BOOK
Clinical Arrhythmology and Electrophysiology E-Book
Ziad Issa | John M. Miller | Douglas P. Zipes
(2018)
Additional Information
Book Details
Abstract
Part of the highly regarded Braunwald’s family of cardiology references, Clinical Arrhythmology and Electrophysiology, 3rd Edition, offers complete coverage of the latest diagnosis and management options for patients with arrhythmias. Expanded clinical content and clear illustrations keep you fully abreast of current technologies, new syndromes and diagnostic procedures, new information on molecular genetics, advances in ablation, and much more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC1 | ||
| Clinical Arrhythmology and Electrophysiology | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Foreword | vii | ||
| Preface | viii | ||
| Table Of Contents | ix | ||
| Braunwald’s Heart Disease Family Of Books | xi | ||
| Braunwald’s Heart Disease Companions | xi | ||
| Braunwald’s Heart Disease Review and Assessment | xii | ||
| Braunwald’s Heart Disease Imaging Companions | xii | ||
| 1 Molecular Mechanisms of Cardiac Electrical Activity | 1 | ||
| Outline | 1 | ||
| Ionic Equilibrium | 1 | ||
| Transmembrane Potentials | 1 | ||
| Cardiac Action Potential | 2 | ||
| Fast Response Action Potential | 3 | ||
| Phase 4: The Resting Membrane Potential | 3 | ||
| Phase 0: The Upstroke—Rapid Depolarization | 6 | ||
| Phase 1: Early Repolarization | 6 | ||
| Phase 2: The Plateau | 6 | ||
| Phase 3: Final Rapid Repolarization | 7 | ||
| Phase 4: Restoration of Resting Membrane Potential | 7 | ||
| Regional Heterogeneity of the Action Potential | 7 | ||
| Atrioventricular Heterogeneity of the Action Potential | 7 | ||
| Ventricular Regional Heterogeneity of the Action Potential | 7 | ||
| Slow Response Action Potential | 8 | ||
| Phase 4: Diastolic Depolarization | 8 | ||
| Phase 0: The Upstroke—Slow Depolarization | 8 | ||
| Excitability | 8 | ||
| Refractoriness | 9 | ||
| Propagation | 10 | ||
| Intracellular Propagation | 10 | ||
| Intercellular Propagation | 10 | ||
| Anisotropic Conduction | 11 | ||
| Source-Sink Relationship | 11 | ||
| Safety Factor for Conduction | 12 | ||
| Excitation-Contraction Coupling | 12 | ||
| References | 13 | ||
| 2 Cardiac Ion Channels | 15 | ||
| Outline | 15 | ||
| Sodium Channels | 16 | ||
| Structure and Physiology | 16 | ||
| Function | 18 | ||
| Regulation | 18 | ||
| Pharmacology | 18 | ||
| Inherited Channelopathies | 19 | ||
| Long QT Syndrome | 19 | ||
| Brugada Syndrome | 21 | ||
| Early Repolarization Syndrome | 21 | ||
| Familial Progressive Cardiac Conduction Disease | 21 | ||
| Congenital Sick Sinus Syndrome | 22 | ||
| Familial Atrial Fibrillation | 22 | ||
| Dilated Cardiomyopathy | 22 | ||
| Sudden Infant Death Syndrome | 22 | ||
| Overlap Syndrome | 22 | ||
| Acquired Diseases | 22 | ||
| Potassium Channels | 22 | ||
| Structure and Physiology | 22 | ||
| 3 Electrophysiological Mechanisms of Cardiac Arrhythmias | 51 | ||
| Outline | 51 | ||
| Automaticity | 51 | ||
| Enhanced Normal Automaticity | 51 | ||
| Pacemaker Mechanisms | 51 | ||
| IK-decay theory. | 51 | ||
| Membrane clock. | 52 | ||
| Calcium clock. | 52 | ||
| Hierarchy of Pacemaker Function | 53 | ||
| Subsidiary Pacemakers | 54 | ||
| Subsidiary atrial pacemakers. | 54 | ||
| Subsidiary AV junctional pacemakers. | 54 | ||
| Subsidiary ventricular pacemakers. | 54 | ||
| Regulation of Pacemaker Function | 54 | ||
| Parasympathetic activity. | 54 | ||
| Sympathetic activity. | 54 | ||
| Other influences. | 55 | ||
| Abnormal Automaticity | 55 | ||
| Overdrive Suppression of Automatic Rhythms | 56 | ||
| Arrhythmias Caused by Automaticity | 57 | ||
| Inappropriate Sinus Node Discharge | 57 | ||
| Escape Ectopic Automatic Rhythms | 57 | ||
| Accelerated Ectopic Automatic Rhythms | 57 | ||
| Parasystole | 57 | ||
| Arrhythmias Caused by Abnormal Automaticity | 58 | ||
| Triggered Activity | 58 | ||
| Delayed Afterdepolarizations and Triggered Activity | 58 | ||
| Ionic Basis of Delayed Afterdepolarizations | 58 | ||
| Role of Delayed Afterdepolarizations in Arrhythmogenesis | 59 | ||
| Digitalis. | 60 | ||
| Catecholamines. | 60 | ||
| Myocardial ischemia. | 60 | ||
| Genetic mutations. | 60 | ||
| Drugs. | 60 | ||
| Properties of Delayed Afterdepolarizations | 60 | ||
| EADs and triggered activity. | 60 | ||
| Ionic Basis of Early Afterdepolarizations | 60 | ||
| Role of Early Afterdepolarizations in Arrhythmogenesis | 62 | ||
| Drugs. | 62 | ||
| Long QT syndromes. | 62 | ||
| Structural heart disease. | 63 | ||
| Properties of Early Afterdepolarizations | 63 | ||
| Reentry | 63 | ||
| Basic Principles of Reentry | 63 | ||
| Requisites of Reentry | 63 | ||
| Substrate | 63 | ||
| Central Area of Block | 64 | ||
| Unidirectional Conduction Block | 64 | ||
| Area of Slow Conduction | 64 | ||
| Critical Tissue Mass | 65 | ||
| Initiating Trigger | 65 | ||
| Types of Reentrant Circuits | 65 | ||
| Anatomical Reentry | 65 | ||
| Functional Reentry | 65 | ||
| Leading circle concept. | 65 | ||
| Anisotropic reentry. | 66 | ||
| Figure-of-8 reentry. | 66 | ||
| Reflection. | 67 | ||
| Phase 2 reentry. | 67 | ||
| Spiral wave (rotor) activity. | 67 | ||
| Excitable Gaps in Reentrant Circuits | 68 | ||
| Wavelength Concept | 68 | ||
| Excitable Gaps | 69 | ||
| Resetting Reentrant Tachycardias | 69 | ||
| Basic Principles of Resetting | 69 | ||
| Resetting zone and excitable gap. | 70 | ||
| Return cycle. | 71 | ||
| Orthodromic and antidromic resetting | 71 | ||
| Orthodromic resetting. | 71 | ||
| Antidromic resetting. | 71 | ||
| Resetting Response Curves | 71 | ||
| Flat response curves in reentrant rhythms. | 72 | ||
| Increasing response curves in reentrant rhythms. | 72 | ||
| Mixed response curves in reentrant rhythms. | 72 | ||
| Decreasing response curves in reentrant rhythms. | 72 | ||
| Resetting With Fusion | 72 | ||
| Resetting of Tachycardias With Diverse Mechanisms | 72 | ||
| Site specificity of resetting. | 72 | ||
| Resetting response curves. | 72 | ||
| Resetting with fusion. | 72 | ||
| Entrainment of Reentrant Tachycardias | 73 | ||
| Basic Principles of Entrainment | 73 | ||
| Entrainment Response Curves | 73 | ||
| Relationship of Pacing Site and Cycle Length to Entrainment | 74 | ||
| Diagnostic Criteria of Entrainment | 74 | ||
| Mechanism of Slow Conduction in the Reentrant Circuit | 74 | ||
| Reduced Membrane Excitability | 74 | ||
| Reduced Cellular Coupling | 75 | ||
| Tissue Structure and Geometry | 76 | ||
| Anisotropy and Reentry | 76 | ||
| Cellular Coupling: Gap Junctional Organization | 77 | ||
| Myocyte Packing and Tissue Geometry | 77 | ||
| Uniform Versus Nonuniform Anisotropy | 77 | ||
| Mechanism of Unidirectional Block in the Reentrant Circuit | 78 | ||
| Inhomogeneity of Membrane Excitability and Refractoriness | 78 | ||
| Anisotropy and Unidirectional Block | 78 | ||
| Discontinuities in Tissue Structure and Geometry | 79 | ||
| Videos | 79 | ||
| References | 79 | ||
| 4 Electrophysiological Testing | 81 | ||
| Outline | 81 | ||
| Indications | 81 | ||
| Periprocedural Management | 81 | ||
| Preprocedure Evaluation | 81 | ||
| Consent | 81 | ||
| Procedural Sedation | 82 | ||
| Types of Anesthesia | 82 | ||
| Local anesthesia. | 82 | ||
| Conscious sedation. | 82 | ||
| Deep sedation. | 82 | ||
| General anesthesia. | 82 | ||
| Jet Ventilation | 83 | ||
| Electrophysiological Effects of Anesthetic Medications | 83 | ||
| Oxygen and Carbon Dioxide Monitoring | 83 | ||
| Blood Pressure Monitoring | 83 | ||
| Defibrillator Pads | 83 | ||
| Urinary Problems | 83 | ||
| Antiarrhythmic Drugs | 83 | ||
| Anticoagulation | 83 | ||
| Catheterization Techniques | 84 | ||
| Electrode Catheters | 84 | ||
| Catheter Positioning | 84 | ||
| Transcaval Approach | 85 | ||
| Right Atrial Catheter | 85 | ||
| Right Ventricular Catheter | 85 | ||
| His Bundle Catheter | 86 | ||
| Coronary Sinus Catheter | 86 | ||
| Transaortic Approach | 87 | ||
| Transseptal Approach | 87 | ||
| Anatomical Considerations | 87 | ||
| Anticoagulation | 88 | ||
| Fluoroscopy-Guided Transseptal Catheterization | 88 | ||
| Engaging the fossa ovalis. | 89 | ||
| Confirming position at the fossa ovalis. | 90 | ||
| Puncturing the septum. | 90 | ||
| Confirming position in the LA. | 90 | ||
| Second transseptal puncture. | 91 | ||
| Intracardiac Echocardiography–Guided Transseptal Catheterization | 91 | ||
| Alternative Methods for Difficult Transseptal Catheterization | 93 | ||
| SafeSept Transseptal Guidewire. | 93 | ||
| RF-powered needle. | 93 | ||
| Transseptal Puncture in the Presence of Atrial Septal Defect Repair | 94 | ||
| Complications of Atrial Transseptal Puncture | 94 | ||
| Cardiac perforation. | 94 | ||
| Aortic puncture. | 94 | ||
| Systemic embolism. | 95 | ||
| Interatrial shunt. | 95 | ||
| Subxiphoid Epicardial Approach | 95 | ||
| Anatomical Considerations | 95 | ||
| Technical Considerations | 96 | ||
| Advancing the needle. | 96 | ||
| Puncturing the parietal pericardium. | 96 | ||
| Confirming intrapericardial position of the needle. | 96 | ||
| EpiAccess Smart Needle. | 98 | ||
| “Needle-in-needle” technique. | 98 | ||
| Anterior versus posterior approach for epicardial access. | 98 | ||
| Pericardial adhesions. | 100 | ||
| Complications of Pericardial Access | 100 | ||
| Pericardial bleeding. | 100 | ||
| Intraabdominal bleeding. | 101 | ||
| Pneumopericardium. | 101 | ||
| Signal Acquisition and Processing | 101 | ||
| Analog Versus Digital Recordings | 101 | ||
| Signal Amplification | 101 | ||
| Signal Clipping | 101 | ||
| Signal Filtering | 102 | ||
| High-Pass Filtering | 102 | ||
| Low-Pass Filtering | 103 | ||
| Band-Pass Filtering | 103 | ||
| Notch Filtering | 103 | ||
| Intracardiac Electrograms | 103 | ||
| Unipolar Recordings | 103 | ||
| Spatial Resolution | 103 | ||
| Temporal Resolution | 103 | ||
| Directionality | 103 | ||
| Bipolar Recordings | 104 | ||
| Spatial Resolution | 104 | ||
| Temporal Resolution | 105 | ||
| Directionality | 105 | ||
| Timing of Local Events | 105 | ||
| Choices of Surface and Intracardiac Signals | 105 | ||
| Right Atrial Electrogram | 105 | ||
| His Bundle Electrogram | 106 | ||
| Coronary Sinus Electrogram | 107 | ||
| Right Ventricular Electrogram | 107 | ||
| Baseline Intervals | 107 | ||
| P Wave–Atrial Interval | 107 | ||
| Interatrial Conduction | 108 | ||
| Atrial–His Bundle Interval | 109 | ||
| His Potential | 109 | ||
| His Bundle–Ventricular Interval | 109 | ||
| Programmed Electrical Stimulation | 109 | ||
| Stimulators | 109 | ||
| Pacing Techniques | 109 | ||
| Pacing Output | 109 | ||
| Cycle Length | 109 | ||
| Incremental Versus Decremental | 109 | ||
| Overdrive Pacing (“Straight Pacing”) | 109 | ||
| Burst Pacing | 109 | ||
| Stepwise Rate-Incremental Pacing | 110 | ||
| Ramp Pacing | 110 | ||
| Extrastimulus Technique | 110 | ||
| S1-S1 drive stimuli. | 110 | ||
| S1, S2, S3, …, SN. | 110 | ||
| Ultrarapid Train Stimulation | 110 | ||
| Conduction and Refractoriness | 110 | ||
| Conduction | 110 | ||
| Refractoriness | 110 | ||
| Measurements of Refractory Periods | 111 | ||
| Effective refractory period. | 111 | ||
| Relative refractory period. | 111 | ||
| Functional refractory period. | 111 | ||
| Cycle Lengths Responsiveness of Refractory Periods | 111 | ||
| Limitations of Tests of Conduction and Refractoriness | 112 | ||
| Atrial Stimulation | 112 | ||
| Technical Aspects | 112 | ||
| Normal Response to Rate-Incremental Atrial Pacing | 112 | ||
| Sinus Node Response to Atrial Pacing | 112 | ||
| Atrioventricular Node Response to Atrial Pacing | 113 | ||
| Atrial Response to Atrial Pacing | 113 | ||
| Normal Response to Atrial Premature Stimulation | 114 | ||
| Sinus Node Response to Atrial Extrastimulation | 114 | ||
| Zone I. | 114 | ||
| Zone II. | 114 | ||
| Zone III. | 114 | ||
| Zone IV. | 114 | ||
| Atrioventricular Nodal Response to Atrial Extrastimulation | 114 | ||
| Type I response. | 115 | ||
| Type II response. | 115 | ||
| Type III response. | 115 | ||
| Atrial Response to Atrial Extrastimulation | 115 | ||
| Repetitive Atrial Responses | 115 | ||
| Ventricular Stimulation | 115 | ||
| Technical Aspects | 115 | ||
| Normal Response to Rate-Incremental Ventricular Pacing | 117 | ||
| Normal Response to Ventricular Premature Stimulation | 117 | ||
| Repetitive Ventricular Responses | 118 | ||
| Bundle Branch Reentry Beats | 118 | ||
| Ventricular Echo Beats | 120 | ||
| Intraventricular Reentrant Beats | 120 | ||
| Miscellaneous Electrophysiological Phenomena | 120 | ||
| Concealed Conduction | 120 | ||
