BOOK
Interpretation of Complex Arrhythmias: A Case-Based Approach, An Issue of Cardiac Electrophysiology Clinics, E-Book
(2016)
Additional Information
Book Details
Abstract
This special case-based issue of Cardiac Electrophysiology Clinics features a selection of cases on the following topics: Use of the Surface ECG to Define the Nature of Challenging Arrhythmias; Diagnostic and Prognostic Implications of Surface Recordings from Patients with A-V Block; Supraventricular Tachycardia; Ventricular Tachycardia; Atrial Fibrillation and Flutter; Troubleshooting Device Function; Adult Congenital Cardiac Disease; and Arrhythmias in Patients with Genetic Arrhythmia Syndromes.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Interpretation of Complex Arrhythmias:A Case-Based Approach\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
CONSULTING EDITORS | iii | ||
EDITOR | iii | ||
EDITORS | iii | ||
AUTHORS | iv | ||
Contents | ix | ||
Foreword: Interpretation of Complex Arrhythmias: A Case-Based Approach\r | ix | ||
Preface: Challenging Cases, Match Wits with the Masters\r | ix | ||
Use of the Surface Electrocardiogram to Define the Nature of Challenging Arrhythmias\r | ix | ||
Diagnostic and Prognostic Implications of Surface Recordings from Patients with Atrioventricular Block\r | ix | ||
1: Supraventricular Tachycardia Editor: Nitish Badhwar | ix | ||
Antidromic Atrioventricular Reciprocating Tachycardia Using a Concealed Retrograde Conducting Left Lateral Accessory Pathway\r | ix | ||
Supraventricular Tachycardia in a Patient with an Interrupted Inferior Vena Cava\r | x | ||
Atrioventricular Nodal Reentrant Tachycardia with 2:1 Atrioventricular Block\r | x | ||
Implantable Cardioverter-Defibrillator Shock Caused by Uncommon Variety of Nonreentrant Atrioventricular Nodal Tachycardia\r | x | ||
Incessant Palpitations and Narrow Complex Tachycardia\r | x | ||
Narrow Complex Tachycardia: What is the Mechanism?\r | x | ||
Incessant Long R-P Tachycardia\r | xi | ||
2: Ventricular Tachycardia Editor: Henry H. Hsia | xi | ||
Ventricular Tachycardias\r | xi | ||
Unusual Outflow Tract Ventricular Tachycardia\r | xi | ||
Ventricular Arrhythmias from the Left Ventricular Summit: Critical Importance of\rAnatomy, Imaging, and Detailed Mapping to Allow Safe and Effective Ablation\r | xi | ||
Catheter Ablation of Ventricular Arrhythmias Arising from the Left Ventricular Summit\r | xii | ||
Ventricular Tachycardia Arising from Cardiac Crux: Electrocardiogram Recognition and Site of Ablation\r | xii | ||
Anatomical Ablation Strategy for Noninducible Fascicular Tachycardia\r | xii | ||
Ablation of Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy\r | xii | ||
Pleomorphic Ventricular Tachycardias in Nonischemic Cardiomyopathy\r | xii | ||
Ventricular Tachycardia in a Patient with Biventricular Noncompaction\r | xiii | ||
3: Atrial Fibrillation and Flutter Editor: Edward P. Gerstenfeld \r | xiii | ||
