits | 298 | ||
| Further Molecular Diversity of Kv Channels: Accessory β Subunits | 298 | ||
| Relation between Kv Channel Subunits and Cardiac Transient Outward K+ Channels | 300 | ||
| Relation between Kv Channel Subunits and Cardiac Delayed Rectifier K+ Channels | 301 | ||
| Molecular Correlates of Other Cardiac K+ Currents | 302 | ||
| Two-Pore Domain K+ Channels | 302 | ||
| Summary and Conclusions | 303 | ||
| References | 303 | ||
| CHAPTER 29 - Gap Junction Distribution and Regulation in the Heart | 307 | ||
| Gap Junction Expression in the Heart | 307 | ||
| Transcriptional Regulation of Cardiac Connexins | 308 | ||
| Connexin Life Cycle: Half-life, Export to the Plasma Membrane, and Degradation | 311 | ||
| Analysis of Connexin43 Phosphorylation | 311 | ||
| Connexin43 Conformation: The Utility of Phosphorylation Status-Specific Antibodies | 312 | ||
| Connexin Interacting Proteins: Zona Occludens-1 and Src Crosstalk | 312 | ||
| Gap Junction Remodeling | 312 | ||
| Summary | 313 | ||
| Acknowledgements | 314 | ||
| References | 314 | ||
| PART V - Models of Cardiac Excitation | 317 | ||
| CHAPTER 30 - Ionic Mechanisms of Ventricular Action Potential Excitation | 317 | ||
| Fast Sodium Current | 317 | ||
| L-type Calcium Current | 319 | ||
| Rapid Delayed Rectifier Potassium Current | 321 | ||
| Slow Delayed Rectifier Potassium Current | 324 | ||
| Summary and Conclusions | 324 | ||
| References | 326 | ||
| CHAPTER 31 - Theory of Reentry | 329 | ||
| Geometry of the Spiral Wave | 329 | ||
| Spiral Waves in Heterogeneous Tissue | 331 | ||
| Initiation of Spiral Waves | 333 | ||
| Induced Drift of Spiral Waves | 334 | ||
| Model Used for Illustrations | 335 | ||
| Acknowledgments | 336 | ||
| References | 336 | ||
| CHAPTER 32 - Nonlinear Dynamics of Excitation and Propagation in Cardiac Muscle | 339 | ||
| Voltage and Calcium Dynamics in Isolated Cardiac Myocytes | 339 | ||
| Wave Dynamics in Cardiac Tissue | 343 | ||
| Conclusions and Perspectives | 347 | ||
| References | 347 | ||
| CHAPTER 33 - Rotors and Spiral Waves in the Heart | 349 | ||
| Stages of Ventricular Fibrillation | 349 | ||
| Phase Mapping, Phase Singularities, and Rotors | 349 | ||
| Animal Models | 350 | ||
| Summary | 357 | ||
| Acknowledgements | 357 | ||
| References | 357 | ||
| CHAPTER 34 - Modeling Cardiac Defibrillation | 361 | ||
| Brief Historical Overview of Defibrillation Mechanisms | 361 | ||
| Early Insights Provided by the Bidomain Model | 362 | ||
| Three-Dimensional Models of Defibrillation | 362 | ||
| Virtual Electrode Polarization Induced by the Shock in the Three-Dimensional Volume of the Ventricles | 362 | ||
| Synthesizing Fluorescent Imaging Maps of Virtual Electrode Polarization in the Ventricles | 365 | ||
| Activity Originating from the Virtual Electrode Polarization Established by the Shock | 365 | ||
| Mechanisms for the Isoelectric Window Following Shocks Near the Upper Limit of Vulnerability | 368 | ||
| Shock-Induced Phase Singularities and Filaments | 369 | ||
| Conclusions | 371 | ||
| References | 371 | ||
| PART VI - Neural Control of Cardiac Electrical Activity | 373 | ||
| CHAPTER 35 - Adrenergic Signaling and Cardiac Ion Channels | 373 | ||
| Overview of the Adrenergic Signaling in the Heart | 373 | ||
| Voltage-Gated Sodium Channels | 375 | ||
| Voltage-Gated Calcium Channels | 376 | ||
| Voltage-Gated Potassium Channels | 376 | ||
| Sinoatrial and Atrioventricular Nodes | 377 | ||
| Conclusions | 379 | ||
| References | 379 | ||
| CHAPTER 36 - Nerve Sprouting and Cardiac Arrhythmias | 381 | ||
| Cardiac Nerves | 381 | ||
| Imaging Evidence of Sympathetic Neural Remodeling | 382 | ||
| Histologic Evidence of Sympathetic Neural Remodeling | 382 | ||
| Mechanisms of Sympathetic Neural Remodeling | 382 | ||
| Alteration of Sympathetic Innervation and Cardiac Arrhythmia | 383 | ||
| Sympathetic Neural Remodeling and Cardiac Arrhythmia | 385 | ||
| Arrhythmogenic Mechanism of Sympathetic Nerve Sprouting after MI | 385 | ||
| Conclusions | 387 | ||
| Acknowledgment | 387 | ||
| References | 387 | ||
| CHAPTER 37 - Neurocardiac Imaging | 391 | ||
| Autonomic Nervous System | 391 | ||
| Radiopharmaceuticals | 392 | ||
| Principles of Tomographic Imaging | 393 | ||