| Ventricular Response During Atrial Fibrillation | 120 | ||
| Unexpected Prolongation or Failure of Conduction | 120 | ||
| Unexpected Facilitation of Conduction | 120 | ||
| Perpetuation of Aberrant Conduction During Supraventricular Tachycardias | 121 | ||
| Gap Phenomenon | 121 | ||
| Supernormality | 122 | ||
| Complications of Electrophysiological Testing | 122 | ||
| Risks and Complications | 122 | ||
| Iatrogenic Problems Encountered During Electrophysiological Testing | 123 | ||
| Videos | 123 | ||
| References | 123 | ||
| 5 Conventional Intracardiac Mapping Techniques | 125 | ||
| Outline | 125 | ||
| Activation Mapping | 125 | ||
| Fundamental Concepts | 125 | ||
| Unipolar Recordings | 125 | ||
| Timing of local activation. | 125 | ||
| Direction of local activation. | 125 | ||
| Advantages of unipolar recordings. | 125 | ||
| Disadvantages of unipolar recordings. | 126 | ||
| Bipolar Recordings | 126 | ||
| Timing of local activation. | 126 | ||
| Direction of local activation. | 127 | ||
| Advantages of bipolar recordings. | 127 | ||
| Disadvantages of bipolar recordings. | 127 | ||
| Mapping Procedure | 127 | ||
| Selection of the Electrical Reference Point | 128 | ||
| Defining the Goal of Mapping | 128 | ||
| Epicardial Versus Endocardial Mapping | 128 | ||
| Mapping Catheters | 129 | ||
| Mapping Focal Tachycardias | 129 | ||
| Technique of activation mapping of focal tachycardias. | 131 | ||
| Mapping Macroreentrant Tachycardias | 132 | ||
| Continuous electrical activity. | 134 | ||
| Mid-diastolic activity. | 134 | ||
| Limitations | 135 | ||
| Entrainment Mapping | 135 | ||
| Fundamental Concepts | 135 | ||
| Entrainment Criteria | 138 | ||
| Fusion During Entrainment | 138 | ||
| Entrainment with manifest fusion. | 141 | ||
| Entrainment with concealed fusion. | 141 | ||
| Entrainment with inapparent fusion. | 141 | ||
| Entrainment with antidromic capture. | 141 | ||
| Postpacing Interval | 142 | ||
| Stimulus–Electrocardiogram Complex Interval During Entrainment | 143 | ||
| Number of Pacing Stimuli Needed to Entrain | 143 | ||
| Mapping Procedure | 144 | ||
| Clinical Implications | 144 | ||
| Limitations | 146 | ||
| Pace Mapping | 146 | ||
| Fundamental Concepts | 146 | ||
| Pace Map Matching | 148 | ||
| Stimulus–QRS Interval During Pace Mapping | 151 | ||
| Mapping Procedure | 152 | ||
| Clinical Implications | 152 | ||
| Limitations | 152 | ||
| Videos | 152 | ||
| References | 153 | ||
| 6 Advanced Mapping and Navigation Modalities | 155 | ||
| Outline | 155 | ||
| Electroanatomic Mapping | 156 | ||
| Fundamental Concepts | 156 | ||
| CARTO Electroanatomic Mapping System | 156 | ||
| CARTO-3. | 156 | ||
| CARTO-Merge. | 156 | ||
| CARTO-Univu. | 157 | ||
| CARTO-Sound. | 157 | ||
| EnSite NavX Electroanatomic Mapping System | 158 | ||
| Rhythmia Electroanatomic Mapping System | 160 | ||
| Electroanatomic Activation Mapping | 161 | ||
| Anatomical Reference | 161 | ||
| Electrical Reference | 161 | ||
| Window of Interest | 162 | ||
| Local Activation Time | 162 | ||
| Data Acquisition | 165 | ||
| Activation Map | 166 | ||
| Isochronal Map | 167 | ||
| Propagation Map | 167 | ||
| Entrainment Map | 167 | ||
| Limitations of Electroanatomic Activation Mapping | 169 | ||
| Electroanatomic Voltage Mapping | 169 | ||
| Factors Influencing Voltage Mapping Resolution | 170 | ||
| Electrode size. | 170 | ||
| Vector of activation. | 170 | ||
| Tissue contact. | 170 | ||
| Mapping density. | 170 | ||
| Limitations of Electroanatomic Voltage Mapping | 171 | ||
| High-Resolution Electroanatomic Mapping | 171 | ||
| Ripple Mapping | 172 | ||
| Anatomical Mapping | 172 | ||
| Limitations of Anatomical Mapping | 174 | ||
| Clinical Implications | 174 | ||
| Choice of Electroanatomic Mapping System | 175 | ||
| CARTO | 176 | ||
| EnSite NavX | 176 | ||
| Rhythmia | 176 | ||
| Ensite Noncontact Mapping System | 176 | ||
| Fundamental Concepts | 176 | ||
| Technology Application | 177 | ||
| Clinical Implications | 180 | ||
| Limitations | 180 | ||
| Basket Catheter Mapping | 180 | ||
| Fundamental Concepts | 180 | ||
| Technology Application | 181 | ||
| Clinical Implications | 181 | ||
| Limitations | 181 | ||
| Focal Impulse and Rotor Mapping | 182 | ||
| Technology Application | 182 | ||
| Clinical Implications | 182 | ||
| Limitations | 182 | ||
| Stereotaxis Magnetic Navigation System | 183 | ||
| Fundamental Concepts | 183 | ||
| Technology Application | 184 | ||
| Clinical Implications | 185 | ||
| Limitations | 185 | ||
| Sensei Robotic Navigation System | 186 | ||
| Fundamental Concepts | 186 | ||
| Technology Application | 186 | ||
| Clinical Implications | 186 | ||
| Limitations | 187 | ||
| Mediguide Navigation System | 187 | ||
| Fundamental Concepts | 187 | ||
| Technology Application | 187 | ||
| Clinical Implications | 188 | ||
| Limitations | 188 | ||
| Body Surface Potential Mapping | 188 | ||
| Fundamental Concepts | 188 | ||
| Clinical Implications | 190 | ||
| Limitations | 190 | ||
| Electrocardiographic Mapping | 190 | ||
| Fundamental Concepts | 190 | ||
| Technology Application | 191 | ||
| Clinical Implications | 192 | ||
| Limitations | 193 | ||
| Intracardiac Echocardiography | 193 | ||
| Catheter Design | 193 | ||
| Mechanical Ultrasound Catheter Radial Imaging System | 193 | ||
| Electronic Phased-Array Catheter Sector Imaging System | 193 | ||
| Imaging Technique | 193 | ||
| Using the Mechanical Radial Intracardiac Echocardiographic Catheter | 193 | ||
| Using the AcuNav Catheter | 194 | ||
| RA targets. | 194 | ||
| Interatrial septum. | 194 | ||
| LA structures. | 195 | ||
| LV and RV targets. | 195 | ||
| Clinical Implications | 195 | ||
| Computed Tomography and Magnetic Resonance Imaging | 197 | ||
| Fundamental Concepts | 197 | ||
| Image Acquisition | 197 | ||
| Image Segmentation | 197 | ||
| Image Registration | 197 | ||
| Computed Tomography Overlay | 198 | ||
| Image Integration Technique | 198 | ||
| Image Registration Using CARTO-Merge | 198 | ||
| Image Registration Using CARTO-Sound | 198 | ||
| Image Registration Using NavX Fusion | 198 | ||
| Image Registration Using Fluoroscopy (Computed Tomography Overlay) | 199 | ||
| Clinical Implications | 199 | ||
| Limitations | 201 | ||
| Three-Dimensional Rotational Angiography | 202 | ||
| Fundamental Concepts | 202 | ||
| Imaging Technique | 202 | ||
| Clinical Implications | 203 | ||
| Limitations | 203 | ||
| Videos | 203 | ||
| References | 203 | ||
| 7 Ablation Energy Sources | 206 | ||
| Outline | 206 | ||
| Radiofrequency Ablation | 206 | ||
| Biophysics of Radiofrequency Energy | 206 | ||
| Radiofrequency Energy Delivery | 206 | ||
| Unipolar RF systems. | 206 | ||
| Bipolar RF systems. | 207 | ||
| Tissue Heating | 208 | ||
| Convective Cooling | 209 | ||
| Catheter Tip Temperature | 209 | ||
| Biophysics of Cooled Radiofrequency Ablation | 210 | ||
| Pathophysiology of Radiofrequency Lesion Formation | 211 | ||
| Cellular Effects of Radiofrequency Ablation | 211 | ||
| Tissue Effects of Radiofrequency Ablation | 211 | ||
| Coagulum Formation | 212 | ||
| Steam Pop | 212 | ||
| Determinants of Radiofrequency Lesion Size | 212 | ||
| Ablation Electrode Temperature | 213 | ||
| Radiofrequency Power Amplitude | 213 | ||
| Duration of Radiofrequency Application | 213 | ||
| Electrode-Tissue Contact | 213 | ||
| Electrode Length | 214 | ||
| Electrode Orientation | 214 | ||
| Electrode Material | 214 | ||
| Reference Patch Electrode Location and Size | 215 | ||
| Convective Cooling | 215 | ||
| Radiofrequency System Polarity | 215 | ||
| Electrode Flexibility | 215 | ||
| Monitoring Radiofrequency Lesion Formation | 215 | ||
| Impedance Monitoring | 216 | ||
| Electrode Temperature Monitoring | 216 | ||
| Electrophysiological Effects of Ablation | 217 | ||
| Tissue Temperature Monitoring | 217 | ||
| Titration of Standard Radiofrequency Energy | 217 | ||
| Titration of Cooled Radiofrequency Energy | 217 | ||
| Optimizing Catheter-Tissue Contact | 218 | ||
| Record Electrograms | 218 | ||
| Fluoroscopy | 219 | ||
| Tactile Feedback | 219 | ||
| Intracardiac Echocardiography | 219 | ||
| Temperature Monitoring | 219 | ||
| Impedance Monitoring | 219 | ||
| Electroanatomical Catheter Localization | 219 | ||
| Contact Force Monitoring | 219 | ||
| Electrogram-Gated Ablation | 221 | ||
| Prevention of Steam Pops | 221 | ||
| Ablation Electrode Temperature | 222 | ||
| Power Output | 222 | ||
| Impedance Monitoring | 222 | ||
| Contact Force Monitoring | 222 | ||
| Intracardiac Echocardiography | 222 | ||
| Tissue Temperature Monitoring | 222 | ||
| High-Frequency Ultrasound | 222 | ||
| Clinical Applications of Standard Radiofrequency Ablation | 222 | ||
| Clinical Applications of Cooled Radiofrequency Ablation | 222 | ||
| Potential Advantages of Cooled Radiofrequency Ablation | 223 | ||
| Potential Risks of Cooled Radiofrequency Ablation | 223 | ||
| Phased Radiofrequency Ablation | 223 | ||
| nMARQ Ablation System | 225 | ||
| Cryoablation | 225 | ||
| Biophysics of Cryothermal Energy | 225 | ||
| Pathophysiology of Lesion Formation by Cryoablation | 226 | ||
| Extracellular Ice Formation (Solution Effect Injury) | 226 | ||
| Intracellular Ice Formation | 227 | ||
| Vascular-Mediated Tissue Injury | 228 | ||
| Chronic Cryogenic Lesion Formation | 228 | ||
| Determinants of Cryogenic Lesion Size | 228 | ||
| Technical Aspects of Cryoablation | 229 | ||
| Cryomapping | 229 | ||
| Cryoablation | 229 | ||
| Cryoballoon Ablation | 229 | ||
| Clinical Advantages of Cryoablation | 230 | ||
| Clinical Applications of Cryoablation | 230 | ||
| Atrioventricular Nodal Reentrant Tachycardia | 230 | ||
| Bypass Tracts | 230 | ||
| Typical Atrial Flutter | 230 | ||
| Pulmonary Vein Isolation | 231 | ||
| Focal Atrial Tachycardia | 231 | ||
| Ventricular Tachycardia | 231 | ||
| Laser Energy | 231 | ||
| Biophysics of Laser Energy | 231 | ||
| Clinical Applications of Laser Energy | 231 | ||
| Ultrasound Energy | 232 | ||
| Biophysics of Ultrasound Energy | 232 | ||
| Pathophysiology of Lesion Formation by Ultrasound Energy | 232 | ||
| Clinical Applications of Ultrasound Energy | 233 | ||
| Microwave Ablation | 233 | ||
| Biophysics of Microwave Energy | 233 | ||
| Pathophysiology of Lesion Formation by Microwave Ablation | 234 | ||
| Clinical Applications of Microwave Ablation | 234 | ||
| Electroporation | 235 | ||
| Videos | 235 | ||
| References | 235 | ||
| 8 Sinus Node Dysfunction | 238 | ||
| Outline | 238 | ||
| Anatomy and Physiology of the Sinus Node | 238 | ||
| Anatomy | 238 | ||
| Histology | 238 | ||
| Physiology | 238 | ||
| Blood Supply | 239 | ||
| Innervation | 239 | ||
| Pathophysiology of Sinus Node Dysfunction | 240 | ||
| Intrinsic Sinus Node Dysfunction | 240 | ||
| Degenerative Diseases | 240 | ||
| Ischemic Heart Disease | 240 | ||
| Atrial Arrhythmias | 241 | ||
| Familial Sinus Node Dysfunction | 241 | ||
| Congenital Heart Disease | 241 | ||
| Other Causes | 241 | ||
| Extrinsic Sinus Node Dysfunction | 241 | ||
| Drugs | 241 | ||
| Autonomic Influences | 241 | ||
| Other Causes | 242 | ||
| Clinical Presentation | 242 | ||
| Epidemiology and Natural History | 242 | ||
| Diagnostic Evaluation | 242 | ||
| Electrocardiogram and Ambulatory Monitoring | 242 | ||
| Autonomic Modulation | 243 | ||
| Exercise Testing | 243 | ||
| Electrophysiological Testing | 243 | ||
| Electrocardiographic Features | 243 | ||
| Sinus Bradycardia | 243 | ||
| Sinus Arrest | 243 | ||
| Sinoatrial Exit Block | 243 | ||
| Chronotropic Incompetence | 243 | ||
| Tachycardia-Bradycardia Syndrome | 244 | ||
| Atrial Fibrillation With Slow Ventricular Response | 244 | ||
| Carotid Sinus Hypersensitivity | 245 | ||
| Atrial Standstill | 245 | ||
| Sinus Arrhythmia | 245 | ||
| Wandering Atrial Pacemaker | 246 | ||
| Electrophysiological Testing | 246 | ||
| Role of Electrophysiological Testing | 246 | ||
| Sinus Node Recovery Time | 246 | ||
| Technique | 246 | ||
| Pacing site. | 246 | ||
| Pacing cycle length. | 247 | ||
| Pacing duration. | 247 | ||
| Measurements | 247 | ||
| Sinus node recovery time. | 247 | ||
| Corrected SNRT. | 247 | ||
| Maximum SNRT. | 247 | ||
| Ratio of SNRT to sinus CL. | 247 | ||
| Total recovery time. | 247 | ||
| Secondary pauses. | 247 | ||
| Limitations of Sinus Node Recovery Time | 247 | ||
| Sinus Node Recovery Time in Patients With Sinus Node Dysfunction | 247 | ||
| Sinoatrial Conduction Time | 248 | ||
| Direct Recordings | 248 | ||
| Strauss Technique | 248 | ||
| Zone I: zone of collision. | 248 | ||
| Zone II: zone of reset. | 248 | ||
| Zone III: zone of interpolation. | 250 | ||