Concomitant Isolation of the Pulmonary Veins and Posterior Wall Using a Box Lesion\rSet in a Patient with Persistent Atrial Fibrillation and Variant Pulmonary Venous\rAnatomy\r | xiii | ||
Acquired Pulmonary Vein Isolation in a Patient with Friedreich Ataxia\r | xiii | ||
Ablation of Atrial Fibrillation in a Patient with a Mechanical Mitral Valve\r | xiii | ||
Atrial Fibrillation Ablation Without Pulmonary Vein Isolation in a Patient with Fontan Palliation\r | xiv | ||
4: Troubleshooting Device Function Editor: Byron Lee | xiv | ||
A Case of Cough-induced Ventricular Tachycardia in a Patient with a Left Ventricular Assist Device\r | xiv | ||
An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve\r | xiv | ||
Implantable Cardioverter-Defibrillator Discharge in a Patient with Dilated Cardiomyopathy: What Is the Mechanism?\r | xiv | ||
Inappropriate Implantable Cardioverter-Defibrillator Shock from QRS Double Counting in the Setting of Hyperkalemia\r | xv | ||
A Confused Pacemaker\r | xv | ||
A Subclavian Arteriovenous Fistula Associated with Implantable Cardioverter-Defibrillator Implantation\r | xv | ||
5: Adult Congenital Cardiac Disease Editor: Ronn Tanel | xv | ||
Slow Pathway Modification in a Patient with D-Transposition of the Great Arteries and Atrial Switch Procedure\r | xv | ||
Intra-atrial Reentrant Tachycardia in Complete Transposition of the Great Arteries Without Femoral Venous Access\r | xv | ||
Ventricular Tachycardia Following Surgical Repair of Complex Congenital Heart Disease\r | xvi | ||
Ventricular Tachycardia in Congenital Pulmonary Stenosis\r | xvi | ||
6: Arrhythmias in Patients with Genetic Arrhythmia Syndromes Editor: Marwan M. Refaat | xvi | ||
Twin Atrioventricular Nodal Reentrant Tachycardia Associated with Heterotaxy\rSyndrome with Malaligned Atrioventricular Canal Defect and Atrioventricular\rDiscordance\r | xvi | ||
Arrhythmogenic Right Ventricular Cardiomyopathy Caused by a Novel Frameshift Mutation\r | xvi | ||
The Muscle-Bound Heart\r | xvii | ||
Catecholaminergic Polymorphic Ventricular Tachycardia\r | xvii | ||
Brugada Syndrome\r | xvii | ||
Iron Overload Leading to Torsades de Pointes in β-Thalassemia and Long QT Syndrome\r | xvii | ||
CARDIAC ELECTROPHYSIOLOGY CLINICS\r | xviii | ||
FORTHCOMING ISSUES | xviii | ||
June 2016 | xviii | ||
September 2016 | xviii | ||
December 2016 | xviii | ||
RECENT ISSUES | xviii | ||
December 2015 | xviii | ||
September 2015 | xviii | ||
June 2015 | xviii | ||
Foreword:Interpretation \rof Complex Arrhythmias: A Case-Based Approach | xix | ||
Preface:Challenging \rCases, Match Wits with the Masters | xxi | ||
Use of the Surface Electrocardiogram to Define the Nature of Challenging Arrhythmias | 1 | ||
Key points | 1 | ||
INTRODUCTION | 1 | ||
BE METHODICAL | 1 | ||
THE PROCESS IS MORE IMPORTANT THAN THE ANSWER | 1 | ||
USE A LADDER DIAGRAM | 2 | ||
TAKE THE TIME TO NURTURE YOUR PRACTICE | 2 | ||
DISORDERS OF IMPULSE CONDUCTION: WHAT IS THE MECHANISM AND LOCATION OF THE BLOCK? | 2 | ||