| Quantification of Autonomic Nervous System Function | 394 | ||
| Experimental and Clinical Observations | 395 | ||
| Additional Reading | 399 | ||
| Conclusion | 399 | ||
| References | 399 | ||
| CHAPTER 38 - Neural Mechanisms Initiating and Maintaining Arrhythmias: Summarizing Data from Animal Models and Human Diseases | 405 | ||
| Autonomic Neural Mechanisms | 405 | ||
| Sinus Bradycardia and Tachycardia (Patient Studies) | 406 | ||
| Atrial Fibrillation (Animal Studies) | 407 | ||
| Supraventricular Tachycardia and Atrial Fibrillation (Patient Studies) | 408 | ||
| Ventricular Tachycardia and Ventricular Fibrillation (Animal Studies) | 409 | ||
| Ventricular Tachycardia and Ventricular Fibrillation (Patient Studies) | 410 | ||
| Conclusion | 411 | ||
| References | 411 | ||
| PART VII - Arrhythmia Mechanisms | 415 | ||
| CHAPTER 39 - Role of Cardiac and Thoracic Veins in Arrhythmogenesis | 415 | ||
| Role of the Pulmonary Veins | 415 | ||
| Superior Vena Cava | 417 | ||
| Left Superior Vena Cava | 419 | ||
| Ligament of Marshall | 419 | ||
| Coronary Sinus | 420 | ||
| Inferior Vena Cava | 421 | ||
| Conclusion | 422 | ||
| References | 422 | ||
| CHAPTER 40 - Dominant Frequency and the Mechanisms of Maintenance of Atrial Fibrillation | 425 | ||
| Relation between Activity in the Left and Right Atria | 425 | ||
| Reentrant Activity during Acute Atrial Fibrillation in the Isolated Sheep Heart | 427 | ||
| Frequency-Dependent Breakdown of Propagation | 427 | ||
| Spatial Distribution of Dominant Frequencies during Atrial Fibrillation in Patients | 428 | ||
| High Dominant Frequency Sites and Maintenance of Atrial Fibrillation | 430 | ||
| Activation Frequency and Driver Mechanisms | 432 | ||
| Summary and Future Directions | 433 | ||
| References | 434 | ||
| CHAPTER 41 - Electrophysiologic Basis of Electrogram Fragmentation in Atrial Fibrillation | 437 | ||
| Complex Fractionated Atrial Electrograms | 437 | ||
| Fractionation of Atrial Electrograms: General Mechanism | 437 | ||
| Relation between Frequency and Fractionation: Boundary of the High-Frequency Domains | 439 | ||
| Summary | 441 | ||
| References | 441 | ||
| CHAPTER 42 - Structural Atrial Remodeling Alters the Substrate and Spatiotemporal Organization of Atrial Fibrillation | 443 | ||
| Substrate Differences among Models of Atrial Fibrillation | 443 | ||
| Spatiotemporal Organization in the Different Models of Atrial Fibrillation | 445 | ||
| Comparison of the Atrial Fibrillation Models | 448 | ||
| Other Applications with the Different Models of Atrial Fibrillation | 449 | ||
| Conclusion | 450 | ||
| References | 451 | ||
| CHAPTER 43 - Molecular Remodeling and Chronic Atrial Fibrillation | 453 | ||
| Features of the Atrial Fibrillation-Maintaining Substrate | 453 | ||
| Paradigms of Atrial Fibrillation Maintenance | 453 | ||
| Molecular Determinants of Atrial Fibrillation-Maintaining Paradigms | 455 | ||
| Molecular Basis of Ectopic Impulse Formation | 459 | ||
| Potential Therapeutic Implications | 461 | ||
| Conclusions | 461 | ||
| References | 462 | ||
| CHAPTER 44 - Noninvasive Electrocardiographic Imaging: Methodology and Excitation of the Normal Human Heart | 467 | ||
| Electrocardiographic Imaging Methodology | 467 | ||
| Activation and Repolarization of the Normal Human Heart | 468 | ||
| Acknowledgement | 472 | ||
| References | 472 | ||
| CHAPTER 45 - Dynamics and Molecular Mechanisms of Ventricular Tachycardia and Fibrillation in Normal Hearts | 473 | ||
| Functional Reentry and Spiral Waves | 473 | ||
| Rotors and Their Breakup | 473 | ||
| Rotors and Ventricular Fibrillation in the Human Heart | 474 | ||
| Potassium Channels and Cardiac Excitation | 474 | ||
| Inwardly Rectifying Potassium Current Controls Ventricular Fibrillation Frequency | 474 | ||
| From the Molecule to the Organ | 476 | ||
| Dynamics of Fibrillatory Conduction | 476 | ||
| Clinical Implications | 478 | ||
| Conclusions | 479 | ||
| References | 480 | ||
| CHAPTER 46 - Mechanisms of Ischemic Ventricular Fibrillation | 483 | ||
| Ventricular Fibrillation Associated with Acute Regional Ischemia | 483 | ||
| Ventricular Fibrillation in Globally Ischemic Heart | 486 | ||
| Future Directions | 488 | ||
| References | 489 | ||