| Zone IV: zone of reentry. | 250 | ||
| Narula Method | 250 | ||
| Kirkorian-Touboul Method | 250 | ||
| Sinoatrial Conduction Time in Patients With Sinus Node Dysfunction | 250 | ||
| Effects of Drugs | 250 | ||
| Autonomic Blockade (Intrinsic Heart Rate) | 250 | ||
| Atropine | 250 | ||
| Propranolol | 250 | ||
| Isoproterenol/Epinephrine | 250 | ||
| Digoxin | 250 | ||
| Verapamil and Diltiazem | 250 | ||
| Antiarrhythmic Agents | 250 | ||
| Principles of Management | 251 | ||
| Acute Management | 251 | ||
| Chronic Management | 251 | ||
| Pacemaker Device and Mode Selection | 251 | ||
| Pacemaker Syndrome | 252 | ||
| Minimizing Right Ventricular Pacing | 252 | ||
| Rate Adaptive Programming | 253 | ||
| Mode Switch Algorithms | 253 | ||
| References | 253 | ||
| 9 Atrioventricular Conduction Abnormalities | 255 | ||
| Outline | 255 | ||
| Anatomy and Physiology of the Atrioventricular Junction | 255 | ||
| Internodal and Interatrial Conduction | 255 | ||
| Central Fibrous Body | 255 | ||
| Triangle of Koch | 256 | ||
| Atrioventricular Node | 257 | ||
| His Bundle | 257 | ||
| Pathophysiology of Atrioventricular Block | 257 | ||
| Congenital and Inherited Atrioventricular Block | 257 | ||
| Congenital Atrioventricular Block | 257 | ||
| Hereditary Cardiac Conduction Disease | 258 | ||
| Neuromyopathies | 258 | ||
| Long-QT Syndrome | 258 | ||
| Acquired Atrioventricular Block | 258 | ||
| Drugs | 258 | ||
| Ischemic Heart Disease | 258 | ||
| Acute Inferior Myocardial Infarction | 259 | ||
| Acute Anterior Myocardial Infarction | 259 | ||
| Chronic Ischemic Heart Disease | 259 | ||
| Degenerative Diseases | 259 | ||
| Rheumatic Diseases | 259 | ||
| Infectious Diseases | 260 | ||
| Infiltrative Processes | 260 | ||
| Atrioventricular Block in Athletes | 260 | ||
| Iatrogenic Atrioventricular Block | 260 | ||
| Other Causes of Atrioventricular Block | 261 | ||
| Paroxysmal Atrioventricular Block | 261 | ||
| Paroxysmal Vagally Mediated Atrioventricular Block | 261 | ||
| Paroxysmal Intrinsic Atrioventricular Block | 261 | ||
| Paroxysmal Idiopathic Atrioventricular Block | 262 | ||
| Clinical Presentation | 262 | ||
| Natural History | 263 | ||
| Diagnostic Evaluation | 264 | ||
| Electrocardiography | 264 | ||
| Autonomic Modulation | 264 | ||
| Exercise Testing | 264 | ||
| Electrophysiological Testing | 264 | ||
| Electrocardiographic Features | 264 | ||
| First-Degree Atrioventricular Delay | 264 | ||
| Site of Block | 265 | ||
| Atrioventricular node. | 265 | ||
| His-Purkinje system. | 265 | ||
| Atrium. | 265 | ||
| Second-Degree Atrioventricular Block | 265 | ||
| Type 1 Second-Degree Atrioventricular Block | 265 | ||
| Site of block. | 267 | ||
| Atrioventricular node. | 267 | ||
| His-Purkinje system. | 267 | ||
| Type 2 Second-Degree Atrioventricular Block | 267 | ||
| Site of block | 268 | ||
| His-Purkinje system. | 268 | ||
| Atrioventricular node. | 268 | ||
| Second-Degree 2 : 1 Atrioventricular Block | 269 | ||
| Site of block. | 269 | ||
| High-Grade Atrioventricular Block | 270 | ||
| Site of block. | 270 | ||
| Third-Degree (Complete) Atrioventricular Block | 270 | ||
| Site of Block | 270 | ||
| Atrioventricular node. | 270 | ||
| His-Purkinje system. | 270 | ||
| Electrophysiological Testing | 270 | ||
| Role of Electrophysiological Testing | 270 | ||
| Normal Atrioventricular Conduction | 272 | ||
| Localization of the Site of Atrioventricular Block | 272 | ||
| Site of First-Degree Atrioventricular Block | 273 | ||
| 10 Intraventricular Conduction Abnormalities | 286 | ||
| Outline | 286 | ||
| Transient Bundle Branch Block | 286 | ||
| Acceleration-Dependent Bundle Branch Block | 286 | ||
| Aberration Caused By Premature Excitation | 287 | ||
| Ashman Phenomenon | 287 | ||
| Aberration Caused by Heart Rate Acceleration | 289 | ||
| Pause-Dependent Bundle Branch Block | 289 | ||
| Aberration Caused by Concealed Transseptal Conduction | 291 | ||
| Perpetuation of Aberrant Conduction During Tachyarrhythmias | 291 | ||
| Unexpected Persistence of Acceleration-Dependent Aberration | 292 | ||
| Alternation of Aberration During Atrial Bigeminal Rhythm | 293 | ||
| Chronic Bundle Branch Block | 293 | ||
| Anatomy and Physiology of the His-Purkinje System | 293 | ||
| Cardiac Skeleton | 293 | ||
| His Bundle | 293 | ||
| Right Bundle | 293 | ||
| Left Bundle | 293 | ||
| Purkinje Fibers | 294 | ||
| Blood Supply | 294 | ||
| Innervation | 294 | ||
| Pathophysiology of His-Purkinje System Disease | 294 | ||
| Right Bundle | 294 | ||
| Left Bundle | 294 | ||
| Nonspecific Intraventricular Conduction Disturbances | 295 | ||
| Clinical Significance | 295 | ||
| Electrocardiographic Features | 295 | ||
| Bundle Branch Block | 295 | ||
| Right Bundle Branch Block | 296 | ||
| Atypical RBBB. | 296 | ||
| Incomplete RBBB. | 296 | ||
| Left Bundle Branch Block | 297 | ||
| Atypical LBBB. | 298 | ||
| Incomplete LBBB. | 298 | ||
| Fascicular Block | 298 | ||
| Left Anterior Fascicular Block | 298 | ||
| Left Posterior Fascicular Block | 299 | ||
| Left Median Fascicular Block | 299 | ||
| Other Types of Intraventricular Conduction Abnormalities | 299 | ||
| Nonspecific Intraventricular Conduction Defects | 299 | ||
| Bifascicular Blocks | 299 | ||
| Trifascicular Blocks | 299 | ||
| Alternating Bundle Branch Block | 299 | ||
| Masquerading Bundle Branch Block | 299 | ||
| Intermittent Bundle Branch Block | 299 | ||
| Electrophysiological Testing | 300 | ||
| Baseline Intervals | 300 | ||
| His-Ventricular Interval | 300 | ||
| Localization of the Site of Block in Right Bundle Branch Block | 300 | ||
| Localization of the Site of Block in Left Bundle Branch Block | 301 | ||
| Diagnostic Maneuvers | 301 | ||
| Atrial Extrastimulation | 301 | ||
| Atrial Pacing | 302 | ||
| His Bundle Pacing | 302 | ||
| Ventricular Pacing | 302 | ||
| Procainamide Challenge | 303 | ||
| Role of Electrophysiological Testing | 303 | ||
| References | 304 | ||
| 11 Focal Atrial Tachycardia | 305 | ||
| Outline | 305 | ||
| Classification of Atrial Tachycardias | 305 | ||
| Pathophysiology | 305 | ||
| Incessant Atrial Tachycardias | 307 | ||
| Anatomical Locations | 307 | ||
| Pulmonary Vein Tachycardia | 308 | ||
| Multifocal Atrial Tachycardia | 308 | ||
| Sinus Node Reentrant Tachycardia | 309 | ||
| Epidemiology | 309 | ||
| Clinical Presentation | 309 | ||
| Initial Evaluation | 309 | ||
| Principles of Management | 309 | ||
| Acute Management | 309 | ||
| Chronic Management | 310 | ||
| Catheter Ablation | 310 | ||
| Pharmacological Therapy | 311 | ||
| Electrocardiographic Features | 311 | ||
| P Wave Morphology | 311 | ||
| QRS Morphology | 311 | ||
| P/QRS Relationship | 311 | ||
| Localization of the Tachycardia Site of Origin | 311 | ||
| Right Versus Left Atrial Tachycardias | 311 | ||
| Right Atrial Tachycardias | 314 | ||
| Crista terminalis. | 314 | ||
| Anterior septum. | 314 | ||
| Midseptum. | 314 | ||
| Posterior septum. | 314 | ||
| Tricuspid annulus. | 314 | ||
| RA appendage. | 317 | ||
| Left Atrial Tachycardias | 317 | ||
| Pulmonary veins. | 317 | ||
| LA appendage. | 318 | ||
| Mitral annulus. | 318 | ||
| Coronary sinus. | 318 | ||
| Noncoronary aortic sinus of Valsalva. | 318 | ||
| Electrophysiological Testing | 318 | ||
| Baseline Observations During Sinus Rhythm | 318 | ||
| Induction of Tachycardia | 318 | ||
| Initiation by Programmed Atrial Stimulation | 318 | ||
| Initiation by Programmed Ventricular Stimulation | 320 | ||
| Tachycardia Features | 320 | ||
| Atrial Activation Sequence | 320 | ||
| Atrial-Ventricular Relationship | 320 | ||
| Oscillation of the Tachycardia Cycle Length | 320 | ||
| Effects of Bundle Branch Block | 320 | ||
| Termination and Response to Physiological and Pharmacological Maneuvers | 320 | ||
| Diagnostic Maneuvers During Tachycardia | 321 | ||
| Programmed Atrial Stimulation During Tachycardia | 321 | ||
| Microreentrant atrial tachycardia. | 321 | ||
| Triggered-activity AT. | 322 | ||
| Automatic AT. | 322 | ||
| Ventriculoatrial linking. | 322 | ||
| Differential-site atrial pacing. | 322 | ||
| Variability in PPIs. | 322 | ||
| Programmed Ventricular Stimulation During Tachycardia | 322 | ||
| Diagnostic Maneuvers During Sinus Rhythm After Tachycardia Termination | 323 | ||
| Atrial Pacing at the Tachycardia Cycle Length | 323 | ||
| Ventricular Pacing at the Tachycardia Cycle Length | 323 | ||
| Exclusion of Other Arrhythmia Mechanisms | 324 | ||
| Mapping | 324 | ||
| Conventional Activation Mapping | 324 | ||
| Reference Electrogram | 325 | ||
| Local Activation Time | 326 | ||
| Tachycardia Transformation | 328 | ||
| Right Versus Left Atrial Foci | 328 | ||
| Right Atrial Versus Right Superior Pulmonary Vein Foci | 328 | ||
| Pace Mapping | 328 | ||
| Mapping Postpacing Intervals | 329 | ||
| Electroanatomic Mapping | 330 | ||
| Mapping Technique | 330 | ||
| Advantages | 330 | ||
| Limitations | 330 | ||
| Mapping Nonsustained Focal Atrial Tachycardia | 332 | ||
| Ensite Noncontact Mapping System | 332 | ||
| 12 Typical Atrial Flutter | 339 | ||
| Outline | 339 | ||
| Pathophysiology | 339 | ||
| Right Atrial Anatomy | 339 | ||
| Typical Atrial Flutter Circuit | 340 | ||
| Interrelationship of Atrial Flutter and Atrial Fibrillation | 341 | ||
| Double-Wave Reentry | 342 | ||
| Epidemiology and Natural History | 343 | ||
| Clinical Presentation | 343 | ||
| Initial Evaluation | 343 | ||
| Principles of Management | 344 | ||
| Rate Control | 344 | ||
| Restoration of Sinus Rhythm | 345 | ||
| Peri-Cardioversion Anticoagulation | 345 | ||
| Electrical Cardioversion | 346 | ||
| Overdrive Atrial Pacing | 346 | ||
| Pharmacological Cardioversion | 346 | ||
| 13 Macroreentrant Atrial Tachycardia | 375 | ||
| Outline | 375 | ||
| Pathophysiology | 375 | ||
| Macroreentry | 375 | ||
| Dual-Loop Reentry | 375 | ||
| Localized Reentry | 375 | ||
| Cavotricuspid Isthmus-Dependent Right Atrial Macroreentry | 377 | ||
| Lower Loop Reentry | 377 | ||
| Intra-Isthmus Reentry | 378 | ||
| Non-CTI-Dependent Right Atrial Macroreentry | 378 | ||
| Incisional Right Atrial Macroreentry | 378 | ||
| Right Atrial Macroreentry in the Absence of Previous Surgery | 378 | ||
| Upper Loop Reentry | 378 | ||
| Left Atrial Macroreentry | 378 | ||
| Incisional Left Atrial Macroreentry | 378 | ||
| Left Atrial Macroreentry Postablation of Atrial Fibrillation | 379 | ||
| Perimitral Left Atrial Macroreentry | 379 | ||
| Circuits Involving the Pulmonary Veins | 379 | ||
| Left Septal Circuits | 379 | ||
| Left Atrial Macroreentry in the Absence of Previous Surgery or Ablation | 380 | ||
| Epidemiology | 380 | ||
| Clinical Presentation | 381 | ||
| Initial Evaluation | 381 | ||
| Principles of Management | 381 | ||
| Electrocardiographic Features | 381 | ||
| Right Atrial Macroreentry | 381 | ||
| Incisional Right Atrial Macroreentry | 381 | ||
| Upper Loop Reentry | 382 | ||
| Lower Loop Reentry | 382 | ||
| Intra-Isthmus Reentry | 382 | ||
| Left Atrial Macroreentry | 382 | ||
| Perimitral Left Atrial Macroreentry | 382 | ||
| Pulmonary Vein Circuits | 382 | ||
| Left Septal Circuits | 382 | ||
| Electrophysiological Testing | 382 | ||
| Induction of Tachycardia | 382 | ||
| Tachycardia Features | 382 | ||
| Diagnostic Maneuvers During Tachycardia | 383 | ||
| Atrial Extrastimulation During Tachycardia | 383 | ||
| Atrial Pacing During Tachycardia | 384 | ||
| Entrainment. | 384 | ||
| Entrainment criteria. | 384 | ||
| Entrainment with fusion. | 384 | ||
| Entrainment with manifest fusion. | 386 | ||
| Entrainment with inapparent fusion. | 387 | ||
| Entrainment with concealed fusion. | 387 | ||
| Termination. | 388 | ||
| Overdrive suppression. | 388 | ||
| Transformation. | 388 | ||
| Mapping | 388 | ||
| Electroanatomic Mapping | 388 | ||
| Mapping Technique | 388 | ||
| Localization of the Reentrant Circuit Chamber (Right Versus Left Atrium) | 389 | ||
| Activation Map | 389 | ||
| Identification of the Critical Isthmus | 391 | ||
| Voltage Map | 392 | ||
| Propagation Map | 392 | ||
| Tachycardia Transformation | 392 | ||
| Limitation of the Use of Electroanatomic Mapping | 392 | ||
| Entrainment Mapping | 392 | ||
| Postpacing Interval | 393 | ||
| Number of Pacing Stimuli Needed to Entrain | 393 | ||
| Conduction Time From the Pacing Site to the Circuit Exit Site | 393 | ||
| Localization of the Reentry Circuit | 394 | ||
| Identification of the Critical Isthmus | 394 | ||
| Color-Coded Mapping of Postpacing Intervals | 394 | ||
| Limitations of Entrainment Mapping | 395 | ||
| Noncontact Mapping | 395 | ||
| Limitations of Noncontact Mapping | 396 | ||