CONCEALED CONDUCTION | 5 | ||
Dual Atrioventricular Nodal Physiology | 8 | ||
FROM NARROW TO WIDE | 9 | ||
FROM WIDE TO NARROW | 13 | ||
REENTRY VERSUS PARASYSTOLE | 15 | ||
TRIGGERED ACTIVITY AND TORSADE DE POINTES | 20 | ||
SUPERNORMAL CONDUCTION | 22 | ||
SUMMARY | 22 | ||
REFERENCES | 24 | ||
Diagnostic and Prognostic Implications of Surface Recordings from Patients with Atrioventricular Block | 25 | ||
Key points | 25 | ||
ATRIOVENTRICULAR BLOCK | 25 | ||
First-Degree Atrioventricular Block | 25 | ||
Second-Degree Atrioventricular Block | 25 | ||
Third-degree (Complete) Atrioventricular Block | 27 | ||
Computer: Third-Degree Atrioventricular Block | 27 | ||
Computer: short QT interval | 27 | ||
SOME FOOLERS | 33 | ||
Section 1: SupraventricularTachycardiaEditor: Nitish Badhwar | A1 | ||
Antidromic Atrioventricular Reciprocating Tachycardia Using a Concealed Retrograde Conducting Left Lateral Accessory Pathway | 37 | ||
Key points | 37 | ||
CLINICAL PRESENTATION | 37 | ||
ELECTROPHYSIOLOGY STUDY | 37 | ||
QUESTION | 38 | ||
DISCUSSION | 38 | ||
CLINICAL COURSE | 38 | ||
SUMMARY | 43 | ||
REFERENCES | 43 | ||
Supraventricular Tachycardia in a Patient with an Interrupted Inferior Vena Cava | 45 | ||
Key points | 45 | ||
CLINICAL PRESENTATION | 45 | ||
CLINICAL QUESTION | 45 | ||
ELECTROPHYSIOLOGY STUDY | 45 | ||
QUESTION | 47 | ||
DISCUSSION | 47 | ||
CLINICAL COURSE | 49 | ||
SUMMARY | 49 | ||
REFERENCES | 49 | ||
Atrioventricular Nodal Reentrant Tachycardia with 2:1 Atrioventricular Block | 51 | ||
Key points | 51 | ||
CLINICAL PRESENTATION | 51 | ||
ELECTROPHYSIOLOGY STUDY | 51 | ||
QUESTION | 52 | ||
DISCUSSION | 52 | ||
SUMMARY | 55 | ||
REFERENCES | 55 | ||
Implantable Cardioverter-Defibrillator Shock Caused by Uncommon Variety of Nonreentrant Atrioventricular Nodal Tachycardia | 57 | ||
Key points | 57 | ||
CLINICAL PRESENTATION | 57 | ||
QUESTION | 57 | ||
DISCUSSION | 58 | ||
ELECTROPHYSIOLOGY STUDY AND ABLATION | 58 | ||
DISCUSSION | 59 | ||
SUMMARY | 60 | ||
REFERENCES | 60 | ||
Incessant Palpitations and Narrow Complex Tachycardia | 61 | ||
Key points | 61 | ||
CLINICAL PRESENTATION | 61 | ||
ELECTROPHYSIOLOGY STUDY | 61 | ||
Tachycardia Induction | 61 | ||
QUESTION | 61 | ||
MANEUVERS DURING TACHYCARDIA | 62 | ||
MAPPING AND ABLATION | 62 | ||
SUMMARY | 65 | ||
REFERENCES | 65 | ||
Narrow Complex Tachycardia | 67 | ||
Key points | 67 | ||
CLINICAL PRESENTATION | 67 | ||
QUESTION | 67 | ||
DISCUSSION | 67 | ||
REFERENCES | 69 | ||
Incessant Long R-P Tachycardia | 71 | ||
Key points | 71 | ||
CLINICAL PRESENTATION | 71 | ||
ELECTROPHYSIOLOGY STUDY | 71 | ||
QUESTION: WHERE IS THE SITE OF ORIGIN OF THE FOCAL ATRIAL TACHYCARDIA? | 72 | ||
DISCUSSION | 72 | ||
REFERENCES | 74 | ||
Section 2: Ventricular Tachycardia Editor: \rHenry H. Hsia | A3 | ||
Ventricular Tachycardias | 75 | ||
Key points | 75 | ||
REFERENCES | 77 | ||
Unusual Outflow Tract Ventricular Tachycardia | 79 | ||
Key points | 79 | ||
INTRODUCTION | 79 | ||