| CHAPTER 47 - Insight into Mechanisms of Ventricular Tachycardia from Isolated Wedge Preparations | 491 | ||
| Ventricular Tachycardia Caused by Focal Activation in Proarrhythmic Substrates | 491 | ||
| Dynamics of Ventricular Heterogeneity As a Proarrhythmic Substrate | 493 | ||
| Ventricular Tachycardia Induced by Phase 2 Reentry in Brugada Syndrome | 494 | ||
| Ventricular Tachycardia by Transmural Reentry During Arterial Occlusion and Reperfusion | 496 | ||
| Summary | 497 | ||
| References | 497 | ||
| CHAPTER 48 - Mechanisms of Defibrillation | 499 | ||
| Mechanisms by Which Defibrillation Shocks Alter the Transmembrane Potential | 499 | ||
| Ionic Currents Responsible for the Changes of Transmembrane Potential During Defibrillation Shocks | 501 | ||
| Mechanisms by Which Defibrillation Shocks Reinitiate Reentry and Ventricular Fibrillation | 503 | ||
| Mechanisms by Which a Shock Defibrillates | 504 | ||
| Future Research | 507 | ||
| References | 507 | ||
| PART VIII - Molecular Genetics and Pharmacogenomics | 509 | ||
| CHAPTER 49 - Single Nucleotide Polymorphisms and Cardiac Arrhythmias | 509 | ||
| Primer on Molecular Genetics and Single Nucleotide Polymorphisms | 509 | ||
| Prevalence of Channel Variants in LQTS-Associated Genes Among Healthy Subjects | 510 | ||
| Functional Common Polymorphisms within Channelopathy-Susceptibility Genes | 510 | ||
| Functional Common Polymorphisms within Non-Ion-Channel Genes | 516 | ||
| References | 517 | ||
| CHAPTER 50 - Inheritable Sodium Channel Diseases | 519 | ||
| Cardiac Sodium Channel Gene | 519 | ||
| Disorders with Ventricular Arrhythmia and Sudden Death | 519 | ||
| Disorders with Impaired Cardiac Conduction | 522 | ||
| Other Disorders of Cardiac Sodium Channels | 523 | ||
| Management of Cardiac Sodium Channel Diseases | 524 | ||
| References | 524 | ||
| CHAPTER 51 - Inheritable Potassium Channel Diseases | 527 | ||
| Long-QT Syndromes | 527 | ||
| Short-QT Syndromes | 531 | ||
| References | 532 | ||
| CHAPTER 52 - Inheritable Disease of Intracellular Calcium Regulation | 535 | ||
| Genetics | 535 | ||
| Pathophysiology | 536 | ||
| Conclusions | 544 | ||
| References | 544 | ||
| CHAPTER 53 - Pharmacogenomics of Cardiac Arrhythmias and Effect on Drug Therapy | 547 | ||
| Pharmacokinetics | 547 | ||
| Mechanisms of Drug Interactions | 549 | ||
| Role of Genetics in Pharmacokinetics and Pharmacodynamics | 549 | ||
| Emerging Approaches in Genomic Medicine | 551 | ||
| Summary | 552 | ||
| References | 552 | ||
| PART IX - Supraventricular Arrhythmias: Mechanisms, Features, and Management | 555 | ||
| CHAPTER 54 - Morphologic Correlates of Atrial ArrhythmiasSiew Yen Ho receives funding support from The Royal Brompton and Harefield Hospital Charitable Fund for her research. | 555 | ||
| The Heart in the Chest and the Atria | 555 | ||
| Structure of the Right Atrium | 556 | ||
| The Atrial Septum | 559 | ||
| Structure of the Left Atrium | 559 | ||
| Myoarchitecture and Interatrial Connections | 561 | ||
| Cardiac Conduction System: Sinus Node and Atrioventricular Node | 562 | ||
| Accessory Atrioventricular Pathways | 563 | ||
| Innervation | 563 | ||
| Remodeling | 563 | ||
| Conclusions | 563 | ||
| References | 564 | ||
| CHAPTER 55 - Atrial Flutter | 567 | ||
| Mechanism of Atrial Flutter | 567 | ||
| Clinical Features of Atrial Flutter | 570 | ||
| Management of Atrial Flutter | 572 | ||
| Summary | 574 | ||
| References | 575 | ||
| CHAPTER 56 - Atrial Fibrillation: Mechanisms, Features, and Management | 577 | ||
| Epidemiologic Aspects | 577 | ||
| Classification | 577 | ||
| Pathophysiology | 577 | ||
| Treatment | 579 | ||
| Thromboembolism and Anticoagulation in Atrial Fibrillation | 585 | ||
| Conclusions and Future Directions | 587 | ||
| References | 587 | ||
| CHAPTER 57 - Atrial Tachycardia | 589 | ||
| Classification and Mechanisms | 589 | ||
| Focal Atrial Tachycardias | 589 | ||
| Electrocardiographic Localization of Focal Atrial Tachycardia | 591 | ||
| Electrophysiologic Differential Diagnosis of Focal Atrial Tachycardia | 595 | ||
| Macro-reentrant Atrial Tachycardia | 598 | ||
| Electrocardiographic Characterization of Macro-reentrant Atrial Tachycardia | 599 | ||
| Specific Types of Macro-reentrant Atrial Tachycardia | 601 | ||