| Practical Approach to Mapping Macroreentrant Atrial Tachycardia | 396 | ||
| Exclusion of Cavotricuspid Isthmus Dependence | 396 | ||
| Localization of the Reentrant Circuit Chamber (Right Versus Left Atrium) | 396 | ||
| Patient history. | 396 | ||
| Electrocardiographic findings. | 396 | ||
| TCL variations. | 396 | ||
| Activation sequence in the CS. | 396 | ||
| Activation mapping. | 396 | ||
| Entrainment mapping. | 396 | ||
| Identification of Barriers and Potential Lines of Block | 397 | ||
| Identification of the Complete Reentrant Circuit | 397 | ||
| 14 Atrial Tachyarrhythmias in Adults With Congenital Heart Disease | 407 | ||
| Outline | 407 | ||
| Pathophysiology | 407 | ||
| Macroreentrant Atrial Tachycardia | 407 | ||
| Focal Atrial Tachycardia | 408 | ||
| Atrial Fibrillation | 408 | ||
| Early Postoperative Atrial Tachycardia | 408 | ||
| Atrial Septal Defect | 409 | ||
| Tetralogy of Fallot | 409 | ||
| Dextro-Transposition of the Great Arteries | 410 | ||
| Univentricular Hearts With Fontan Palliation | 410 | ||
| Epidemiology and Natural History | 410 | ||
| Clinical Presentation | 411 | ||
| Initial Evaluation | 411 | ||
| Principles of Management | 411 | ||
| Rate Control | 411 | ||
| Restoration of Sinus Rhythm | 411 | ||
| Maintenance of Sinus Rhythm | 412 | ||
| Catheter Ablation | 412 | ||
| Antiarrhythmic Drug Therapy | 412 | ||
| Surgical Ablation | 412 | ||
| Pacemaker Implantation | 412 | ||
| Prevention of Systemic Embolization | 412 | ||
| Electrocardiographic Features | 412 | ||
| Mapping | 412 | ||
| Vascular and Cardiac Access | 413 | ||
| Access to the Systemic Venous Atrium | 413 | ||
| Access to the Arrhythmia Substrate and Cavotricuspid Isthmus | 413 | ||
| Access to the Coronary Sinus and Atrioventricular Node | 413 | ||
| Access to the Pulmonary Venous Atrium | 414 | ||
| Mapping Approach | 415 | ||
| Exclusion of Cavotricuspid Isthmus Dependence | 415 | ||
| Identification of Barriers and Potential Lines of Block | 416 | ||
| Identification of the Complete Reentrant Circuit | 416 | ||
| Identification of the Critical Isthmus | 417 | ||
| Ablation | 417 | ||
| Target of Ablation | 417 | ||
| Ablation Technique | 418 | ||
| Endpoints of Ablation | 419 | ||
| Tachycardia Termination | 419 | ||
| Noninducibility of Tachycardia | 419 | ||
| Documentation of a Line of Block | 419 | ||
| Double potentials. | 419 | ||
| Atrial activation sequence. | 419 | ||
| Differential pacing. | 419 | ||
| Outcome | 420 | ||
| Videos | 420 | ||
| References | 420 | ||
| 15 Atrial Fibrillation | 421 | ||
| Outline | 421 | ||
| Pathophysiology | 422 | ||
| Classification of Atrial Fibrillation | 422 | ||
| Mechanism of Atrial Fibrillation | 423 | ||
| Mechanism of Initiation of Atrial Fibrillation | 423 | ||
| PV triggers. | 424 | ||
| Non-PV triggers. | 425 | ||
| Mechanism of Maintenance of Atrial Fibrillation | 425 | ||
| Multiple wave reentry hypothesis. | 425 | ||
| Localized source hypothesis. | 426 | ||
| Mapping human AF. | 426 | ||
| Substrate for Atrial Fibrillation | 427 | ||
| Atrial Electrophysiological Properties | 428 | ||
| Atrial Fibrosis | 428 | ||
| Atrial Stretch | 428 | ||
| Inflammation | 428 | ||
| Atrial Remodeling in Atrial Fibrillation | 429 | ||
| Electrical Remodeling | 429 | ||
| Contractile and Structural Remodeling | 429 | ||
| Role of Autonomic Nervous System in Atrial Fibrillation | 430 | ||
| Role of the Pulmonary Veins in Atrial Fibrillation | 430 | ||
| Pulmonary Vein Anatomy | 431 | ||
| Electrophysiology of Pulmonary Vein Musculature | 431 | ||
| Pulmonary Vein Tachycardia Versus Pulmonary Vein Fibrillation | 431 | ||
| Genetics in Atrial Fibrillation | 433 | ||
| Epidemiology | 433 | ||
| Atrial Fibrillation Risk Prediction | 434 | ||
| Clinical Risk Factors Predisposing to Atrial Fibrillation | 434 | ||
| Unmodifiable Risk Factors | 434 | ||
| Age. | 434 | ||
| Gender. | 434 | ||
| Race. | 434 | ||
| Genetics. | 435 | ||
| Modifiable Risk Factors | 435 | ||
| Hypertension. | 435 | ||
| Heart failure. | 435 | ||
| Valvular heart disease. | 436 | ||
| Coronary artery disease. | 436 | ||
| Congenital heart disease. | 436 | ||
| Obstructive sleep apnea. | 436 | ||
| Obesity. | 437 | ||
| Diabetes. | 437 | ||
| Hyperthyroidism. | 437 | ||
| Pulmonary embolism. | 437 | ||
| Chronic kidney disease. | 437 | ||
| Exercise and fitness. | 437 | ||
| Alcohol. | 438 | ||
| Smoking. | 438 | ||
| Caffeine. | 438 | ||
| Recreational drugs. | 438 | ||
| Drug-Induced Atrial Fibrillation | 438 | ||
| Postoperative Atrial Fibrillation | 439 | ||
| Epidemiology | 439 | ||
| Prognosis | 439 | ||
| Mechanism | 439 | ||
| Clinical Presentation | 439 | ||
| Symptomatic Atrial Fibrillation | 439 | ||
| Atrial Fibrillation Symptom Scales | 440 | ||
| Silent Atrial Fibrillation | 440 | ||
| Device-Detected Atrial Fibrillation | 440 | ||
| Accuracy of Device-Detected Atrial Fibrillation | 441 | ||
| Clinical Implications of Device-Detected Atrial Fibrillation | 441 | ||
| Risk of Thromboembolism | 441 | ||
| Stroke Risk Stratification | 442 | ||
| Bleeding Risk Stratification | 443 | ||
| Initial Evaluation | 444 | ||
| Diagnostic Cardiac Testing | 444 | ||
| Laboratory Testing | 445 | ||
| Electrophysiological Testing | 445 | ||
| Other Diagnostic Tests | 445 | ||
| Screening for Atrial Fibrillation | 445 | ||
| Principles of Management | 445 | ||
| Prevention of Systemic Embolization | 445 | ||
| Antithrombotic Drug Therapy | 445 | ||
| Antiplatelet therapy. | 445 | ||
| Vitamin K antagonists. | 445 | ||
| Non–vitamin K antagonist oral anticoagulants. | 446 | ||
| Nonpharmacological Interventions | 446 | ||
| Recommendations for Long-Term Stroke Prevention | 447 | ||
| Anticoagulation in the Pericardioversion Period | 447 | ||
| Rate Control | 448 | ||
| Pharmacologic Therapy | 448 | ||
| Atrioventricular Junction Ablation | 448 | ||
| Rhythm Control | 449 | ||
| Reversion to Normal Sinus Rhythm | 449 | ||
| Timing of cardioversion. | 449 | ||
| Electrical cardioversion. | 449 | ||
| Pharmacological cardioversion. | 450 | ||
| Ibutilide. | 450 | ||
| Dofetilide. | 450 | ||
| Amiodarone. | 450 | ||
| Flecainide and propafenone. | 450 | ||
| Vernakalant. | 450 | ||
| Other antiarrhythmic agents. | 450 | ||
| Maintenance of Normal Sinus Rhythm | 450 | ||
| Amiodarone. | 452 | ||
| Dofetilide. | 452 | ||
| Flecainide and propafenone. | 452 | ||
| Sotalol. | 452 | ||
| Dronedarone. | 452 | ||
| Disopyramide. | 452 | ||
| Rhythm Control Versus Rate Control | 452 | ||
| Catheter Ablation of Atrial Fibrillation | 453 | ||
| Catheter ablation as first-line therapy. | 454 | ||
| Catheter ablation for asymptomatic AF. | 454 | ||
| Surgical Ablation of Atrial Fibrillation | 454 | ||
| Other Nonpharmacological Approaches for Rhythm Control | 455 | ||
| Atrial antitachycardia pacing. | 455 | ||
| Atrial defibrillators. | 455 | ||
| Upstream Therapy | 455 | ||
| Risk Factor Management | 456 | ||
| Hypertension | 456 | ||
| Diabetes | 456 | ||
| Sleep Disordered Breathing | 456 | ||
| Lifestyle Modifications | 456 | ||
| Management of Postoperative Atrial Fibrillation | 457 | ||
| Primary Prevention | 457 | ||
| Beta-blockers. | 457 | ||
| Amiodarone. | 457 | ||
| Sotalol. | 457 | ||
| Other therapies. | 457 | ||
| Rate Versus Rhythm Control | 457 | ||
| Prevention of Systemic Embolization | 457 | ||
| Follow-Up of Patients With Postoperative Atrial Fibrillation | 457 | ||
| Electrocardiographic Features | 457 | ||
| Atrial Activity | 457 | ||
| Atrioventricular Conduction During Atrial Fibrillation | 458 | ||
| Ventricular Preexcitation During Atrial Fibrillation | 459 | ||
| Regular Ventricular Rate During Atrial Fibrillation | 459 | ||
| Effect of Digitalis Toxicity on the Ventricular Response | 459 | ||
| QRS Morphology | 461 | ||
| Catheter Ablation of Atrial Fibrillation | 462 | ||
| Evolution of Catheter Ablation Approaches for Atrial Fibrillation | 462 | ||
| Catheter Ablation of Atrial Fibrillation: Elimination of Triggers | 462 | ||
| Focal ablation of triggers. | 462 | ||
| PV isolation. | 462 | ||
| Catheter Ablation of Atrial Fibrillation: Substrate Modification | 462 | ||
| Periprocedural Management | 463 | ||
| Antiarrhythmic Drug Therapy | 463 | ||
| Periprocedural Anticoagulation | 463 | ||
| Preprocedural anticoagulation. | 463 | ||
| Intraprocedural anticoagulation. | 464 | ||
| Postprocedural anticoagulation. | 464 | ||
| Transesophageal Echocardiography | 464 | ||
| Postprocedural Electrocardiogram Monitoring | 465 | ||
| Pulmonary Vein Imaging | 465 | ||
| Technical Aspects Common to Different Methods of Ablation | 465 | ||
| Sedation During Ablation | 465 | ||
| Left Atrial Access | 466 | ||
| Identification of the Pulmonary Veins | 466 | ||
| Fluoroscopy. | 466 | ||
| Intracardiac echocardiography. | 466 | ||
| Electroanatomic mapping. | 466 | ||
| Combining electroanatomic mapping systems with cardiac imaging. | 466 | ||
| PV angiography. | 466 | ||
| Catheterization of the Pulmonary Veins | 466 | ||
| Focal Ablation of Pulmonary Vein Triggers | 467 | ||
| Rationale | 467 | ||
| Identification of Arrhythmogenic Pulmonary Veins | 467 | ||
| Definition of an Arrhythmogenic Pulmonary Vein | 467 | ||
| Provocation of Pulmonary Vein Ectopy | 467 | ||
| Mapping Pulmonary Vein Ectopy | 467 | ||
| Electrocardiogram Localization of Pulmonary Vein Ectopy | 467 | ||
| Endocardial Activation Mapping | 467 | ||
| Target of Ablation | 470 | ||
| Ablation Technique | 470 | ||
| Endpoints of Ablation | 470 | ||
| Outcome | 470 | ||
| Segmental Ostial Pulmonary Vein Isolation | 471 | ||
| Rationale | 471 | ||
| Electrical Isolation of Pulmonary Veins | 471 | ||
| Which Pulmonary Veins to Isolate | 471 | ||
| Only arrhythmogenic PVs. | 471 | ||
| All four PVs. | 471 | ||
| Circumferential Mapping of Pulmonary Vein Potentials | 471 | ||
| Ring Catheter Mapping | 471 | ||
| Mapping During Normal Sinus Rhythm | 472 | ||
| Identification of PV potentials using pacing maneuvers. | 472 | ||
| Ablation target sites. | 474 | ||
| Mapping During Atrial Fibrillation | 474 | ||
| Intermittent PV tachycardia. | 474 | ||
| Organization of PV potentials. | 478 | ||
| Basket Catheter Mapping | 479 | ||
| Basket catheter positioning. | 479 | ||
| Basket catheter mapping. | 479 | ||
| Advantages of the basket catheter. | 479 | ||
| Disadvantages of the basket catheter. | 479 | ||
| Target of Ablation | 480 | ||
| Ablation Technique | 480 | ||
| Endpoints of Ablation | 480 | ||
| Electrical Disconnection of the Pulmonary Vein | 480 | ||
| Entrance block. | 480 | ||
| Exit block. | 480 | ||
| Waiting Period and Pharmacological Provocation | 481 | ||
| Inability to Isolate a Pulmonary Vein | 482 | ||
| Outcome | 483 | ||
| Circumferential Antral Pulmonary Vein Isolation | 483 | ||
| Rationale | 483 | ||
| Identification of Pulmonary Vein Antra | 483 | ||
| Ring Catheter Mapping | 484 | ||
| Basket Catheter Mapping | 484 | ||
| Electroanatomic Mapping | 484 | ||
| Computed Tomography and Magnetic Resonance Imaging | 485 | ||
| Intracardiac Echocardiography | 485 | ||
| Target of Ablation | 485 | ||
| Ablation Technique | 487 | ||
| Conventional Radiofrequency Ablation | 487 | ||
| Cryoballoon Ablation | 487 | ||
| Positioning the cryoballoon. | 488 | ||
| Assessment of PV occlusion. | 488 | ||
| Mapping PV potentials. | 488 | ||
| Cryoenergy application. | 488 | ||
| Prevention of phrenic nerve injury. | 490 | ||
| Advantages. | 490 | ||
| Disadvantages. | 491 | ||
| Laser Ablation | 491 | ||
| Ablation technique. | 491 | ||
| Endpoints of Ablation | 493 | ||
| Electrical Disconnection of All Pulmonary Veins | 493 | ||
| Elimination of Residual Potentials Inside the Circumferential Ablation Lines | 493 | ||
| Noninducibility of Atrial Fibrillation | 493 | ||
| Outcome | 493 | ||
| Radiofrequency Pulmonary Vein Isolation | 493 | ||
| Cryoballoon Pulmonary Vein Isolation | 494 | ||
| Laser Balloon Pulmonary Vein Isolation | 494 | ||
| Circumferential Left Atrial Ablation | 494 | ||
| Rationale | 494 | ||
| Electroanatomic Mapping | 494 | ||
| Target of Ablation | 495 | ||
| Ablation Technique | 495 | ||
| Endpoints of Ablation | 496 | ||
| Voltage Mapping | 496 | ||
| Activation Mapping | 496 | ||
| Pulmonary Vein Isolation | 496 | ||
| Termination of Persistent Atrial Fibrillation | 496 | ||
| Organized Atrial Arrhythmias | 496 | ||
| Noninducibility of Atrial Fibrillation | 496 | ||
| 16 Inappropriate Sinus Tachycardia | 549 | ||
| Outline | 549 | ||
| Anatomy and Physiology of the Sinus Node | 549 | ||
| Pathophysiology | 549 | ||
| Epidemiology and Natural History | 550 | ||
| Clinical Presentation | 550 | ||
