BOOK
Controversies in Electrophysiology, An Issue of the Cardiac Electrophysiology Clinics, E-Book
(2015)
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Book Details
Abstract
Controversies in Cardiac Electrophysiology are examined in this issue of Cardiac Electrophysiology Clinics. Difficult cases are presented and esteemed leaders in the field debate the pros and cons of various forms of management and treatment.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Controversies in Electrophysiology\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITORS | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Controversies in Electrophysiology\r | vii | ||
| Preface: The Value of a Healthy Debate\r | vii | ||
| Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-Whit ..\r | vii | ||
| Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-Whit ...\r | vii | ||
| Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?\r | vii | ||
| Patients with Minimal Atrial Fibrillation Events Should Not Undergo Concomitant Atrial Ablation During Open Heart Procedures\r | viii | ||
| Left Atrial Appendage Closure Is Preferred to Chronic Warfarin Therapy: The Pro Perspective\r | viii | ||
| Left Atrial Appendage Closure Device in Atrial Fibrillation\r | viii | ||
| To Extract or Retain a Sterile, Nonfunctional Lead: The Case for Extraction\r | viii | ||
| Extraction of Sterile Leads Is the Preferred Approach Rather than Implanting a New Lead: The Con Perspective\r | viii | ||
| Cardiac Resynchronization Therapy Is Appropriate for All Patients Requiring Chronic Right Ventricular Pacing: The Pro Persp ..\r | ix | ||
| Cardiac Resynchronization Therapy Is Appropriate for All Patients Requiring Chronic Right Ventricular Pacing: The CON Persp ..\r | ix | ||
| Biventricular Pacemaker/Defibrillators Versus Biventricular Pacemakers in Patients with Non-ischemic Cardiomyopathy\r | ix | ||
| Patients with Nonischemic Cardiomyopathy Requiring Cardiac Resynchronization Therapy Should Also Undergo Implantation of a ...\r | ix | ||
| Device Therapy for Acute Systolic Heart Failure and Atrial Fibrillation\r | x | ||
| Device Therapy in the Setting of Long QT Syndrome\r | x | ||
| Generator Exchange in a Primary Prevention Cardiac Resynchronziation Responder: Do You Reimplant a Defibrillator?\r | x | ||
| Management of Pace-Terminated Ventricular Arrhythmias\r | x | ||
| Management of Device-detected Atrial High-rate Episodes\r | xi | ||
| Approach to Ablation of Unmappable Ventricular Arrhythmias\r | xi | ||
| The Role of Defibrillation Testing\r | xi | ||
| Ethical Considerations for Turning off Pacemakers and Defibrillators\r | xi | ||
| CARDIAC ELECTROPHYSIOLOGY CLINICS\r | xii | ||
| FORTHCOMING ISSUES | xii | ||
| December 2015 | xii | ||
| March 2016 | xii | ||
| June 2016 | xii | ||
| RECENT ISSUES | xii | ||
| June 2015 | xii | ||