| References | 602 | ||
| CHAPTER 58 - Atrioventricular Reentry and Variants | 605 | ||
| Definitions | 605 | ||
| Anatomic Substrate for Atrioventricular Reentry | 605 | ||
| Clinical Presentation | 605 | ||
| Electrocardiographic Characterization | 606 | ||
| Electrophysiologic Characterization | 608 | ||
| Mapping and Ablation of Accessory Pathways | 611 | ||
| Therapy | 612 | ||
| Summary | 612 | ||
| References | 613 | ||
| CHAPTER 59 - Electrophysiologic Characteristics of Atrioventricular Nodal Reentrant Tachycardia: Implications for Reentrant Circuits | 615 | ||
| Dual-Atrioventricular Nodal Pathway Physiology | 615 | ||
| Slow/Fast Atrioventricular Nodal Reentrant Tachycardia | 626 | ||
| Slow/Slow and Fast/Slow Atrioventricular Nodal Reentrant Tachycardia | 632 | ||
| Differential Diagnosis and Management of Atrioventricular Nodal Reentrant Tachycardia | 637 | ||
| References | 644 | ||
| CHAPTER 60 - Atrial Arrhythmias in Congenital Heart Disease | 647 | ||
| General Considerations | 647 | ||
| Clinical Background | 647 | ||
| Intra-atrial Reentrant Tachycardia | 647 | ||
| Atrial Fibrillation | 654 | ||
| Bradycardia | 654 | ||
| Conclusions | 655 | ||
| References | 655 | ||
| PART X - Ventricular Arrhythmias: Mechanisms, Features, and Management | 657 | ||
| CHAPTER 61 - Ventricular Tachycardia in Patients with Structurally Normal Hearts | 657 | ||
| Adenosine-Sensitive Ventricular Tachycardia | 657 | ||
| Verapamil-Sensitive Fascicular Tachycardia | 662 | ||
| References | 666 | ||
| CHAPTER 62 - Ventricular Tachycardia in Patients with Coronary Artery Disease | 669 | ||
| Pathophysiologic Substrate | 669 | ||
| Mechanism of Sustained Ventricular Tachycardia | 670 | ||
| Response to Programmed Stimulation | 671 | ||
| Clinical Presentation and Management | 672 | ||
| Long-Term Management | 672 | ||
| Future Directions | 673 | ||
| References | 673 | ||
| CHAPTER 63 - Ventricular Tachycardia in Patients with Dilated Cardiomyopathy | 675 | ||
| Incidence and Survival | 675 | ||
| Genetics | 675 | ||
| Pathophysiology | 676 | ||
| Imaging | 679 | ||
| Predictors of Mortality and Ventricular Arrhythmias | 679 | ||
| Drug Therapy | 681 | ||
| Device Therapy | 683 | ||
| Catheter Ablation | 684 | ||
| Conclusions | 685 | ||
| References | 686 | ||
| CHAPTER 64 - Arrhythmogenic Right Ventricular Cardiomyopathies | 689 | ||
| Terminology | 689 | ||
| Advances in Cellular and Molecular Biology and in the Understanding of Arrhythmogenic Right Ventricular Cardiomyopathies | 689 | ||
| Classification of Arrhythmogenic Right Ventricular Cardiomyopathies | 691 | ||
| Differential Diagnosis | 696 | ||
| Animal Models | 696 | ||
| Summary | 696 | ||
| Acknowledgments | 697 | ||
| References | 697 | ||
| CHAPTER 65 - Ventricular Arrhythmias in Hypertrophic Cardiomyopathy | 699 | ||
| Historical Context | 699 | ||
| Ventricular Tachycardia | 699 | ||
| Mechanisms of Sudden Death | 700 | ||
| Prevention of Sudden Death | 701 | ||
| The Risk Period in Hypertrophic Cardiomyopathy | 703 | ||
| Complications | 703 | ||
| Industry-Related Issues | 705 | ||
| Conclusions and Implications | 705 | ||
| References | 705 | ||
| CHAPTER 66 - Ventricular Tachycardia in Patients with Heart Failure | 707 | ||
| Overview | 707 | ||
| Electrical Remodeling | 707 | ||
| Heart Rate | 709 | ||
| Repolarization | 709 | ||
| Calcium and Arrhythmogenesis in Heart Failure | 710 | ||
| Mechanisms of Electrical Remodeling in Heart Failure | 711 | ||
| Mechanisms for Triggered Activity | 712 | ||
| References | 713 | ||
| CHAPTER 67 - Ventricular Tachycardia in Patients after Surgery for Congenital Heart Disease | 717 | ||
| Background | 717 | ||
| Anatomy and Surgical Technique | 717 | ||
| Spontaneous Occurrence of Ventricular Arrhythmias | 718 | ||
| Inducible Ventricular Tachycardia and Sudden Death | 718 | ||
| Treatment of Ventricular Tachycardia in the Postoperative Patient | 719 | ||
| References | 721 | ||
| CHAPTER 68 - The Brugada Syndrome | 723 | ||
| Overview | 723 | ||
| Diagnosis | 723 | ||
| Historical Background | 724 | ||
| Incidence and Distribution | 724 | ||
| Etiology and Genetics | 724 | ||
| Pathophysiology | 726 | ||
| Electrophysiologic Substrate | 727 | ||
| Differential Diagnosis | 727 | ||