| Initial Evaluation | 550 | ||
| Holter Monitoring | 550 | ||
| Exercise Testing | 551 | ||
| Isoproterenol Provocation | 551 | ||
| Autonomic Evaluation | 551 | ||
| Electrophysiological Testing | 551 | ||
| Differential Diagnosis | 551 | ||
| Postural Orthostatic Tachycardia Syndrome | 551 | ||
| Supraventricular Tachycardia | 552 | ||
| Principles of Management | 552 | ||
| Pharmacological Therapy | 552 | ||
| Catheter Ablation | 553 | ||
| Surgical Ablation | 553 | ||
| Electrophysiological Testing | 553 | ||
| Induction of Tachycardia | 553 | ||
| Tachycardia Features | 553 | ||
| Exclusion of Other Arrhythmia Mechanisms | 554 | ||
| Ablation | 554 | ||
| Target of Ablation | 554 | ||
| Ablation Technique | 554 | ||
| Endpoints of Ablation | 555 | ||
| Outcome | 558 | ||
| Videos | 558 | ||
| References | 558 | ||
| 17 Atrioventricular Nodal Reentrant Tachycardia | 560 | ||
| Outline | 560 | ||
| Anatomy and Physiology of the Atrioventricular Node | 560 | ||
| Triangle of Koch | 560 | ||
| Atrioventricular Node | 560 | ||
| Atrionodal Region | 561 | ||
| Nodal Region | 561 | ||
| Nodal-His Region | 562 | ||
| Pathophysiology | 562 | ||
| Tachycardia Circuit | 562 | ||
| Differences Between the Fast and Slow Pathways | 562 | ||
| Fast Pathway | 562 | ||
| Slow Pathways | 562 | ||
| Upper Turnaround Point | 563 | ||
| Lower Turnaround Point | 563 | ||
| Types of Atrioventricular Nodal Reentry | 563 | ||
| Typical (Slow-Fast) Atrioventricular Nodal Reentrant Tachycardia | 564 | ||
| 18 Typical Atrioventricular Bypass Tracts | 599 | ||
| Outline | 599 | ||
| Types of Bypass Tracts | 599 | ||
| Atrioventricular Bypass Tracts | 599 | ||
| Atrionodal Bypass Tracts | 599 | ||
| Atrio-Hisian Bypass Tracts | 599 | ||
| Atypical Bypass Tracts | 600 | ||
| Types of Preexcitation Syndromes | 600 | ||
| 19 Atypical Bypass Tracts | 677 | ||
| Outline | 677 | ||
| “Mahaim Fibers” | 677 | ||
| “Mahaim Tachycardia” | 677 | ||
| Atypical Atrioventricular and Atriofascicular Bypass Tracts | 677 | ||
| Long Decrementally Conducting Atrioventricular and Atriofascicular Bypass Tracts | 677 | ||
| Short Decrementally Conducting Atrioventricular Bypass Tracts | 678 | ||
| Arrhythmias Associated With Atypical Atrioventricular and Atriofascicular Bypass Tracts | 678 | ||
| Supraventricular Tachycardias Requiring a Bypass Tract for Initiation and Maintenance | 678 | ||
| Supraventricular Tachycardias Not Requiring a Bypass Tract for Initiation and Maintenance | 678 | ||
| Electrocardiographic Features | 678 | ||
| Normal Sinus Rhythm | 678 | ||
| Preexcited QRS Morphology | 679 | ||
| Supraventricular Tachycardias | 679 | ||
| Electrophysiological Testing | 679 | ||
| Baseline Observations During Sinus Rhythm | 679 | ||
| Programmed atrial stimulation during sinus rhythm. | 679 | ||
| Programmed ventricular stimulation during sinus rhythm. | 679 | ||
| Response to physiological and pharmacological maneuvers. | 679 | ||
| Induction of Tachycardia | 679 | ||
| Initiation by programmed atrial stimulation. | 679 | ||
| Initiation by programmed ventricular stimulation. | 681 | ||
| Features of Tachycardia | 682 | ||
| Antidromic AVRT | 682 | ||
| Site of earliest ventricular activation. | 682 | ||
| VH interval. | 682 | ||
| Atrioventricular relationship. | 683 | ||
| Response to drugs. | 683 | ||
| Changes in TCL. | 683 | ||
| Response to RBBB. | 683 | ||
| Diagnostic Maneuvers During Tachycardia | 683 | ||
| Programmed atrial stimulation during tachycardia | 683 | ||
| Resetting. | 683 | ||
| Entrainment. | 684 | ||
| Programmed ventricular stimulation during tachycardia. | 684 | ||
| Differential Diagnosis | 684 | ||
| Mapping | 684 | ||
| Mapping the Atrial Insertion Site | 685 | ||
| Mapping the shortest atrial stimulus to the delta (S-V) interval. | 685 | ||
| AES mapping during supraventricular tachycardias. | 686 | ||
| Mapping the Ventricular Insertion Site | 686 | ||
| Mapping the distal fascicular insertion site (for atriofascicular BTs). | 686 | ||
| Mapping the distal ventricular insertion site (for slowly conducting AV BTs). | 686 | ||
| Mapping the Bypass Tract Potential | 686 | ||
| Mapping Sites of Mechanically Induced Loss of Preexcitation | 686 | ||
| Ablation | 688 | ||
| Target of Ablation | 688 | ||
| Ablation Technique | 688 | ||
| Endpoints of Ablation | 688 | ||
| Outcome | 688 | ||
| Nodofascicular and Nodoventricular Bypass Tracts | 688 | ||
| Arrhythmias Associated With Nodofascicular and Nodoventricular Bypass Tracts | 688 | ||
| Electrocardiographic Features | 689 | ||
| Electrophysiological Testing | 689 | ||
| Baseline Observations During Sinus Rhythm | 689 | ||
| Tachycardia Features | 689 | ||
| Diagnostic Maneuvers During Tachycardia | 689 | ||
| Mapping | 690 | ||
| Ablation | 690 | ||
| Fasciculoventricular Bypass Tracts | 690 | ||
| General Considerations | 690 | ||
| Electrocardiographic Features | 690 | ||
| Electrophysiological Testing | 690 | ||
| Baseline Observations During Sinus Rhythm | 690 | ||
| Programmed Atrial Stimulation | 691 | ||
| Programmed His Bundle Stimulation | 691 | ||
| Response to Pharmacological Maneuvers | 692 | ||
| Atrio-Hisian Bypass Tracts | 692 | ||
| General Considerations | 692 | ||
| Supraventricular Tachycardias in Patients With Short PR Intervals | 695 | ||
| Patients With Enhanced Atrioventricular Node Conduction | 695 | ||
| Patients With Atrio-Hisian Bypass Tracts | 695 | ||
| Electrophysiological Testing | 695 | ||
| Baseline Observations During Sinus Rhythm | 695 | ||
| Programmed Atrial Stimulation | 695 | ||
| 20 Paroxysmal Supraventricular Tachycardias | 697 | ||
| Outline | 697 | ||
| Epidemiology and Natural History | 697 | ||
| Clinical Presentation | 698 | ||
| Initial Evaluation | 699 | ||
| Principles of Management | 699 | ||
| Acute Management | 699 | ||
| Chronic Management | 701 | ||
| Catheter Ablation | 701 | ||
| Pharmacological Therapy | 701 | ||
| Electrocardiographic Features | 702 | ||
| Regularity of the Tachycardia | 702 | ||
| Atrial Activity | 702 | ||
| Atrial Rate | 702 | ||
| P Wave Morphology | 702 | ||
| Characterization of P/QRS Relationship | 703 | ||
| RP-PR Interval Ratio | 703 | ||
| Atrial-Ventricular Relationship | 703 | ||
| QRS Morphology | 703 | ||
| Effects of Interventions | 703 | ||
| Electrophysiological Testing | 703 | ||
| Baseline Observations During Sinus Rhythm | 704 | ||
| Programmed Electrical Stimulation During Sinus Rhythm | 704 | ||
| Programmed Atrial Stimulation During Sinus Rhythm | 704 | ||
| Dual AVN physiology. | 704 | ||
| Ventricular preexcitation. | 704 | ||
| Extra atrial beats. | 704 | ||
| Intraatrial reentrant beats. | 704 | ||
| Catheter-induced atrial beats. | 704 | ||
| AVN echo beats. | 704 | ||
| AV echo beats. | 704 | ||
| Programmed Ventricular Stimulation During Sinus Rhythm | 704 | ||
| Retrograde VA conduction. | 704 | ||
| Retrograde atrial activation sequence. | 705 | ||
| Retrograde dual AVN physiology. | 705 | ||
| VES during His bundle refractoriness. | 705 | ||
| Differential-site RV pacing. | 705 | ||
| VA interval. | 705 | ||
| Atrial activation sequence. | 705 | ||
| Limitations. | 705 | ||
| Retrograde RBBB during VES. | 706 | ||
| Extra ventricular beats. | 707 | ||
| Bundle branch reentrant beats. | 707 | ||
| AVN echo beats. | 707 | ||
| AV echo beats. | 707 | ||
| Intraventricular reentrant beats. | 707 | ||
| Catheter-induced ventricular beats. | 707 | ||
| Para-Hisian Pacing During Sinus Rhythm | 707 | ||
| Concept of para-Hisian pacing. | 707 | ||
| Technique of para-Hisian pacing. | 707 | ||
| Response to para-Hisian pacing. | 707 | ||
| Interpretation of results of para-Hisian pacing. | 709 | ||
| Limitations of para-Hisian pacing. | 709 | ||
| Dual-Chamber Sequential Extrastimulation During Sinus Rhythm | 709 | ||
| Induction of Tachycardia | 710 | ||
| Initiation by Programmed Atrial Stimulation | 710 | ||
| 21 Wide Complex Tachycardias | 730 | ||
| Outline | 730 | ||
| Clinical Considerations | 730 | ||
| Causes of Wide Complex Tachycardias | 730 | ||
| Clinical History | 730 | ||
| Age | 730 | ||
| Symptoms | 730 | ||
| Duration of the Arrhythmia | 730 | ||
| Presence of Underlying Heart Disease | 730 | ||
| Pacemaker or Implantable Cardioverter-Defibrillator Implantation | 731 | ||
| Medications | 731 | ||
| Physical Examination | 731 | ||
| Laboratory Testing | 732 | ||
| Pharmacological Intervention | 732 | ||
| Electrocardiographic Features | 732 | ||
| Ventricular Tachycardia Versus Aberrantly Conducted Supraventricular Tachycardia | 732 | ||
| Rate | 732 | ||
| Regularity | 732 | ||
| Atrioventricular Dissociation | 732 | ||
| Dissociated P waves. | 733 | ||
| Fusion beats. | 733 | ||
| Capture beats. | 733 | ||
| QRS Duration | 733 | ||
| QRS Axis | 734 | ||
| Precordial QRS Concordance | 734 | ||
| QRS Morphology | 734 | ||
| RBBB pattern. | 734 | ||
| Lead V1. | 735 | ||
| Lead V6. | 735 | ||
| LBBB pattern. | 735 | ||
| Lead V1. | 737 | ||
| Lead V6. | 737 | ||
| BBB during sinus rhythm. | 738 | ||
| Variation in QRS and ST-T Morphology | 738 | ||
| Algorithms for the Electrocardiographic Diagnosis of Wide Complex Tachycardia | 738 | ||
| Brugada Criteria | 739 | ||
| Step 1. | 739 | ||
| Step 2. | 739 | ||
| Step 3. | 740 | ||
| Step 4. | 740 | ||
| Griffith Algorithm | 740 | ||
| Bayesian Algorithm | 740 | ||
| Vereckei Algorithm | 740 | ||
| The aVR Algorithm | 741 | ||
| Lead II R Wave Peak Time | 741 | ||
| Ventricular Tachycardia Versus Preexcited Supraventricular Tachycardia | 742 | ||
| Step 1 | 742 | ||
| Step 2 | 742 | ||
| Step 3 | 742 | ||
| Limitations of Electrocardiographic Criteria for Diagnosis of Wide Complex Tachycardia | 742 | ||
| Electrophysiological Testing | 742 | ||
| Baseline Observations During Normal Sinus Rhythm | 742 | ||
| Induction of Tachycardia | 743 | ||
| Tachycardia Features | 743 | ||
| Atrioventricular Relationship | 743 | ||
| Oscillation in the Tachycardia Cycle Length | 743 | ||
| Atrial Activation Sequence | 743 | ||
| QRS Morphology | 743 | ||
| His Bundle–Ventricular Interval | 743 | ||
| Response to Right Bundle Branch Block | 743 | ||
| His Bundle–Right Bundle Electrogram Sequence | 743 | ||
| Effects of Adenosine | 743 | ||
| Diagnostic Maneuvers During Tachycardia | 744 | ||
| Atrial Extrastimulation | 744 | ||
| Atrial Pacing | 745 | ||
| Ventricular Extrastimulation | 745 | ||
| Ventricular Pacing | 747 | ||
| References | 747 | ||
| 22 Ventricular Arrhythmias in Ischemic Heart Disease | 748 | ||
| Outline | 748 | ||
| Classification of Ventricular Tachyarrhythmias | 748 | ||
| Classification According to Tachycardia Morphology | 748 | ||
| Classification According to Tachycardia Duration | 749 | ||
| Classification According to QRS Morphology in Lead V1 | 749 | ||
| Classification According to Tachycardia Mechanism | 749 | ||
| Pathophysiology | 749 | ||
| Mechanisms of Ventricular Arrhythmias Associated With Acute Ischemia | 749 | ||
| Phase 1: Acute Phase of Myocardial Ischemia | 750 | ||
| Phase 2: Subacute Phase of Myocardial Ischemia | 750 | ||
| Mechanisms of Ventricular Arrhythmias Associated With Healed Infarction | 750 | ||
| Epidemiology and Natural History | 751 | ||
| Premature Ventricular Complexes | 752 | ||
| Accelerated Idioventricular Rhythm | 752 | ||
| Reperfusion Arrhythmias | 752 | ||
| Nonsustained Ventricular Tachycardia | 752 | ||
| Polymorphic Ventricular Tachycardia | 752 | ||
| Ventricular Fibrillation | 752 | ||
| Sudden Cardiac Death | 752 | ||
| Sustained Monomorphic Ventricular Tachycardia | 752 | ||
| Clinical Presentation | 753 | ||
| Initial Evaluation | 753 | ||
| Evaluation of Type and Burden of Ventricular Arrhythmias | 753 | ||
| Evaluation of the Triggers of Ventricular Arrhythmias | 753 | ||
| Evaluation of Myocardial Ischemia | 753 | ||
| Role of Electrophysiological Testing | 753 | ||
| Risk Stratification | 754 | ||
| Ventricular Arrhythmias | 754 | ||
| Syncope | 754 | ||
| Left Ventricular Ejection Fraction | 754 | ||
| Invasive Electrophysiological Testing | 756 | ||
| Measures of Cardiac Repolarization | 756 | ||
| Measures of Autonomic Imbalance | 756 | ||
| Measures of Myocardial Conduction Disorders | 757 | ||
| Genetic Testing | 757 | ||
| Cardiac Magnetic Resonance Imaging | 757 | ||
| Risk Stratification Early Postinfarction | 757 | ||
| Principles of Management | 757 | ||
| Pharmacological Therapy | 757 | ||
| Acute Therapy | 757 | ||
| Chronic Therapy | 758 | ||
| Implantable Cardioverter-Defibrillator | 758 | ||
| Secondary Prevention | 758 | ||
| Primary Prevention | 759 | ||
| Catheter Ablation | 760 | ||
| Alternative Interventional Treatment | 762 | ||