ANATOMY OF THE OUTFLOW TRACTS | 79 | ||
CASE PRESENTATION | 81 | ||
UNUSUAL OUTFLOW TRACT VENTRICULAR TACHYCARDIA | 84 | ||
GENERAL APPROACH TO OUTFLOW TRACT VENTRICULAR ARRHYTHMIAS | 86 | ||
REFERENCES | 87 | ||
Ventricular Arrhythmias from the Left Ventricular Summit | 89 | ||
Key points | 89 | ||
INTRODUCTION | 89 | ||
CASE 1 | 89 | ||
CASE 2 | 93 | ||
DISCUSSION | 94 | ||
Electrocardiographic Considerations | 96 | ||
Predictors of Success | 97 | ||
SUMMARY | 97 | ||
REFERENCES | 97 | ||
Catheter Ablation of Ventricular Arrhythmias Arising from the Left Ventricular Summit | 99 | ||
Key points | 99 | ||
INTRODUCTION | 99 | ||
THE CASE | 99 | ||
DISCUSSION | 101 | ||
Left Ventricular Summit Anatomy and Electrocardiography Correlates | 101 | ||
Approach to Catheter Ablation of Left Ventricular Summit Arrhythmias | 104 | ||
Outcomes of Catheter Ablation of Left Ventricular Summit Arrhythmias | 106 | ||
SUMMARY | 107 | ||
REFERENCES | 107 | ||
Ventricular Tachycardia Arising from Cardiac Crux | 109 | ||
Key points | 109 | ||
CLINICAL PRESENTATION | 109 | ||
SUMMARY | 112 | ||
REFERENCES | 113 | ||
Anatomical Ablation Strategy for Noninducible Fascicular Tachycardia | 115 | ||
Key points | 115 | ||
CLINICAL PRESENTATION | 115 | ||
Question 1: What Is the Most Likely Type of This Tachycardia? | 115 | ||
VENTRICULAR TACHYCARDIA INDUCTION | 115 | ||
Question 2: What Are These Wide QRS Complexes and What Is the Role of Atropine? | 115 | ||
Question 3: What Is the Ablation Strategy for This Case? | 117 | ||
Question 4: After it became inducible, where to ablate the Ventricular Tachycardia? | 117 | ||
DISCUSSION | 118 | ||
REFERENCES | 120 | ||
Ablation of Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy | 121 | ||
Key points | 121 | ||
CASE INTRODUCTION | 121 | ||
PREABLATION ASSESSMENT | 121 | ||
USING THE 12-LEAD AND QRS MORPHOLOGY TO DETERMINE EXIT OF VENTRICULAR TACHYCARDIA | 122 | ||
CASE REVISITED | 122 | ||
MECHANISM OF ISCHEMIC VENTRICULAR TACHYCARDIA | 122 | ||
MAPPING TECHNIQUES | 123 | ||
Activation Mapping | 124 | ||
Substrate Mapping | 124 | ||
Pace Mapping and Entrainment Mapping | 124 | ||
ENDOCARDIAL SUBSTRATE-BASED ABLATION | 127 | ||
CASE REVISITED | 127 | ||
SUMMARY | 127 | ||
REFERENCES | 129 | ||
Pleomorphic Ventricular Tachycardias in Nonischemic Cardiomyopathy | 131 | ||
Key points | 131 | ||
CASE PRESENTATION | 131 | ||
ELECTROPHYSIOLOGY STUDY AND CATHETER ABLATION | 131 | ||
DISCUSSION | 133 | ||
REFERENCES | 136 | ||
Ventricular Tachycardia in a Patient with Biventricular Noncompaction | 139 | ||
Key points | 139 | ||
INTRODUCTION | 139 | ||
ELECTROPHYSIOLOGY STUDY AND ABLATION | 139 | ||
QUESTION | 140 | ||
DISCUSSION | 140 | ||
SUMMARY | 144 | ||
REFERENCES | 144 | ||
Section 3: Atrial Fibrillationand FlutterEditor: Edward P. Gerstenfeld\r | A5 | ||
Concomitant Isolation of the Pulmonary Veins and Posterior Wall Using a Box Lesion Set in a Patient with Persistent Atrial ... | 145 | ||
Key points | 145 | ||