| Clinical Manifestations | 727 | ||
| Prognosis and Risk Stratification | 727 | ||
| Treatment | 729 | ||
| References | 729 | ||
| CHAPTER 69 - Long QT and Short QT Syndromes | 731 | ||
| Long QT Syndrome | 731 | ||
| Short QT Syndrome | 740 | ||
| References | 742 | ||
| CHAPTER 70 - Catecholaminergic Polymorphic Ventricular Tachycardia | 745 | ||
| Definition | 745 | ||
| Clinical Phenotype and Diagnosis | 745 | ||
| Genetic Features and Genotype-Phenotype Correlations | 746 | ||
| Clinical Management: Risk Stratification and Specific Therapy | 749 | ||
| Summary and Conclusions | 749 | ||
| References | 749 | ||
| CHAPTER 71 - Andersen-Tawil Syndrome | 753 | ||
| Background | 753 | ||
| Clinical Manifestations | 753 | ||
| Molecular Correlate of IK1 | 753 | ||
| Cellular Basis for the Clinical Syndrome | 754 | ||
| Treatment Options | 755 | ||
| References | 755 | ||
| CHAPTER 72 - Timothy Syndrome | 757 | ||
| Historical Notes | 757 | ||
| Phenotype and Natural History | 757 | ||
| Cardiac Events and Mortality in Timothy Syndrome | 757 | ||
| Genetics of Timothy Syndrome | 757 | ||
| Pathophysiology | 760 | ||
| Extracardiac Phenotype | 760 | ||
| Therapy for Timothy Syndrome | 760 | ||
| Summary | 761 | ||
| References | 761 | ||
| CHAPTER 73 - Idiopathic Ventricular Fibrillation | 763 | ||
| Overview | 763 | ||
| Diagnostic Evaluation | 763 | ||
| Electrocardiographic Features | 764 | ||
| Triggers | 765 | ||
| Follow-up and Therapy | 766 | ||
| References | 767 | ||
| CHAPTER 74 - Drug-Induced Ventricular Tachycardia | 769 | ||
| Overview | 769 | ||
| Pharmacokinetic Risk Factors | 769 | ||
| Genetic Predisposition | 769 | ||
| Drug-Induced Long QT Syndrome | 770 | ||
| Risk Factors for Torsades de Pointes | 771 | ||
| Sodium Channel Blocker-Related Toxicity | 773 | ||
| Acquired Brugada Syndrome | 774 | ||
| Digitalis Toxicity | 775 | ||
| Other Drug-Induced Toxicity | 776 | ||
| References | 776 | ||
| CHAPTER 75 - Progressive Cardiac Conduction Disease | 779 | ||
| Genetic Basis of Progressive Cardiac Conduction Disease | 779 | ||
| Treatment for Progressive Cardiac Conduction Disease | 785 | ||
| References | 785 | ||
| CHAPTER 76 - Sudden Infant Death Syndrome | 789 | ||
| Overview | 789 | ||
| Linking Sudden Infant Death Syndrome and Arrhythmia | 789 | ||
| Sudden Infant Death Syndrome and Long QT Syndrome | 791 | ||
| Sudden Infant Death Syndrome and Brugada Syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia, and Short QT Syndrome | 792 | ||
| Congenital Arrhythmia and SIDS: How Frequent? | 793 | ||
| Congenital Arrhythmia in Sudden Infant Death Syndrome: Triple Risk Hypothesis | 793 | ||
| Implications for Screening, Therapy, and Further Research | 793 | ||
| References | 794 | ||
| CHAPTER 77 - Sudden Cardiac Death | 797 | ||
| Sudden Cardiac Death as a Public Health Burden: Estimates of Incidence | 797 | ||
| Causes and Clinical Expressions of Sudden Cardiac Death | 798 | ||
| Pathologic Findings in Sudden Cardiac Death Victims | 799 | ||
| Prediction and Strategies for Prevention of Sudden Cardiac Death | 800 | ||
| Prediction of Risk of Sudden Cardiac Death in Coronary Heart Disease | 801 | ||
| Sudden Cardiac Death Risk in Nonischemic Dilated Cardiomyopathy | 803 | ||
| Tachyarrhythmic and Bradysystolic or Asystolic Cardiac Arrest Mechanisms | 803 | ||
| Epidemiologic Paradigms for Sudden Cardiac Death Prediction | 803 | ||
| References | 807 | ||
| CHAPTER 78 - Arrhythmias in Patients with Neurologic Disorders | 809 | ||
| The Muscular Dystrophies | 809 | ||
| Friedreich’s Ataxia | 812 | ||
| The Periodic Paralyses | 812 | ||
| Mitochondrial Encephalomyopathies | 813 | ||
| Guillain-Barré Syndrome | 813 | ||
| Myasthenia Gravis | 813 | ||
| Epilepsy | 814 | ||
| Acute Cerebrovascular Disease | 814 | ||
| References | 814 | ||
| PART XI - Electrocardiographic Recognition | 817 | ||
| CHAPTER 79 - Parasystole | 817 | ||
| General Considerations | 817 | ||
| Classic Parasystole | 817 | ||
| Electrocardiographic Characteristics of Modulated Ventricular Parasystole | 818 | ||
| Pacemaker Annihilation | 819 | ||
| Parasystolic Entrainment | 819 | ||
| Intermittent Parasystole | 820 | ||
| Intermittency of Manifest Parasystolic Activity: Recapitulation | 820 | ||