| Electrocardiographic Features | 762 | ||
| Electrocardiographic Clues to the Underlying Substrate | 762 | ||
| Electrocardiographic Localization of Postinfarction Ventricular Tachycardia | 763 | ||
| QRS Duration | 763 | ||
| QRS Axis | 764 | ||
| Bundle Branch Block Pattern | 764 | ||
| Precordial Concordance | 764 | ||
| Presence of QS Complexes | 764 | ||
| Inferior Myocardial Infarction Ventricular Tachycardias | 764 | ||
| VT with LBBB morphology. | 764 | ||
| VT with RBBB morphology. | 764 | ||
| Anterior Myocardial Infarction Ventricular Tachycardias | 767 | ||
| VT with LBBB morphology. | 767 | ||
| VT with RBBB morphology. | 767 | ||
| High Posterolateral Myocardial Infarction Ventricular Tachycardias | 767 | ||
| Epicardial Ventricular Tachycardias | 767 | ||
| Electrophysiological Testing | 768 | ||
| Induction of Tachycardia | 768 | ||
| Recommended Stimulation Protocols | 768 | ||
| Number of VESs. | 768 | ||
| Pacing drive CL. | 769 | ||
| Site of ventricular stimulation. | 769 | ||
| Pacing current output. | 769 | ||
| Isoproterenol administration. | 769 | ||
| Reproducibility of Ventricular Tachycardia Initiation | 769 | ||
| Endpoints of Programmed Electrical Stimulation | 769 | ||
| Induction of clinical SMVT. | 769 | ||
| Induction of multiple SMVTs. | 769 | ||
| Induction of polymorphic VT or VF. | 770 | ||
| Induction of very fast VT. | 770 | ||
| Tachycardia Features | 770 | ||
| His Bundle Activation | 770 | ||
| No visible His potential during VT. | 770 | ||
| Visible His potential during VT. | 770 | ||
| Right Ventricular Apical Local Activation Time | 771 | ||
| Relationship of Ventricular Stimulus to the Onset of Ventricular Tachycardia | 771 | ||
| Diagnostic Maneuvers During Tachycardia | 771 | ||
| Ventricular Extrastimulation During Tachycardia | 771 | ||
| Manifest perpetuation. | 771 | ||
| Concealed perpetuation. | 771 | ||
| Resetting. | 771 | ||
| Effect of number of VESs. | 772 | ||
| Effect of site of stimulation. | 772 | ||
| Return cycle. | 772 | ||
| Resetting response curves. | 772 | ||
| Resetting with fusion. | 772 | ||
| Tachycardia termination. | 774 | ||
| Ventricular Pacing During Tachycardia | 774 | ||
| Overdrive suppression. | 774 | ||
| Tachycardia acceleration. | 774 | ||
| Tachycardia transformation. | 775 | ||
| Entrainment. | 775 | ||
| Entrainment criteria. | 775 | ||
| Entrainment with fusion. | 775 | ||
| Entrainment with manifest fusion. | 775 | ||
| Entrainment with inapparent fusion. | 775 | ||
| Entrainment with concealed fusion. | 776 | ||
| Entrainment with antidromic capture. | 777 | ||
| Tachycardia termination. | 777 | ||
| Response to Antiarrhythmic Drugs | 779 | ||
| Exclusion of Other Arrhythmia Mechanisms | 779 | ||
| Exclusion of Triggered-Activity Ventricular Tachycardia | 779 | ||
| Stimulation site specificity. | 779 | ||
| Inducibility with programmed electrical stimulation. | 779 | ||
| Reproducibility of initiation. | 779 | ||
| Relationship of ventricular stimulus to the onset of VT. | 779 | ||
| Effects of catecholamines. | 779 | ||
| Response to antiarrhythmic drugs. | 779 | ||
| Diastolic electrical activity. | 779 | ||
| Exclusion of Bundle Branch Reentrant Ventricular Tachycardia | 779 | ||
| His bundle–ventricular interval. | 779 | ||
| Oscillation of TCL. | 779 | ||
| Activation sequence. | 779 | ||
| Exclusion of Supraventricular Tachycardia | 779 | ||
| SVT with aberrancy. | 779 | ||
| Preexcited SVT. | 779 | ||
| Mapping | 780 | ||
| Preprocedural Evaluation | 780 | ||
| Optimization of Cardiac Function | 780 | ||
| Evaluation for Intracardiac Thrombi | 780 | ||
| Imaging the Arrhythmogenic Substrate | 780 | ||
| Ventriculography. | 780 | ||
| Echocardiography. | 780 | ||
| Cardiac magnetic resonance. | 780 | ||
| Positron emission tomography. | 781 | ||
| Cardiac CT. | 781 | ||
| Left Ventricular Access | 781 | ||
| Hemodynamic Support | 781 | ||
| Electroanatomic Mapping | 782 | ||
| Activation Mapping | 784 | ||
| Technique of Activation Mapping | 784 | ||
| Continuous Activity | 784 | ||
| Mid-Diastolic Activity | 786 | ||
| Limitations of Activation Mapping | 786 | ||
| Entrainment Mapping | 786 | ||
| Technique of Entrainment Mapping | 786 | ||
| Entrainment With Concealed Fusion | 787 | ||
| Postpacing Interval | 787 | ||
| Electrogram-to-QRS Interval Versus Stimulus-to-QRS Interval | 789 | ||
| Ratio of Stimulus-to-QRS Interval to Tachycardia Cycle Length | 791 | ||
| Limitations of Entrainment Mapping | 792 | ||
| Pace Mapping | 792 | ||
| Technique of Pace Mapping | 792 | ||
| QRS Morphology During Pacing Versus Tachycardia | 793 | ||
| Stimulus-to-QRS Interval During Pace Mapping | 793 | ||
| Limitations of Pace Mapping | 794 | ||
| Substrate Mapping During Baseline Rhythm | 795 | ||
| Voltage (Scar) Mapping | 795 | ||
| Technique of voltage mapping. | 796 | ||
| Abnormal Local Ventricular Electrograms | 796 | ||
| Local abnormal ventricular activity. | 796 | ||
| Late potentials. | 797 | ||
| Substrate Image Integration | 798 | ||
| PET-CT. | 799 | ||
| CMR. | 799 | ||
| Contrast-enhanced CT. | 799 | ||
| Intracardiac ultrasound. | 799 | ||
| Limitation of Substrate Mapping | 799 | ||
| Noncontact Mapping | 800 | ||
| Technique of Noncontact Mapping | 800 | ||
| Limitations of Noncontact Mapping | 801 | ||
| Mapping Postinfarction Premature Ventricular Complexes | 801 | ||
| Mapping of Epicardial Circuits | 801 | ||
| Practical Approach to Ventricular Tachycardia Mapping | 802 | ||
| Identification of the Tachycardia Substrate | 802 | ||
| Step 1: preprocedural substrate imaging. | 802 | ||
| Step 2: scar mapping during sinus rhythm. | 802 | ||
| Step 3: identification of conducting channels during sinus rhythm. | 803 | ||
| Voltage channels. | 803 | ||
| Late potentials. | 803 | ||
| S-QRS intervals. | 803 | ||
| Identification of the Critical Isthmus | 804 | ||
| Activation mapping during tachycardia. | 804 | ||
| Entrainment mapping during tachycardia. | 804 | ||
| Pace mapping during sinus rhythm. | 804 | ||
| Ablation | 805 | ||
| Target of Ablation | 805 | ||
| Selective Ablation of the Critical Isthmus of the Reentrant Circuit | 805 | ||
| Substrate-Based Ablation | 805 | ||
| Scar homogenization. | 806 | ||
| Scar dechanneling. | 806 | ||
| Core isolation. | 807 | ||
| Linear ablation. | 807 | ||
| Multiple Inducible Ventricular Tachycardias | 807 | ||
| Ablation Technique | 808 | ||
| Endpoints of Ablation | 810 | ||
| Noninducibility of All Sustained Monomorphic Ventricular Tachycardias | 810 | ||
| Noninducibility of All Clinical Ventricular Tachycardias | 810 | ||
| Elimination of the Arrhythmogenic Substrate | 810 | ||
| Management After Ablation | 810 | ||
| Outcome | 811 | ||
| Success and Recurrence | 811 | ||
| Causes of Arrhythmia Recurrence | 811 | ||
| Complications | 812 | ||
| Videos | 812 | ||
| References | 812 | ||
| 23 Idiopathic Focal Ventricular Tachycardia | 816 | ||
| Outline | 816 | ||
| Pathophysiology | 816 | ||
| Mechanism of Focal Idiopathic Ventricular Tachycardia | 818 | ||
| Mechanism of Premature Ventricular Complex-Induced Cardiomyopathy | 818 | ||
| Anatomical Considerations | 818 | ||
| Right Ventricular Outflow Tract | 818 | ||
| Pulmonary Root | 820 | ||
| Left Ventricular Outflow Tract | 820 | ||
| Aortic Root | 820 | ||
| Sinotubular Junction | 820 | ||
| Aortic Valve | 820 | ||
| Aortic Sinuses | 821 | ||
| Interleaflet Triangles | 821 | ||
| Ventriculo-Aortic Junction | 821 | ||
| Anatomical Relationships | 821 | ||
| Left Aortic Sinus of Valsalva | 821 | ||
| Right Aortic Sinus of Valsalva | 822 | ||
| Noncoronary Aortic Sinus of Valsalva | 822 | ||
| Aortomitral Continuity | 822 | ||
| Left Ventricular Summit | 822 | ||
| Left Ventricular Papillary Muscles | 822 | ||
| Cardiac Crux | 823 | ||
| Epidemiology and Natural History | 823 | ||
| Clinical Presentation | 823 | ||
| Initial Evaluation | 824 | ||
| Electrocardiography | 824 | ||
| Ambulatory Cardiac Monitoring | 824 | ||
| Exercise Electrocardiography | 824 | ||
| Cardiac Magnetic Resonance | 824 | ||
| Differential Diagnosis | 825 | ||
| Arrythmogenic Right Ventricular Cardiomyopathy | 825 | ||
| Electrocardiogram During Sinus Rhythm | 825 | ||
| Electrocardiogram During Ventricular Tachycardia | 825 | ||
| Invasive Electrophysiology Testing | 825 | ||
| Isoproterenol Testing | 825 | ||
| Cardiac Imaging | 825 | ||
| Dilated Cardiomyopathy | 825 | ||
| Idiopathic Ventricular Fibrillation | 826 | ||
| Other Arrhythmia Mechanisms | 826 | ||
| Principles of Management | 826 | ||
| Acute Management | 826 | ||
| Chronic Management | 826 | ||
| Conservative Management | 826 | ||
| Pharmacological Therapy | 826 | ||
| Catheter Ablation | 827 | ||
| Implantable Cardioverter-Defibrillator | 827 | ||
| Electrocardiographic Localization of Focal Ventricular Tachycardia | 827 | ||
| Precordial Transition | 827 | ||
| Frontal Plane Horizontal Axis | 828 | ||
| Frontal Plane Vertical Axis | 828 | ||
| Right Ventricular Outflow Tract Tachycardias | 829 | ||
| Posteromedial versus free wall RVOT. | 829 | ||
| Left (anteromedial) vs. right (posterolateral) aspect of the RVOT. | 829 | ||
| Superior vs. inferior aspect of the RVOT. | 829 | ||
| Suprapulmonic vs. subpulmonic RVOT. | 829 | ||
| Right Versus Left Ventricular Outflow Tract Tachycardias | 829 | ||
| R wave duration index. | 829 | ||
| R/S wave amplitude index. | 829 | ||
| V2 transition ratio. | 829 | ||
| V2S/V3R index. | 830 | ||
| Transitional zone index. | 830 | ||
| Aortic Root Ventricular Tachycardias | 831 | ||
| Right aortic sinus of Valsalva. | 832 | ||
| Left aortic sinus of Valsalva. | 832 | ||
| Right-left aortic sinus commissure. | 833 | ||
| Noncoronary aortic sinus of Valsalva. | 833 | ||
| Basal Left Ventricular Tachycardias | 833 | ||
| Left Ventricular Summit Tachycardias | 833 | ||
| Left Ventricular Papillary Muscle Tachycardias | 834 | ||
| Cardiac Crux Ventricular Tachycardias | 835 | ||
| Right Ventricular Papillary Muscle Tachycardias | 835 | ||
| Focal Purkinje Ventricular Tachycardias | 835 | ||
| Tricuspid Annular Ventricular Tachycardias | 835 | ||
| Electrophysiological Testing | 836 | ||
| Induction of Tachycardia | 836 | ||
| Tachycardia Features | 837 | ||
| Diagnostic Maneuvers During Tachycardia | 837 | ||
| Mapping | 837 | ||
| Activation Mapping | 837 | ||
| Pace Mapping | 840 | ||
| Technique | 840 | ||
| Interpretation | 840 | ||
| Pitfalls | 840 | ||
| Electroanatomic Mapping | 841 | ||
| Noncontact Mapping | 842 | ||
| Basket Catheter Mapping | 843 | ||
| Ablation | 843 | ||
| Target of Ablation | 843 | ||
| Ablation Technique | 843 | ||
| Ventricular Tachycardias Originating in the Right Ventricular Outflow Tract | 843 | ||
| Ventricular Tachycardias Originating in the Pulmonary Cusps | 844 | ||
| Ventricular Tachycardias Originating in the Left Ventricular Outflow Tract | 844 | ||
| Ventricular Tachycardias Originating in the Aortic Sinuses of Valsalva | 846 | ||
| Right aortic sinus of Valsalva. | 850 | ||
| Left aortic sinus of Valsalva. | 850 | ||
| Noncoronary aortic sinus of Valsalva. | 850 | ||
| Epicardial Idiopathic Ventricular Tachycardias | 851 | ||
| Ventricular Tachycardias Originating in the Left Ventricular Summit | 851 | ||
| Ventricular Tachycardias Arising From the Cardiac Crux | 851 | ||
| Ventricular Tachycardias Originating From the Left Ventricular Papillary Muscles | 852 | ||
| Para-Hisian Ventricular Tachycardias | 853 | ||
| Intramural Ventricular Tachycardias | 853 | ||
| Endpoints of Ablation | 854 | ||
| Outcome | 854 | ||
| Cryoablation | 854 | ||
| Videos | 854 | ||
| References | 855 | ||
| 24 Fascicular Ventricular Tachycardia | 858 | ||
| Outline | 858 | ||
| Pathophysiology | 858 | ||
| Tachycardia Circuit | 858 | ||
| Anatomy of the Left Fascicular System | 858 | ||
| Epidemiology | 859 | ||
| Clinical Presentation | 859 | ||
| Initial Evaluation | 859 | ||
| Principles of Management | 860 | ||
| Acute Management | 860 | ||
| Chronic Management | 860 | ||
| Electrocardiographic Features | 860 | ||
| Electrocardiogram During Normal Sinus Rhythm | 860 | ||
| Electrocardiogram During Ventricular Tachycardia | 860 | ||
| Electrophysiological Testing | 860 | ||
| Induction of Tachycardia | 860 | ||
| Diagnostic Maneuvers During Tachycardia | 861 | ||
| Entrainment | 861 | ||
| Resetting | 861 | ||
| Termination | 861 | ||
| Exclusion of Other Arrhythmia Mechanisms | 861 | ||
| Interfascicular Ventricular Tachycardia | 861 | ||
| Supraventricular Tachycardia | 861 | ||
| Papillary Muscle Ventricular Tachycardia | 861 | ||
| Focal Purkinje Ventricular Tachycardia | 861 | ||