| March 2015 | xii | ||
| December 2014 | xii | ||
| Foreword\r | xiii | ||
| ARRHYTHMIAS: IS LESS ALWAYS MORE? | xiii | ||
| CARDIAC IMPLANTABLE ELECTRONIC DEVICES: WHO GETS WHAT, WHEN, AND FOR HOW LONG? | xiii | ||
| Preface\r | xv | ||
| Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-Whit ... | 371 | ||
| Key points | 371 | ||
| THE NATURAL HISTORY OF WOLFF-PARKINSON-WHITE SYNDROME IN THE ERA OF CATHETER ABLATION: AN EPOCHAL CHANGE | 371 | ||
| WHY IS IT NECESSARY TO PERFORM ELECTROPHYSIOLOGIC TESTING AND CATHETER ABLATION IN THE WOLFF-PARKINSON-WHITE POPULATION? | 372 | ||
| CATHETER ABLATION IN SELECTED ASYMPTOMATIC PATIENTS WITH WOLFF-PARKINSON-WHITE | 373 | ||
| ELECTROPHYSIOLOGIC TESTING AND RISK STRATIFICATION IN THE ASYMPTOMATIC WOLFF-PARKINSON-WHITE POPULATION | 374 | ||
| PREDICTORS OF THE RISK OF SUDDEN DEATH IN THE ASYMPTOMATIC WOLFF-PARKINSON-WHITE POPULATION | 374 | ||
| THE IMPACT OF RADIOFREQUENCY ABLATION ON THE NATURAL HISTORY OF WOLFF-PARKINSON-WHITE SYNDROME | 375 | ||
| SUMMARY | 375 | ||
| REFERENCES | 375 | ||
| Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-Whit ... | 377 | ||
| Key points | 377 | ||
| INTRODUCTION | 378 | ||
| TRADITIONAL KNOWLEDGE | 378 | ||
| A Reevaluation of Data in the Modern Catheter Ablation Era: Asymptomatic Patients | 379 | ||
| AGE OF PRESENTATION | 380 | ||
| THE IMPACT OF RISK FACTORS IN ASYMPTOMATIC PATIENTS | 380 | ||
| The Impact of Catheter Ablation | 380 | ||
| SUMMARY | 381 | ||
| REFERENCES | 381 | ||
| Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry? | 385 | ||
| Key points | 385 | ||
| INTRODUCTION | 385 | ||
| RADIOFREQUENCY ABLATION/CRYOBALLOON ABLATION: A CURE FOR ATRIAL FIBRILLATION? | 386 | ||
| IS ABLATION SUPERIOR TO ANTIARRHYTHMIC DRUG THERAPY FOR SYMPTOMS? | 386 | ||
| IS ABLATION SAFER THAN DRUG THERAPY? | 388 | ||
| THE RISKS OF ANTIARRHYTHMIC DRUG THERAPY | 388 | ||
| DOES ABLATION OFFER ADVANTAGES COMPARED WITH DRUG THERAPY FOR STROKE PREVENTION? | 390 | ||
| DOES EARLY RADIOFREQUENCY ABLATION/CRYOBALLOON ABLATION PREVENT PROGRESSION TO PERMANENT ATRIAL FIBRILLATION? | 390 | ||
| TREAT THE UNDERLYING CAUSE | 390 | ||
| SUMMARY | 391 | ||
| REFERENCES | 391 | ||
| Patients with Minimal Atrial Fibrillation Events Should Not Undergo Concomitant Atrial Ablation During Open Heart Procedures | 395 | ||
| Key points | 395 | ||
| INTRODUCTION | 395 | ||
| PATIENT SELECTION | 396 | ||
| EVOLUTION OF SURGICAL ATRIAL FIBRILLATION ABLATION | 397 | ||
| OUTCOMES IN COMPARATIVE STUDIES | 397 | ||
| ADVANTAGES AND DISADVANTAGES | 398 | ||
| HOW DOES THE INFORMATION APPLY TO OUR PATIENT? | 398 | ||
| SUMMARY | 400 | ||
| REFERENCES | 400 | ||
| Left Atrial Appendage Closure Is Preferred to Chronic Warfarin Therapy | 403 | ||
| Key points | 403 | ||
| INTRODUCTION | 404 | ||
| CASE | 404 | ||
| THROMBOEMBOLIC RISK | 404 | ||