CLINICAL HISTORY | 145 | ||
CLINICAL QUESTION | 145 | ||
CLINICAL COURSE | 145 | ||
DISCUSSION | 146 | ||
REFERENCES | 148 | ||
Acquired Pulmonary Vein Isolation in a Patient with Friedreich Ataxia | 151 | ||
Key points | 151 | ||
CLINICAL PRESENTATION | 151 | ||
CLINICAL QUESTION | 151 | ||
CLINICAL COURSE | 151 | ||
DISCUSSION | 153 | ||
REFERENCES | 153 | ||
Ablation of Atrial Fibrillation in a Patient with a Mechanical Mitral Valve | 155 | ||
Key points | 155 | ||
CLINICAL PRESENTATION | 155 | ||
CLINICAL QUESTION | 155 | ||
CLINICAL COURSE | 155 | ||
DISCUSSION | 158 | ||
REFERENCES | 159 | ||
Section 4: Troubleshooting Device Function Editor: Byron \rLee | A7 | ||
Atrial Fibrillation Ablation Without Pulmonary Vein Isolation in a Patient with Fontan Palliation | 161 | ||
Key points | 161 | ||
CLINICAL HISTORY | 161 | ||
CLINICAL QUESTION | 161 | ||
CLINICAL COURSE | 161 | ||
DISCUSSION | 162 | ||
REFERENCES | 164 | ||
A Case of Cough-induced Ventricular Tachycardia in a Patient with a Left Ventricular Assist Device | 165 | ||
Key points | 165 | ||
CLINICAL PRESENTATION | 165 | ||
CLINICAL QUESTION | 166 | ||
CLINICAL COURSE | 166 | ||
DISCUSSION | 166 | ||
REFERENCES | 167 | ||
An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve | 169 | ||
Key points | 169 | ||
CLINICAL PRESENTATION | 169 | ||
CLINICAL QUESTIONS | 169 | ||
CLINICAL COURSE | 169 | ||
DISCUSSION | 171 | ||
REFERENCES | 171 | ||
Implantable Cardioverter-Defibrillator Discharge in a Patient with Dilated Cardiomyopathy | 173 | ||
Key points | 173 | ||
INTRODUCTION | 173 | ||
WHAT IS THE RHYTHM THAT LED TO THE PATIENT’S IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR SHOCK? | 173 | ||
Commentary | 173 | ||
SUMMARY | 176 | ||
REFERENCES | 176 | ||
Inappropriate Implantable Cardioverter-Defibrillator Shock from QRS Double Counting in the Setting of Hyperkalemia | 177 | ||
Key points | 177 | ||
CLINICAL PRESENTATION | 177 | ||
CLINICAL QUESTION | 177 | ||
CLINICAL COURSE | 177 | ||
DISCUSSION | 178 | ||
REFERENCES | 179 | ||
A Confused Pacemaker | 181 | ||
Key points | 181 | ||
CLINICAL PRESENTATION | 181 | ||
CLINICAL QUESTIONS | 181 | ||
DISCUSSION | 181 | ||
SUMMARY | 183 | ||
A Subclavian Arteriovenous Fistula Associated with Implantable Cardioverter-Defibrillator Implantation | 185 | ||
Key points | 185 | ||
CLINICAL PRESENTATION | 185 | ||
CLINICAL QUESTION | 186 | ||
CLINICAL COURSE | 186 | ||
DISCUSSION | 186 | ||
REFERENCES | 187 | ||
Section 5: Adult Congenital Cardiac Disease Editor: Ronn \rTanel | A9 | ||
Slow Pathway Modification in a Patient with D-Transposition of the Great Arteries and Atrial Switch Procedure | 191 | ||
Key points | 191 | ||
CLINICAL PRESENTATION | 191 | ||
CLINICAL COURSE | 191 | ||
CLINICAL QUESTION | 192 | ||
MANAGEMENT AND ABLATION | 192 | ||
DISCUSSION | 193 | ||
REFERENCES | 195 | ||
Intra-atrial Reentrant Tachycardia in Complete Transposition of the Great Arteries Without Femoral Venous Access | 197 | ||