| Mapping | 861 | ||
| Activation Mapping | 861 | ||
| Site of Earliest Ventricular Activation | 861 | ||
| Purkinje Potential | 862 | ||
| Late Diastolic Potential | 863 | ||
| Ventricular Activation Sequence | 863 | ||
| Entrainment Mapping | 863 | ||
| Pace Mapping | 863 | ||
| Electroanatomic Mapping | 864 | ||
| Noncontact Mapping | 864 | ||
| Ablation | 864 | ||
| Target of Ablation | 864 | ||
| Ablation Technique | 866 | ||
| Endpoints of Ablation | 867 | ||
| Outcome | 867 | ||
| Empirical Ablation of Noninducible Ventricular Tachycardia | 867 | ||
| References | 868 | ||
| 25 Ventricular Tachycardia in Nonischemic Dilated Cardiomyopathy | 869 | ||
| Outline | 869 | ||
| Pathophysiology | 869 | ||
| Molecular Genetics | 869 | ||
| Ventricular Arrhythmias | 870 | ||
| Epidemiology and Natural History | 871 | ||
| Initial Evaluation | 871 | ||
| Risk Stratification | 872 | ||
| Left Ventricular Ejection Fraction | 872 | ||
| Syncope | 872 | ||
| Nonsustained Ventricular Tachycardia | 872 | ||
| Electrophysiological Testing | 872 | ||
| Electrocardiographic Markers | 872 | ||
| Autonomic Testing | 872 | ||
| Microvolt T Wave Alternans | 873 | ||
| Cardiac Magnetic Resonance Imaging | 873 | ||
| Genetic Testing | 873 | ||
| Principles of Management | 873 | ||
| Pharmacological Therapy | 873 | ||
| Implantable Cardioverter-Defibrillator | 873 | ||
| Secondary Prevention | 873 | ||
| Primary Prevention | 873 | ||
| Catheter Ablation | 876 | ||
| Electrocardiographic Features | 876 | ||
| Anteroseptal Versus Inferolateral Ventricular Tachycardia | 876 | ||
| Apical Ventricular Tachycardia | 876 | ||
| Septal Ventricular Tachycardia | 876 | ||
| Epicardial Ventricular Tachycardia | 876 | ||
| Mapping | 877 | ||
| Preprocedural Evaluation | 878 | ||
| Left Ventricular Access | 878 | ||
| Hemodynamic Support | 878 | ||
| Induction of Tachycardia | 878 | ||
| Substrate Mapping | 878 | ||
| Preprocedural Substrate Imaging | 879 | ||
| Scar Mapping | 879 | ||
| Identification of Conducting Channels | 879 | ||
| Voltage channels. | 879 | ||
| Late potentials. | 879 | ||
| Activation Mapping | 882 | ||
| Entrainment Mapping | 882 | ||
| Pace Mapping | 882 | ||
| Epicardial Mapping | 883 | ||
| Ablation | 883 | ||
| Target of Ablation | 883 | ||
| Selective Ablation of the Critical Isthmus of the Reentrant Circuit | 883 | ||
| Substrate-Guided Ablation | 883 | ||
| Scar homogenization. | 884 | ||
| Scar dechanneling. | 884 | ||
| Core isolation. | 884 | ||
| Linear ablation. | 884 | ||
| Ablation Technique | 884 | ||
| Endpoints of Ablation | 884 | ||
| Noninducibility of All Monomorphic Ventricular Tachycardias | 884 | ||
| Noninducibility of All Clinical Ventricular Tachycardias | 885 | ||
| Modification of the Arrhythmogenic Substrate | 885 | ||
| Outcome | 885 | ||
| Cardiac Sarcoidosis | 885 | ||
| Pathophysiology | 885 | ||
| Epidemiology and Natural History | 886 | ||
| Clinical Presentation | 886 | ||
| Initial Evaluation | 886 | ||
| Electrocardiography | 886 | ||
| Echocardiography | 887 | ||
| Cardiac Magnetic Resonance | 887 | ||
| Positron Emission Tomography | 887 | ||
| Histological Examination | 888 | ||
| 26 Bundle Branch Reentrant Ventricular Tachycardia | 897 | ||
| Outline | 897 | ||
| Pathophysiology | 897 | ||
| Epidemiology | 897 | ||
| Clinical Presentation | 898 | ||
| Initial Evaluation | 898 | ||
| Principles of Management | 898 | ||
| Electrocardiographic Features | 898 | ||
| Baseline Electrocardiogram | 898 | ||
| Electrocardiogram During Ventricular Tachycardia | 898 | ||
| Electrophysiological Testing | 898 | ||
| Baseline Observations During Normal Sinus Rhythm | 898 | ||
| Induction of Tachycardia | 898 | ||
| Tachycardia Features | 900 | ||
| Diagnostic Maneuvers During Tachycardia | 902 | ||
| Entrainment | 902 | ||
| Resetting | 902 | ||
| Other Pacing Maneuvers | 902 | ||
| Exclusion of Other Arrhythmia Mechanisms | 902 | ||
| Myocardial Ventricular Tachycardias | 902 | ||
| Idiopathic (Fascicular) Left Ventricular Tachycardia | 902 | ||
| Supraventricular Tachycardia With Aberrancy | 903 | ||
| Antidromic Atrioventricular Reentrant Tachycardia Using an Atriofascicular Bypass Tract | 903 | ||
| Ablation | 903 | ||
| Target of Ablation | 903 | ||
| Ablation Technique | 903 | ||
| Ablation of the Right Bundle Branch | 903 | ||
| Ablation of the Left Bundle Branch | 903 | ||
| Endpoints of Ablation | 905 | ||
| Outcome | 905 | ||
| Interfascicular Reentrant Ventricular Tachycardia | 905 | ||
| References | 906 | ||
| 27 Epicardial Ventricular Tachycardia | 907 | ||
| Outline | 907 | ||
| Electrophysiological Substrate | 907 | ||
| Ischemic Cardiomyopathy | 907 | ||
| Arrhythmogenic Right Ventricular Cardiomyopathy | 908 | ||
| Nonischemic Dilated Cardiomyopathy | 908 | ||
| Idiopathic Ventricular Tachycardia | 908 | ||
| Electrocardiographic Features | 908 | ||
| Ventricular Tachycardia in Nonischemic Dilated Cardiomyopathy | 909 | ||
| Ventricular Tachycardia in Arrhythmogenic Cardiomyopathy | 909 | ||
| Idiopathic Ventricular Tachycardia | 909 | ||
| Postinfarction Ventricular Tachycardia | 910 | ||
| Clinical Considerations | 910 | ||
| Anticoagulation | 911 | ||
| Contrast-Enhanced Cardiac Magnetic Resonance | 911 | ||
| Contrast-Enhanced Computed Tomography | 912 | ||
| Navigating the Pericardial Space | 912 | ||
| Anatomical Considerations | 912 | ||
| Technical Considerations | 912 | ||
| Pericardial Adhesions | 914 | ||
| Epicardial Fat | 914 | ||
| Transthoracic Epicardial Mapping | 915 | ||
| Activation Mapping | 915 | ||
| Entrainment and Pace Mapping | 915 | ||
| Electroanatomic Substrate Mapping | 916 | ||
| Transthoracic Epicardial Ablation | 916 | ||
| Radiofrequency Ablation | 916 | ||
| Cryoablation | 918 | ||
| Complications of Transthoracic Epicardial Ablation | 918 | ||
| Pericardial Bleeding | 918 | ||
| Coronary Artery Injury | 919 | ||
| Phrenic Nerve Injury | 919 | ||
| Pericarditis | 919 | ||
| Intraabdominal Bleeding | 919 | ||
| Pneumopericardium | 920 | ||
| Pleuritis | 920 | ||
| Outcome | 920 | ||
| Transvenous Epicardial Mapping and Ablation | 920 | ||
| Anatomical Considerations | 920 | ||
| Cardiac Venous System | 920 | ||
| Left Ventricular Summit | 921 | ||
| Cardiac Crux | 921 | ||
| Technical Considerations | 922 | ||
| Outcome | 922 | ||
| Videos | 923 | ||
| References | 923 | ||
| 28 Arrhythmias in Hypertrophic Cardiomyopathy | 925 | ||
| Outline | 925 | ||
| Pathophysiology | 925 | ||
| Ventricular Hypertrophy | 925 | ||
| Diastolic Dysfunction | 925 | ||
| Left Ventricular Outflow Obstruction | 925 | ||
| Myocardial Ischemia | 926 | ||
| Ventricular Arrhythmias | 926 | ||
| Molecular Genetics | 926 | ||
| Epidemiology and Natural History | 927 | ||
| Clinical Presentation | 929 | ||
| Heart Failure | 929 | ||
| Left Ventricular Outflow Obstruction | 929 | ||
| Myocardial Ischemia | 929 | ||
| Syncope | 929 | ||
| Atrial Fibrillation | 929 | ||
| Ventricular Arrhythmias | 929 | ||
| Initial Evaluation | 930 | ||
| Electrocardiography | 930 | ||
| Ambulatory Cardiac Monitoring | 930 | ||
| Echocardiography | 930 | ||
| Exercise Testing | 930 | ||
| Electrophysiological Testing | 930 | ||
| Cardiac Magnetic Resonance | 930 | ||
| Genetic Testing | 931 | ||
| Differential Diagnosis | 932 | ||
| Phenocopies of Hypertrophic Cardiomyopathy | 932 | ||
| Athlete’s Heart | 933 | ||
| Demographics | 933 | ||
| Electrocardiography | 934 | ||
| Echocardiography | 934 | ||
| Cardiac Magnetic Resonance | 934 | ||
| Cardiopulmonary Exercise Testing | 934 | ||
| Genetic Testing | 935 | ||
| Deconditioning | 935 | ||
| Risk Stratification | 935 | ||
| Established Risk Markers | 935 | ||
| Cardiac Arrest/Sustained Ventricular Arrhythmias | 935 | ||
| Nonsustained Ventricular Tachycardia | 935 | ||
| Family History of Sudden Death | 935 | ||
| Syncope | 935 | ||
| Extreme Left Ventricular Hypertrophy | 935 | ||
| Abnormal Blood Pressure Response to Exercise | 936 | ||
| Possible Risk Modifiers | 936 | ||
| End-Stage Hypertrophic Cardiomyopathy | 936 | ||
| Left Ventricular Apical Aneurysm | 936 | ||
| Previous Alcohol Septal Ablation | 936 | ||
| Extensive Late Gadolinium Enhancement | 936 | ||
| Left Ventricular Outflow Obstruction | 936 | ||
| Genetic Testing | 936 | ||
| Age at Diagnosis | 936 | ||
| Conventional Risk Stratification Model | 937 | ||
| “HCM Risk-SCD” Model | 937 | ||
| Principles of Management | 938 | ||
| Treatment of Heart Failure and Left Ventricular Outflow Obstruction | 938 | ||
| 29 Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy | 942 | ||
| Outline | 942 | ||
| Pathophysiology | 942 | ||
| Molecular Genetics | 942 | ||
| Pathogenesis | 943 | ||
| Pathology | 945 | ||
| Epidemiology and Natural History | 945 | ||
| Clinical Presentation | 946 | ||
| Phases of Clinical Disease Expression | 946 | ||
| Ventricular Arrhythmias | 946 | ||
| Supraventricular Arrhythmias | 946 | ||
| Thromboembolism | 946 | ||
| Initial Evaluation | 946 | ||
| Diagnostic Criteria | 946 | ||
| Endomyocardial Biopsy | 948 | ||
| Genetic Testing | 948 | ||
| Invasive Electrophysiological Testing | 948 | ||
| Differential Diagnosis | 948 | ||
| Idiopathic Right Ventricular Outflow Tract Tachycardia | 948 | ||
| Electrocardiogram During Sinus Rhythm | 948 | ||
| Electrocardiogram During Ventricular Tachycardia | 948 | ||
| Invasive Electrophysiological Testing | 949 | ||
| Isoproterenol Testing | 949 | ||
| Cardiac Imaging | 949 | ||
| Cardiac Sarcoidosis | 949 | ||
| Dilated Cardiomyopathy | 950 | ||
| Athlete’s Heart | 950 | ||
| Exercise-Induced Arrythmogenic Right Ventricular Cardiomyopathy | 950 | ||
| Risk Stratification | 950 | ||
| Principles of Management | 950 | ||
| Pharmacological Therapy | 950 | ||
| Beta-Blockers | 950 | ||
| Antiarrhythmic Drugs | 951 | ||
| Heart Failure Therapy | 951 | ||
| Anticoagulation Therapy | 951 | ||
| Catheter Ablation | 952 | ||
| Implantable Cardioverter-Defibrillator | 952 | ||
| Participation in Sports | 953 | ||
| Family Screening | 953 | ||
| Electrocardiographic Features | 954 | ||
| Electrocardiogram During Sinus Rhythm | 954 | ||
| Repolarization Abnormalities | 954 | ||
| Depolarization Abnormalities | 954 | ||
| Epsilon wave. | 954 | ||
| Right bundle branch block. | 956 | ||
| Localized prolongation of QRS duration. | 956 | ||
| Prolongation of S wave upstroke. | 956 | ||
| Prolonged terminal activation duration. | 957 | ||
| QRS fragmentation. | 957 | ||
| Late potentials. | 957 | ||
| Electrocardiogram During Ventricular Tachycardia | 957 | ||
| Electrophysiological Features | 957 | ||
| Induction of Tachycardia | 957 | ||
| Tachycardia Features | 957 | ||
| Mapping | 959 | ||
| Activation Mapping | 959 | ||
| Entrainment Mapping | 959 | ||
| Pace Mapping | 960 | ||
| Substrate Mapping | 960 | ||
| Preprocedural Substrate Imaging | 960 | ||
| Scar Mapping | 960 | ||
| Identification of Conducting Channels | 961 | ||
| Voltage channels. | 962 | ||
| Late potentials. | 962 | ||
| Epicardial Mapping | 962 | ||
| Ablation | 962 | ||
| Target of Ablation | 962 | ||
| Selective Ablation of the Critical Isthmus of the Reentrant Circuit | 962 | ||
| Substrate-Based Ablation | 964 | ||
| Ablation of Premature Ventricular Complexes | 964 | ||
| Ablation Technique | 964 | ||
| Endpoints of Ablation | 964 | ||
| Outcome | 964 | ||
| References | 965 | ||
| 30 Ventricular Arrhythmias in Adults With Congenital Heart Disease | 968 | ||
| Outline | 968 | ||
| Pathophysiology | 968 | ||
| Epidemiology and Natural History | 968 | ||
| Initial Evaluation | 969 | ||
| Risk Stratification | 969 | ||
| Noninvasive Risk Stratification | 969 | ||
| Electrophysiological Testing | 970 | ||
| Principles of Management | 970 | ||
| Implantable Cardioverter-Defibrillator | 970 | ||
| Secondary Prevention | 970 | ||
| Primary Prevention | 970 | ||
| Antiarrhythmic Drug Therapy | 970 | ||
| Surgical Repair and Ablation | 971 | ||
| Catheter Ablation | 971 | ||
| Electrocardiographic Features | 971 | ||
| Mapping | 972 | ||
| Vascular and Cardiac Access | 972 | ||
| Identification of Barriers and Potential Lines of Block | 972 | ||
| Identification of the Critical Isthmus | 972 | ||
| Ablation | 973 | ||
| Target of Ablation | 973 | ||
| Ablation Technique | 974 | ||
| Endpoints of Ablation | 974 | ||
| Tachycardia Termination | 974 | ||
| Noninducibility of Tachycardia | 974 | ||
| Documentation of a Line of Block | 974 | ||
| Outcome | 974 | ||
| References | 974 | ||
| 31 Ventricular Arrhythmias in Inherited Channelopathies | 976 | ||
| Outline | 976 | ||
| Long QT Syndrome | 976 | ||
| Genetics of the Long QT Syndrome | 977 | ||