| BLEEDING RISKS | 404 | ||
| TREATMENT PLAN | 405 | ||
| SUMMARY | 410 | ||
| REFERENCES | 410 | ||
| Left Atrial Appendage Closure Device in Atrial Fibrillation | 415 | ||
| Key points | 415 | ||
| SAFETY | 415 | ||
| EFFICACY | 416 | ||
| COSTS | 417 | ||
| DISCUSSION | 417 | ||
| SUMMARY | 417 | ||
| REFERENCES | 417 | ||
| To Extract or Retain a Sterile, Nonfunctional Lead | 419 | ||
| Key points | 419 | ||
| INTRODUCTION | 419 | ||
| REASONS WHY EXTRACTING THE DEFECTIVE LEAD IS SUPERIOR IN THIS PATIENT | 420 | ||
| SUMMARY | 423 | ||
| REFERENCES | 424 | ||
| Extraction of Sterile Leads Is the Preferred Approach Rather than Implanting a New Lead | 427 | ||
| Key points | 427 | ||
| INTRODUCTION | 427 | ||
| COMPLICATIONS IN LEAD EXTRACTION | 427 | ||
| WHAT HAPPENS WITH ABANDONED LEADS? | 428 | ||
| WHEN AND WHY TO PERFORM LEAD EXTRACTION | 430 | ||
| SUMMARY | 431 | ||
| REFERENCES | 431 | ||
| Cardiac Resynchronization Therapy Is Appropriate for All Patients Requiring Chronic Right Ventricular Pacing | 433 | ||
| Key points | 433 | ||
| PACING-INDUCED CARDIOMYOPATHY: NATURAL HISTORY AND PRESENTATION | 435 | ||
| Reversibility | 435 | ||
| Incidence | 436 | ||
| Risk Factors | 436 | ||
| PERCENTAGE OF PACING | 437 | ||
| RANDOMIZED TRIALS OF BIVENTRICULAR PACING VERSUS RIGHT VENTRICULAR PACING | 439 | ||
| INDICATIONS FOR BIVENTRICULAR PACING IRRESPECTIVE OF QRS DURATION | 439 | ||
| Left Ventricular Ejection Fraction of Greater Than 35% | 439 | ||
| IMPACT OF LEFT VENTRICULAR DYSSYNCHRONY | 440 | ||
| RISKS VERSUS BENEFITS OF BIVENTRICULAR PACING | 440 | ||
| ALTERNATIVE PACING SITES | 441 | ||
| SUMMARY | 441 | ||
| REFERENCES | 441 | ||
| Cardiac Resynchronization Therapy Is Appropriate for All Patients Requiring Chronic Right Ventricular Pacing | 445 | ||
| Key points | 445 | ||
| IS CARDIAC RESYNCHRONIZATION THERAPY APPROPRIATE FOR ALL PATIENTS? | 446 | ||
| Mortality | 446 | ||
| Management of Symptoms | 447 | ||
| Prevention of Disease | 449 | ||
| Other Considerations Regarding Cardiac Resynchronization Therapy: Complications and Nonresponders | 451 | ||
| SUMMARY AND CLINICAL RECOMMENDATIONS | 452 | ||
| REFERENCES | 452 | ||
| Biventricular Pacemaker/Defibrillators Versus Biventricular Pacemakers in Patients with Non-ischemic Cardiomyopathy | 455 | ||
| Key points | 455 | ||
| INTRODUCTION | 455 | ||
| CONTROVERSY OVER UBIQUITOUS USE OF BIVENTRICULAR PACEMAKER/DEFIBRILLATOR DEVICES | 456 | ||
| RANDOMIZED TRIALS OF BIVENTRICULAR PACEMAKERS AND BIVENTRICULAR PACEMAKER/DEFIBRILLATORS | 456 | ||
| SUMMARY | 458 | ||
| REFERENCES | 458 | ||
| Patients with Nonischemic Cardiomyopathy Requiring Cardiac Resynchronization Therapy Should Also Undergo Implantation of a ... | 461 | ||
| Key points | 461 | ||
| INTRODUCTION | 461 | ||
| Age | 462 | ||
| Gender | 462 | ||
| QRS Duration | 462 | ||