Key points | 197 | ||
CLINICAL PRESENTATION | 197 | ||
CLINICAL QUESTION | 197 | ||
CLINICAL COURSE | 197 | ||
DISCUSSION | 198 | ||
REFERENCES | 200 | ||
Ventricular Tachycardia Following Surgical Repair of Complex Congenital Heart Disease | 201 | ||
Key points | 201 | ||
CLINICAL PRESENTATION | 201 | ||
ELECTROPHYSIOLOGY STUDY | 202 | ||
MANAGEMENT AND CLINICAL COURSE | 202 | ||
CLINICAL CONSIDERATIONS | 202 | ||
DISCUSSION | 202 | ||
REFERENCES | 204 | ||
Ventricular Tachycardia in Congenital Pulmonary Stenosis | 205 | ||
Key points | 205 | ||
CLINICAL PRESENTATION | 205 | ||
CLINICAL QUESTION | 205 | ||
CLINICAL COURSE | 205 | ||
DISCUSSION | 207 | ||
SUMMARY | 209 | ||
REFERENCES | 209 | ||
Section 6: Arrhythmias in Patients with Genetic Arrhythmia Syndromes Editor: Marwan M. Refaat\r | A11 | ||
Twin Atrioventricular Nodal Reentrant Tachycardia Associated with Heterotaxy Syndrome with Malaligned Atrioventricular Cana ... | 211 | ||
Key points | 211 | ||
PREPROCEDURE PREPARATION | 212 | ||
ELECTROPHYSIOLOGY STUDY AND ABLATION | 212 | ||
DISCUSSION | 215 | ||
REFERENCES | 216 | ||
Arrhythmogenic Right Ventricular Cardiomyopathy Caused by a Novel Frameshift Mutation | 217 | ||
Key points | 217 | ||
CASE PRESENTATION | 217 | ||
DISCUSSION | 217 | ||
GENETICS | 219 | ||
CLINICAL PRESENTATION | 220 | ||
RISK CLASSIFICATION AND MANAGEMENT | 220 | ||
SUMMARY | 221 | ||
REFERENCES | 221 | ||
The Muscle-Bound Heart | 223 | ||
Key points | 223 | ||
INTRODUCTION | 223 | ||
Case Presentation | 223 | ||
BACKGROUND | 223 | ||
SYMPTOMS AND DIAGNOSIS | 224 | ||
THE GENETICS BEHIND HYPERTROPHIC CARDIOMYOPATHY | 225 | ||
HYPERTROPHIC CARDIOMYOPATHY COMPLICATIONS | 226 | ||
THERAPY AND PREVENTION | 227 | ||
SUMMARY | 228 | ||
CASE PRESENTATION: FOLLOW-UP | 229 | ||
REFERENCES | 229 | ||
Catecholaminergic Polymorphic Ventricular Tachycardia | 233 | ||
Key points | 233 | ||
CASE PRESENTATION | 233 | ||
DISCUSSION | 233 | ||
CLINICAL CHARACTERISTICS AND DIAGNOSIS | 234 | ||
GENETICS OF CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA | 234 | ||
MANAGEMENT | 236 | ||
SUMMARY | 236 | ||
REFERENCES | 236 | ||
Brugada Syndrome | 239 | ||
Key points | 239 | ||
CASE PRESENTATION | 239 | ||
DISCUSSION | 239 | ||
Repolarization Versus Depolarization Theory | 240 | ||
Genetic Component | 241 | ||
Sodium channels | 241 | ||
Calcium channels | 241 | ||
Potassium channels | 243 | ||
Clinical Presentation | 243 | ||
Risk Stratification | 243 | ||
MANAGEMENT | 244 | ||
CASE PRESENTATION: FOLLOW-UP | 244 | ||
SUMMARY | 244 | ||
REFERENCES | 244 | ||
Iron Overload Leading to Torsades de Pointes in β-Thalassemia and Long QT Syndrome | 247 | ||
Key points | 247 | ||
INTRODUCTION | 247 | ||
CASE | 248 | ||
GENETIC TESTING | 248 | ||
LONG QT SYNDROME | 249 | ||
Clinical Presentation and Diagnosis | 249 | ||
Molecular Genetics | 252 | ||
Risk Stratification | 252 | ||
Therapy | 253 | ||
CASE PRESENTATION DISCUSSION | 253 | ||
SUMMARY | 254 | ||
REFERENCES | 254 |