| ‘‘Parasystolic Alienation’’ and the Withering of Parasystole | 821 | ||
| References | 822 | ||
| CHAPTER 80 - Differential Diagnosis for Wide QRS Complex Tachycardia | 823 | ||
| Perspective and Definitions | 823 | ||
| Distinguishing Features of Wide QRS Complex Tachycardia | 823 | ||
| Practical Approaches to Diagnosis of Wide Complex Tachycardia | 829 | ||
| Wide Complex Tachycardia: Special Cases | 830 | ||
| Summary | 830 | ||
| References | 830 | ||
| PART XII - Diagnostic Evaluation | 831 | ||
| CHAPTER 81 - Assessment of the Patient with a Cardiac Arrhythmia | 831 | ||
| History Taking | 831 | ||
| Physical Examination | 833 | ||
| Laboratory Tests | 834 | ||
| Summary | 836 | ||
| CHAPTER 82 - Exercise-Induced Arrhythmias | 837 | ||
| Molecular, Cellular, and Physiologic Mechanisms of the Response to Exercise: Where Are the Weak Links? | 837 | ||
| Clinical Exercise-Induced Arrhythmias | 839 | ||
| Prognostic Implications | 841 | ||
| Conclusions | 843 | ||
| References | 843 | ||
| CHAPTER 83 - The Use of Implantable Loop Recorders | 845 | ||
| Overview | 845 | ||
| External Loop Recorders | 845 | ||
| Implanted Loop Recorders | 845 | ||
| Clinical Trials | 847 | ||
| Event Classification | 848 | ||
| Additional Uses of Loop Recorders | 849 | ||
| Future Directions | 849 | ||
| Conclusions | 849 | ||
| References | 849 | ||
| CHAPTER 84 - High-Resolution Electrocardiography | 851 | ||
| Background | 851 | ||
| Methods | 851 | ||
| Ventricular Late Potentials | 852 | ||
| Prognostic Value of Late Potential Measurements after Acute Myocardial Infarction | 854 | ||
| Evaluation of Patients with Syncope of Unknown Origin | 855 | ||
| Evaluation of Patients with Nonischemic Cardiomyopathy | 855 | ||
| Evaluation of Patients with Nonsustained Ventricular Tachycardia | 855 | ||
| Abnormal Intra-QRS Potentials | 855 | ||
| Summary | 856 | ||
| References | 857 | ||
| CHAPTER 85 - Head-up Tilt Table Testing | 859 | ||
| Historical Background | 859 | ||
| Transient Loss of Consciousness and Syncope | 859 | ||
| Physiologic Impact of Upright Posture | 860 | ||
| Pathophysiology of Vasovagal Syncope | 861 | ||
| Head-Up Tilt Table Testing for Assessing Susceptibility to Vasovagal Syncope | 863 | ||
| Head-up Tilt Table Testing Laboratory and Protocols | 867 | ||
| Use of Tilt Table Testing for Prediction of Treatment Effectiveness | 868 | ||
| Recommendations for Use of Head-Up Tilt Table Testing | 868 | ||
| Conclusions | 868 | ||
| Acknowledgment | 869 | ||
| References | 869 | ||
| CHAPTER 86 - Electrocardiographic and Autonomic Testing of Cardiac Risk | 871 | ||
| Background | 871 | ||
| Heart Rate Variability | 871 | ||
| Heart Rate Turbulence and Baroreflex Sensitivity | 874 | ||
| Instantaneous Electrocardiographic Morphology | 876 | ||
| Multivariate Risk Prediction | 877 | ||
| References | 878 | ||
| CHAPTER 87 - Monophasic Action Potential Recording | 881 | ||
| Monophasic Action Potential Recording Devices | 881 | ||
| Accuracy of Monophasic Action Potential Recordings | 882 | ||
| Clinical Applications of Monophasic Action Potential Recording | 882 | ||
| Summary | 885 | ||
| References | 885 | ||
| CHAPTER 88 - T Wave Alternans | 887 | ||
| History of Cardiac Alternans | 887 | ||
| Mechanisms Underlying T Wave Alternans | 887 | ||
| Cellular Basis of Action Potential Alternans | 888 | ||
| Technical Aspects of Assessment of T Wave Alternans | 889 | ||
| Classification and Interpretation of Microvolt T Wave Alternans Recordings | 889 | ||
| Clinical Studies on Microvolt T Wave Alternans | 890 | ||
| Future Role of Microvolt T Wave Alternans Assessment | 894 | ||
| References | 895 | ||
| CHAPTER 89 - Mapping and Imaging | 897 | ||
| Overview | 897 | ||
| Mapping Techniques | 897 | ||
| Imaging in Cardiac Electrophysiology | 901 | ||
| Conclusions | 903 | ||
| References | 903 | ||
| CHAPTER 90 - Noninvasive Electrocardiographic Imaging (ECGI): Clinical Applications | 905 | ||
| Overview | 905 | ||
| Atrial Arrhythmias | 906 | ||
| Ventricular Arrhythmias and Abnormal Electrophysiologic Substrate | 907 | ||
| Summary | 912 | ||
| Acknowledgment | 912 | ||
| References | 912 | ||
| CHAPTER 91 - Syncope | 913 | ||
| Overview | 913 | ||
| Differential Diagnosis | 913 | ||
| Diagnostic Tests | 915 | ||