| Response to Medical Therapy | 462 | ||
| Randomized, Controlled Trials | 462 | ||
| The Additional Risk of Defibrillation | 463 | ||
| ETIOLOGY OF HEART FAILURE: THE ROLE OF CARDIOVASCULAR MAGNETIC RESONANCE | 464 | ||
| SUMMARY | 466 | ||
| REFERENCES | 467 | ||
| Device Therapy for Acute Systolic Heart Failure and Atrial Fibrillation | 469 | ||
| Key points | 469 | ||
| INTRODUCTION | 470 | ||
| PACEMAKER VERSUS INTERNAL CARDIAC DEFIBRILLATOR | 470 | ||
| VVI VERSUS CARDIAC RESYNCHRONIZATION THERAPY | 472 | ||
| REFERENCES | 475 | ||
| Device Therapy in the Setting of Long QT Syndrome | 479 | ||
| Key points | 479 | ||
| LONG QT SYNDROME | 480 | ||
| Risk Factors for Cardiac Events in Long QT Syndrome | 480 | ||
| ANTIADRENERGIC THERAPIES | 481 | ||
| β-Blockers | 481 | ||
| Left Cardiac Sympathetic Denervation | 481 | ||
| CARDIAC PACING | 481 | ||
| Generator Exchange in a Primary Prevention Cardiac Resynchronziation Responder | 487 | ||
| Key points | 487 | ||
| INTRODUCTION | 487 | ||
| BENEFITS OF CARDIAC RESYNCHRONIZATION THERAPY | 488 | ||
| Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapies in Cardiac Resynchronization | 489 | ||
| Prior Ventricular Arrhythmias Are Predictive of Future Ventricular Arrhythmias | 489 | ||
| Cardiac Resynchronization Therapy Responders Have a Lower Incidence of Ventricular Arrhythmias | 489 | ||
| Left Ventricular Ejection Fraction Predicts Ventricular Arrhythmias | 489 | ||
| Cardiac Resynchronization Therapy Causing Ventricular Arrhythmias | 489 | ||
| INAPPROPRIATE DEFIBRILLATOR THERAPIES | 491 | ||
| DIFFERENCES IN BATTERY LONGEVITY | 491 | ||
| Pacemaker Battery Longevity | 492 | ||
| Implantable Cardioverter-Defibrillator Battery Longevity | 492 | ||
| Cardiac Resynchronization Battery Longevity | 492 | ||
| Device Malfunction | 492 | ||
| COST-EFFECTIVENESS OF CARDIAC RESYNCHRONIZATION WITH A PACEMAKER VERSUS CARDIAC RESYNCHRONIZATION WITH A PACEMAKER-DEFIBRIL ... | 492 | ||
| TECHNICAL CHALLENGES DURING GENERATOR EXCHANGE | 493 | ||
| PATIENT EXPERIENCE | 493 | ||
| RECOMMENDATIONS | 493 | ||
| SUMMARY | 494 | ||
| REFERENCES | 494 | ||
| Management of Pace-Terminated Ventricular Arrhythmias | 497 | ||
| Key points | 497 | ||
| INTRODUCTION | 497 | ||
| MECHANICS OF ANTITACHYCARDIA PACING | 498 | ||
| EFFICACY AND EFFECTIVENESS OF ANTITACHYCARDIA PACING | 499 | ||
| OUTCOMES AFTER APPROPRIATE ANTITACHYCARDIA PACING | 503 | ||
| MEDICATIONS FOR TREATMENT AND PREVENTION OF VENTRICULAR TACHYCARDIA | 504 | ||
| ABLATION FOR THE TREATMENT AND PREVENTION OF VENTRICULAR TACHYCARDIA | 505 | ||
| RATIONALE FOR CONSERVATIVE MANAGEMENT AFTER ANTITACHYCARDIA PACING | 509 | ||
| SUMMARY | 509 | ||
| REFERENCES | 509 | ||
| Management of Device-detected Atrial High-rate Episodes | 515 | ||
| Key points | 515 | ||
| THE CLINICAL PROBLEM | 515 | ||
