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Interpretation of Complex Arrhythmias: A Case-Based Approach, An Issue of Cardiac Electrophysiology Clinics, E-Book

Interpretation of Complex Arrhythmias: A Case-Based Approach, An Issue of Cardiac Electrophysiology Clinics, E-Book

Melvin Scheinman

(2016)

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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