| Approach to the Evaluation of Patients with Syncope | 919 | ||
| Hospitalization of Patients with Syncope | 919 | ||
| Selected Issues Concerning the Treatment of Syncope | 919 | ||
| Summary | 921 | ||
| References | 921 | ||
| PART XIII - Arrhythmias in Special Populations | 923 | ||
| CHAPTER 92 - Sudden Cardiac Deaths in Athletes, Including Commotio Cordis | 923 | ||
| Acute Triggering of Sudden Cardiac Death with Athletic Activity | 923 | ||
| Remodeling and Conditioning | 924 | ||
| Electrocardiograms in Athletes | 925 | ||
| Echocardiographic Changes in Athletes | 926 | ||
| Commotio Cordis | 926 | ||
| Screening | 928 | ||
| Bethesda Guidelines for Participation in Competitive Sports | 929 | ||
| Supplements | 929 | ||
| Conclusion | 930 | ||
| References | 930 | ||
| CHAPTER 93 - Gender Differences in Arrhythmias | 933 | ||
| Electrocardiographic Differences | 933 | ||
| Heart Rate Variability | 933 | ||
| Intracardiac Electrophysiologic Measurements | 933 | ||
| Supraventricular Tachycardia | 933 | ||
| Atrial Fibrillation | 934 | ||
| Ventricular Arrhythmias and Sudden Cardiac Death | 935 | ||
| Congenital Long-QT Syndrome | 936 | ||
| Acquired Long-QT Syndrome: Drug-Induced Proarrhythmia | 936 | ||
| Conclusions | 937 | ||
| References | 937 | ||
| CHAPTER 94 - Arrhythmias in Pediatrics | 941 | ||
| Developmental Cardiac Electrophysiology | 941 | ||
| Pediatric Issues in Arrhythmias Seen in All Age Groups | 941 | ||
| Ventricular Arrhythmias | 944 | ||
| Bradycardia | 945 | ||
| Atrioventricular Block | 945 | ||
| Reflex Syncope Syndromes in Childhood | 945 | ||
| Pediatric Therapeutic Concerns | 945 | ||
| Pacing and Device Therapy | 946 | ||
| Special Considerations in Fetal Arrhythmias | 948 | ||
| Conclusion | 949 | ||
| References | 950 | ||
| CHAPTER 95 - Sleep-Disordered Breathing and Arrhythmias | 951 | ||
| Obstructive Sleep Apnea | 951 | ||
| Central Sleep Apnea | 951 | ||
| Mechanisms of Arrhythmias in Sleep Apnea | 952 | ||
| Epidemiology of Arrhythmias in Sleep Apnea | 953 | ||
| Ventricular Arrhythmias and Sudden Cardiac Death | 954 | ||
| Sleep Apnea Therapy and Arrhythmias | 955 | ||
| Approach to the Patient | 956 | ||
| References | 956 | ||
| PART XIV - Pharmacologic Therapy | 959 | ||
| CHAPTER 96 - Standard Antiarrhythmic Drugs | 959 | ||
| Principles of Antiarrhythmic Therapy | 959 | ||
| Class I Antiarrhythmic Drugs | 964 | ||
| Class IA Antiarrhythmic Drugs | 964 | ||
| Class IB Antiarrhythmic Drugs | 967 | ||
| Class IC Antiarrhythmic Drugs | 968 | ||
| Class III Antiarrhythmic Drugs | 969 | ||
| References | 972 | ||
| CHAPTER 97 - New Antiarrhythmic Drugs and New Concepts for Old Drugs | 975 | ||
| Background and Current Clinical Context | 975 | ||
| Atrial Fibrillation | 975 | ||
| Sudden Cardiac Death | 977 | ||
| Other Novel Antiarrhythmic Drugs | 978 | ||
| Targeted Use of Antiarrhythmic Drugs | 979 | ||
| Summary | 980 | ||
| Acknowledgments | 980 | ||
| References | 980 | ||
| CHAPTER 98 - Impact of Nontraditional Antiarrhythmic Drugs on Sudden Cardiac Death | 983 | ||
| Pathophysiology | 983 | ||
| β\r-Adrenergic Blockers | 984 | ||
| Renin-Angiotensin-Aldosterone System | 986 | ||
| Modulators of Cholesterol and Inflammation | 987 | ||
| Conclusion | 989 | ||
| References | 989 | ||
| PART XV - Electrical Therapy | 991 | ||
| CHAPTER 99 - Implantable Cardioverter-Defibrillator: Technical Aspects | 991 | ||
| System Elements | 991 | ||
| Detection of Tachyarrhythmia | 993 | ||
| Therapy for Tachyarrhythmia | 995 | ||
| Recent and Future Directions | 998 | ||
| References | 999 | ||
| CHAPTER 100 - Implantable Cardioverter-Defibrillator: Clinical Aspects | 1001 | ||
| Indications and Use | 1001 | ||
| Implant Testing | 1001 | ||
| Programming | 1005 | ||
| Monitoring and Follow-up | 1007 | ||
| Common Clinical Issues | 1007 | ||
| Complications | 1010 | ||
| Selecting the Appropriate Device | 1010 | ||
| Special Issues | 1010 | ||
| Medical Advisories and Recalls | 1011 | ||
| Future Trends | 1011 | ||
| References | 1011 | ||
| CHAPTER 101 - Implantable Pacemakers | 1015 | ||
| History of Pacing | 1015 | ||
| Pacemaker Nomenclature | 1015 | ||
| Indications for Cardiac Pacing | 1015 | ||
| Basic Pacemaker Function and Modes | 1017 | ||