| DEVICE-DETECTED ATRIAL HIGH-RATE EPISODES CORRELATE WITH TRUE ATRIAL TACHYARRHYTHMIAS | 516 | ||
| ASSOCIATION BETWEEN DEVICE-DETECTED ATRIAL HIGH-RATE EPISODES AND STROKE | 517 | ||
| TEMPORAL ASSOCIATION OF ATRIAL HIGH-RATE EPISODE AND STROKE | 519 | ||
| REMOTE MONITORING FOR ATRIAL FIBRILLATION IN PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES LEADS TO MORE RAPID TREATMENT | 519 | ||
| TREATMENT OF DEVICE-DETECTED ATRIAL HIGH-RATE EPISODES | 520 | ||
| AREAS OF UNCERTAINTY | 522 | ||
| SUMMARY AND RECOMMENDATIONS | 522 | ||
| REFERENCES | 523 | ||
| Approach to Ablation of Unmappable Ventricular Arrhythmias | 527 | ||
| Key points | 527 | ||
| INTRODUCTION | 527 | ||
| MECHANISM OF SCAR-RELATED VENTRICULAR TACHYCARDIA AND CONVENTIONAL MAPPING | 527 | ||
| SUBSTRATE MAPPING | 528 | ||
| TECHNIQUES AND TARGETS FOR SUBSTRATE-GUIDED ABLATION | 528 | ||
| Linear Ablation and Pace Mapping | 528 | ||
| Conducting Channels | 529 | ||
| Late Potentials and Local Abnormal Ventricular Activities | 531 | ||
| Scar Dechanneling | 532 | ||
| SUBSTRATE ABLATION FOR MAPPABLE AND UNMAPPABLE VENTRICULAR ARRHYTHMIAS | 533 | ||
| CARDIAC IMAGING FOR SUBSTRATE CHARACTERIZATION | 533 | ||
| REFERENCES | 535 | ||
| The Role of Defibrillation Testing | 539 | ||
| Key points | 539 | ||
| BACKGROUND | 539 | ||
| SHOULD WE CONTINUE TO CONDUCT DEFIBRILLATION TESTING? | 540 | ||
| The Potential Advantages of Defibrillation Testing | 540 | ||
| The electrical integrity of all system components | 540 | ||
| Proper sensing and detection of VF | 540 | ||
| The Predictors of High Defibrillation Testing, Interventions to Improve Safety Margin | 541 | ||
| Identify patients with an elevated defibrillation threshold | 541 | ||
| Interventions to improve defibrillation safety margin | 541 | ||
| The Potential Risks of Defibrillation Testing | 541 | ||
| The risk of the procedure | 541 | ||
| VF induction in the EP laboratory does not simulate VF in real life | 541 | ||
| Achieving an adequate defibrillation safety margin does not predict future shock efficacy | 541 | ||
| EFFECT OF DEFIBRILLATION TESTING ON OUTCOMES: RESULTS OF OBSERVATIONAL AND RANDOMIZED TRIALS | 542 | ||
| AREAS OF UNCERTAINTY | 543 | ||
| REFERENCES | 545 | ||
| Ethical Considerations for Turning off Pacemakers and Defibrillators | 547 | ||
| Key points | 547 | ||
| INTRODUCTION | 547 | ||
| PHYSICIAN ATTITUDES AND CURRENT PRACTICE | 547 | ||
| COMMON CONCERNS ABOUT DEACTIVATING CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 548 | ||
| THE MORAL STATUS OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 549 | ||
| CLINICAL ETHICS CONSIDERATIONS | 550 | ||
| PRACTICAL RECOMMENDATIONS | 552 | ||
| SPECIAL POPULATIONS | 553 | ||
| Elderly Adults | 553 | ||
| Children | 553 | ||
| Religious Considerations | 553 | ||
| SUMMARY | 553 | ||
| REFERENCES | 553 |