| Selecting the Appropriate Pacing Mode | 1018 | ||
| Selecting the Appropriate Sensor for Rate-Adaptive Pacing | 1019 | ||
| Troubleshooting Electrocardiographic Abnormalities | 1020 | ||
| Automatic Pacemaker Function | 1022 | ||
| Electromagnetic Interference | 1023 | ||
| Summary | 1024 | ||
| References | 1024 | ||
| CHAPTER 102 - Cardiac Resynchronization Therapy | 1027 | ||
| A Worldwide Epidemic of Chronic Heart Failure | 1027 | ||
| Electromechanical Events and Cardiac Pump Function | 1027 | ||
| Mechanisms | 1030 | ||
| Implantation Techniques | 1032 | ||
| Hardware Systems, Programming Considerations, and Troubleshooting | 1035 | ||
| Clinical Experience with Cardiac Resynchronization Therapy | 1038 | ||
| Role of Defibrillation Support | 1040 | ||
| References | 1040 | ||
| CHAPTER 103 - Newer Applications of Pacemakers | 1043 | ||
| Pacing to Improve Hemodynamics (Heart Failure) | 1043 | ||
| Atrioventricular Synchrony | 1043 | ||
| Right Ventricular Stimulation Site | 1044 | ||
| Biventricular Pacing (Cardiac Resynchronization Therapy) | 1044 | ||
| Atrial Fibrillation | 1045 | ||
| Hypertrophic Cardiomyopathy | 1046 | ||
| Neurocardiogenic Syncope | 1046 | ||
| Long-QT Syndrome | 1046 | ||
| Preventing Remodeling after Myocardial Infarction | 1047 | ||
| Permanent Pacing for Chronic Disorders of the Neuromuscular System | 1047 | ||
| Permanent Pacing for Infiltrative Diseases of the Myocardium | 1047 | ||
| Conclusions | 1047 | ||
| References | 1048 | ||
| CHAPTER 104 - Lesion-Forming Technologies for Catheter Ablation | 1051 | ||
| Evolution of Technology | 1051 | ||
| Biophysical Aspects of Lesion Formation | 1051 | ||
| Limitations of Catheter-Based Radiofrequency Ablation | 1053 | ||
| New Developments in Radiofrequency Ablation | 1054 | ||
| Cryoablation | 1054 | ||
| High-Intensity Focused Ultrasound | 1055 | ||
| Other Energy Sources and Approaches for Lesion Formation | 1056 | ||
| References | 1057 | ||
| CHAPTER 105 - Atrial Substrate Ablation in Atrial Fibrillation | 1059 | ||
| Electrogram-Guided Ablation of Atrial Substrate | 1059 | ||
| Linear Ablation | 1063 | ||
| Clinical Outcomes of Atrial Substrate Ablation | 1065 | ||
| Effects of Atrial Substrate Ablation on Atrial Electrical and Mechanical Properties | 1068 | ||
| Use of Three-Dimensional Nonfluoroscopic Imaging for Atrial Substrate Ablation | 1068 | ||
| Conclusion | 1068 | ||
| References | 1069 | ||
| CHAPTER 106 - Pulmonary Vein Isolation for Atrial Fibrillation | 1071 | ||
| Circumferential Pulmonary Vein Ablation | 1071 | ||
| Ablation Procedure | 1073 | ||
| Clinical Outcomes | 1078 | ||
| Anticoagulation Concerns | 1079 | ||
| Remote Mapping and Ablation with Stereotaxis | 1079 | ||
| Conclusions | 1080 | ||
| References | 1081 | ||
| CHAPTER 107 - Catheter Ablation of Supraventricular Arrhythmias | 1083 | ||
| Ablation of Atrioventricular Node Reentrant Tachycardia | 1083 | ||
| Ablation of Atrioventricular Reentrant Tachycardia | 1084 | ||
| Ablation of Atrial Flutter and Macro-reentrant Atrial Tachycardia | 1087 | ||
| Ablation of Focal Atrial Tachycardia | 1089 | ||
| Conclusion | 1090 | ||
| References | 1090 | ||
| CHAPTER 108 - Catheter Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease | 1093 | ||
| Preprocedure Preparation and Consideration of Risks | 1093 | ||
| Electrophysiologic Evaluation | 1093 | ||
| Epicardial Mapping and Ablation | 1096 | ||
| Identifying Ablation Target Sites | 1097 | ||
| Acute Procedural Endpoints and Outcomes | 1100 | ||
| Ablation in Specific Diseases | 1101 | ||
| Ablation for Polymorphic Ventricular Tachycardia and Ventricular Fibrillation | 1101 | ||
| Summary | 1101 | ||
| References | 1102 | ||
| CHAPTER 109 - Catheter Ablation of Ventricular Arrhythmias in Patients without Structural Heart Disease | 1105 | ||
| Ventricular Outflow Tract Arrhythmias | 1105 | ||
| Idiopathic Left Ventricular Tachycardia | 1108 | ||
| References | 1111 | ||
| CHAPTER 110 - Catheter Ablation in Pediatric and Congenital Heart Disease Patients | 1113 | ||
| Preparation for the Procedure | 1113 | ||
| Procedural Issues | 1113 | ||
| Results of Catheter Ablation | 1115 | ||
| Indications | 1117 | ||
| Acknowledgment | 1119 | ||
| References | 1119 | ||
| Index | 1123 |