| Mutations Related to the Potassium Current | 977 | ||
| Mutations related to the slowly activating delayed rectifier potassium current. | 977 | ||
| Mutations related to the rapidly activating delayed rectifier potassium current. | 979 | ||
| Mutations related to the inward rectifier potassium current. | 979 | ||
| Mutations related to the acetylcholine-activated potassium current. | 979 | ||
| Mutations Related to the Sodium Current | 979 | ||
| Mutations Related to the Calcium Current | 979 | ||
| Mutations related to the L-type calcium current. | 979 | ||
| Mutations related to calmodulin (calmodulinopathy). | 980 | ||
| Mutations related to triadin: triadin knockout syndrome. | 980 | ||
| Mutations in the Ankyrin-B Gene: Ankyrin-B Syndrome | 980 | ||
| Pathophysiology of the Long QT Syndrome | 980 | ||
| Mechanism of QT Interval Prolongation | 980 | ||
| Mechanism of Dispersion of Repolarization | 980 | ||
| Mechanism of Torsades de Pointes | 981 | ||
| Mechanism of Exercise-Induced QT Interval Changes | 981 | ||
| Mechanism of Genotype-Phenotype Variability | 982 | ||
| Mechanism of Gender Effects | 982 | ||
| Epidemiology | 983 | ||
| Clinical Presentation and Natural Course | 983 | ||
| Romano-Ward Syndrome | 983 | ||
| Jervell and Lange-Nielsen Syndrome | 985 | ||
| Andersen-Tawil Syndrome | 985 | ||
| Timothy Syndrome | 985 | ||
| Electrocardiographic Features | 985 | ||
| QT Interval Measurement | 985 | ||
| QT Interval Correction for Gender | 986 | ||
| QT Interval Correction for Heart Rate | 986 | ||
| QT Interval Correction to QRS Duration | 987 | ||
| QT Interval Measurement During Right Ventricular Pacing | 987 | ||
| QT Interval Prolongation | 987 | ||
| T Wave Morphology | 988 | ||
| Torsades de Pointes | 989 | ||
| Dispersion of Repolarization | 989 | ||
| Tp-e interval. | 989 | ||
| QT interval dispersion. | 989 | ||
| U wave–to–T wave amplitude ratio. | 989 | ||
| Diagnosis of the Long QT Syndrome | 989 | ||
| Clinical Scoring Systems | 990 | ||
| Ambulatory Cardiac Monitoring | 990 | ||
| QT Interval Response to Abrupt Standing | 990 | ||
| QT Interval Response to Exercise | 991 | ||
| Epinephrine QT Stress Test | 991 | ||
| Genetic Testing | 992 | ||
| Differential Diagnosis: Acquired Long QT Syndrome | 992 | ||
| Etiology | 992 | ||
| Risk Factors of Drug-Induced Long QT Syndrome | 993 | ||
| Genetics | 993 | ||
| Management | 994 | ||
| Risk Stratification | 994 | ||
| Clinical Markers of Risk | 994 | ||
| Syncope. | 994 | ||
| Family history. | 994 | ||
| Gender. | 994 | ||
| Age. | 994 | ||
| Electrocardiographic Markers of Risk | 995 | ||
| QT interval prolongation. | 995 | ||
| T-U wave morphology. | 996 | ||
| Genetic Markers of Risk | 996 | ||
| Principles of Management | 996 | ||
| Pharmacological Therapy | 996 | ||
| Implantable Cardioverter-Defibrillator | 997 | ||
| Left Cervicothoracic Sympathectomy | 999 | ||
| Permanent Pacemaker | 999 | ||
| Catheter Ablation | 999 | ||
| Lifestyle Modifications | 999 | ||
| Participation in Sports | 999 | ||
| Gene-Specific Therapy | 1000 | ||
| LQT3. | 1000 | ||
| LQT2. | 1000 | ||
| Family Screening | 1000 | ||
| Brugada Syndrome | 1000 | ||
| Genetics of the Brugada Syndrome | 1000 | ||
| Mutations Related to the Sodium Current | 1000 | ||
| Mutations Related to the Calcium Current | 1001 | ||
| Mutations Related to the Potassium Current | 1001 | ||
| Other Candidate Genes | 1002 | ||
| Pathophysiology of the Brugada Syndrome | 1002 | ||
| Repolarization Hypothesis | 1002 | ||
| Depolarization Hypothesis | 1002 | ||
| Mechanism of Ventricular Arrhythmias | 1002 | ||
| Mechanism of Age and Gender Effects | 1002 | ||
| Mechanism of Temperature Sensitivity | 1003 | ||
| Mechanism of Exercise-Induced Changes | 1004 | ||
| Mechanism of Drug Effects | 1004 | ||
| Epidemiology | 1004 | ||
| Clinical Presentation | 1004 | ||
| Electrocardiographic Features | 1005 | ||
| Brugada Electrocardiogram Patterns | 1005 | ||
| Electrocardiogram Electrode Locations | 1006 | ||
| Dynamicity of the Brugada Pattern | 1006 | ||
| QT Interval Prolongation | 1007 | ||
| QRS Fragmentation | 1007 | ||
| Conduction Abnormalities | 1007 | ||
| Diagnosis of the Brugada Syndrome | 1008 | ||
| Provocative Drug Testing | 1008 | ||
| Signal-Averaged Electrocardiography | 1009 | ||
| Exercise Testing | 1009 | ||
| Genetic Testing | 1009 | ||
| Electrophysiological Testing | 1009 | ||
| Differential Diagnosis | 1009 | ||
| Acquired Brugada Phenotype | 1009 | ||
| Drug-Induced Brugada Electrocardiogram Pattern | 1010 | ||
| Conditions Associated With Right Precordial ST Elevation | 1011 | ||
| Right bundle branch block. | 1011 | ||
| Healthy athletes. | 1011 | ||
| Pectus excavatum. | 1011 | ||
| Arrhythmogenic right ventricular cardiomyopathy. | 1011 | ||
| Risk Stratification | 1011 | ||
| Cardiac Arrest | 1012 | ||
| Syncope | 1012 | ||
| Gender | 1012 | ||
| Family History | 1012 | ||
| Genotype | 1012 | ||
| Invasive Electrophysiological Testing | 1012 | ||
| Electrocardiographic Parameters | 1012 | ||
| Type 1 Brugada ECG pattern. | 1012 | ||
| Type 2 Brugada ECG pattern. | 1013 | ||
| Early repolarization. | 1013 | ||
| Interval between the peak and the end of the T wave. | 1013 | ||
| S wave in lead I. | 1013 | ||
| aVR sign. | 1013 | ||
| Other ECG markers. | 1013 | ||
| Signal-Averaged Electrocardiogram | 1013 | ||
| Principles of Management | 1013 | ||
| Implantable Cardioverter-Defibrillator | 1013 | ||
| Catheter Ablation | 1014 | ||
| Pharmacological Therapy | 1014 | ||
| Ito blockade. | 1014 | ||
| ICaL augmentation. | 1015 | ||
| INa augmentation. | 1015 | ||
| Lifestyle Modifications | 1015 | ||
| Participation in Sports | 1015 | ||
| Family Screening | 1017 | ||
| Short QT Syndrome | 1017 | ||
| Genetics of the Short QT Syndrome | 1017 | ||
| Mutations Related to the Potassium Current | 1017 | ||
| Mutations Related to the Calcium Current | 1018 | ||
| Pathophysiology of Short QT Syndrome | 1018 | ||
| Epidemiology | 1018 | ||
| Clinical Presentation | 1018 | ||
| Electrocardiographic Features | 1018 | ||
| Diagnosis of the Short QT Syndrome | 1019 | ||
| Electrophysiology Testing | 1019 | ||
| Genetic Testing | 1019 | ||
| Differential Diagnosis | 1019 | ||
| Risk Stratification | 1019 | ||
| Principles of Management | 1019 | ||
| Implantable Cardioverter-Defibrillator | 1019 | ||
| Pharmacological Therapy | 1020 | ||
| Participation in Sports | 1020 | ||
| Catecholaminergic Polymorphic Ventricular Tachycardia | 1020 | ||
| Genetics of Catecholaminergic Polymorphic Ventricular Tachycardia | 1020 | ||
| Pathophysiology of Catecholaminergic Polymorphic Ventricular Tachycardia | 1020 | ||
| Mechanism of Ventricular Arrhythmias | 1020 | ||
| Mechanism of the Bidirectional Morphology of Ventricular Tachycardia | 1021 | ||
| Mechanism of Drug Effects | 1022 | ||
| Epidemiology | 1022 | ||
| Clinical Presentation | 1022 | ||
| Electrocardiographic Features | 1022 | ||
| Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia | 1022 | ||
| Exercise Stress Testing | 1023 | ||
| Ambulatory Cardiac Monitoring | 1023 | ||
| Provocative Drug Testing | 1023 | ||
| Electrophysiological Testing | 1023 | ||
| Genetic Testing | 1023 | ||
| Differential Diagnosis | 1024 | ||
| Risk Stratification | 1024 | ||
| Principles of Management | 1024 | ||
| Pharmacological Therapy | 1024 | ||
| Beta-blockers. | 1024 | ||
| Flecainide. | 1024 | ||
| Verapamil. | 1024 | ||
| Implantable Cardioverter-Defibrillator | 1025 | ||
| Catheter Ablation | 1025 | ||
| Left Cervicothoracic Sympathectomy | 1025 | ||
| Participation in Sports | 1025 | ||
| Family Screening | 1025 | ||
| Idiopathic Ventricular Fibrillation | 1025 | ||
| Genetics of Idiopathic Ventricular Fibrillation | 1025 | ||
| Pathophysiology of Idiopathic Ventricular Fibrillation | 1026 | ||
| Epidemiology | 1026 | ||
| Clinical Presentation | 1026 | ||
| Electrocardiographic Features | 1026 | ||
| Diagnosis of Idiopathic Ventricular Fibrillation | 1026 | ||
| Exclusion of Structural Heart Disease | 1027 | ||
| Exclusion of Primary Arrhythmia Syndromes | 1027 | ||
| Electrophysiological Testing | 1027 | ||
| Genetic Testing | 1028 | ||
| Principles of Management | 1028 | ||
| Pharmacological Therapy | 1028 | ||
| Implantable Cardioverter-Defibrillator | 1028 | ||
| Catheter Ablation | 1028 | ||
| Participation in Sports | 1029 | ||
| Periodic Evaluation | 1029 | ||
| Family Screening | 1029 | ||
| Early Repolarization Syndromes | 1029 | ||
| Genetics of Early Repolarization Syndrome | 1029 | ||
| Pathophysiology of Early Repolarization Syndromes | 1030 | ||
| Mechanism of Early Repolarization and J Waves | 1030 | ||
| Mechanism of Arrhythmogenesis | 1030 | ||
| Modulation of Early Repolarization Pattern | 1030 | ||
| Epidemiology | 1031 | ||
| Clinical Presentation | 1031 | ||
| Electrocardiographic Features | 1031 | ||
| Terminology | 1031 | ||
| Definition | 1031 | ||
| Localization of Early Repolarization | 1033 | ||
| Diagnosis of Early Repolarization Syndrome | 1034 | ||
| Differential Diagnosis | 1034 | ||
| Risk Stratification | 1034 | ||
| J Wave Amplitude | 1035 | ||
| J Wave Distribution | 1036 | ||
| J Wave Morphology | 1036 | ||
| J Wave Amplitude Fluctuation | 1036 | ||
| ST Segment and T Wave Morphology | 1036 | ||
| Short-Coupled Premature Ventricular Complexes | 1036 | ||
| Syncope | 1036 | ||
| Family History | 1037 | ||
| Coexisting Arrhythmia Syndromes | 1037 | ||
| Exercise Testing | 1037 | ||
| Invasive Electrophysiological Testing | 1037 | ||
| Genetic Screening | 1037 | ||
| Principles of Management | 1037 | ||
| Patients With Early Repolarization Syndrome | 1037 | ||
| Syncope Patients With Early Repolarization Pattern | 1037 | ||
| Asymptomatic Patients With Early Repolarization Pattern | 1037 | ||
| Participation in Sports | 1037 | ||
| Family Screening | 1037 | ||
| Videos | 1038 | ||
| References | 1038 | ||
| 32 Complications of Catheter Ablation of Cardiac Arrhythmias | 1042 | ||
| Outline | 1042 | ||
| Local Vascular Complications | 1042 | ||
| Incidence | 1042 | ||
| Detection and Management | 1042 | ||
| Hematomas | 1042 | ||
| Pseudoaneurysms | 1043 | ||
| Arteriovenous Fistulas | 1043 | ||
| Vascular Thromboembolism | 1043 | ||
| Prevention | 1043 | ||
| Cardiac Perforation | 1043 | ||
| Incidence | 1043 | ||
| Mechanism | 1044 | ||
| Detection | 1044 | ||
| Management | 1045 | ||
| Pericardiocentesis | 1045 | ||
| Surgical Repair | 1045 | ||
| Thromboembolism | 1046 | ||
| Mechanism | 1046 | ||
| Prevention | 1046 | ||
| Air Embolism | 1047 | ||
| Mechanism | 1047 | ||
| Clinical Presentation | 1047 | ||
| Detection | 1047 | ||
| Prevention | 1047 | ||
| Management | 1047 | ||
| Coronary Artery Injuries | 1048 | ||
| Mechanism | 1048 | ||
| Clinical Presentation | 1048 | ||
| Prevention | 1048 | ||
| Iatrogenic Cardiac Arrhythmias | 1049 | ||
| Atrioventricular Block | 1049 | ||
| Macroreentrant Atrial Tachycardias | 1049 | ||
| Ventricular Arrhythmias | 1049 | ||
| Abnormal Sinus Node Function | 1049 | ||
| Valvular Damage | 1050 | ||
| Phrenic Nerve Injury | 1051 | ||
| Clinical Presentation | 1051 | ||
| Prevention | 1051 | ||
| Avoiding Ablation in Close Proximity to the Phrenic Nerve | 1051 | ||
| Monitoring Phrenic Nerve Function During Ablation | 1052 | ||
| Percutaneous Displacement of the Phrenic Nerve | 1054 | ||
| Pulmonary Vein Stenosis | 1054 | ||
| Incidence | 1054 | ||
| Mechanism | 1055 | ||
| Clinical Presentation | 1056 | ||
| Detection | 1056 | ||
| Prevention | 1056 | ||
| Management | 1056 | ||
| Esophageal Injury | 1056 | ||
| Incidence | 1056 | ||
| Mechanism | 1057 | ||
| Clinical Presentation | 1057 | ||
| Detection | 1058 | ||
| Management | 1058 | ||
| Prevention | 1058 | ||
| Avoiding Ablation in the Vicinity of the Esophagus | 1059 | ||
| Assessment of Esophageal Location | 1059 | ||
| Mechanical Displacement of the Esophagus | 1061 | ||
| Luminal Esophageal Temperature Monitoring | 1061 | ||
| Limiting Ablation Energy | 1061 | ||
| Prophylactic Proton Pump Inhibitors | 1062 | ||
| Radiation Exposure | 1062 | ||
| Biological Effects of Ionizing Radiation | 1062 | ||
| Nomenclature of Radiation Quantities and Units | 1062 | ||
| Fluoroscopy Time | 1062 | ||
| Air Kerma | 1062 | ||
| Peak Skin Dose | 1062 | ||
| Absorbed Dose | 1062 | ||
| Equivalent Dose | 1063 | ||
| Effective Dose | 1063 | ||
| Exposure to Ionizing Radiation During Electrophysiology Procedures | 1063 | ||
| Clinical Presentation | 1063 | ||
| Radiation-Induced Skin Injury | 1063 | ||
| Radiation-Induced Cataract | 1064 | ||
| Radiation-Induced Cardiovascular Disease | 1064 | ||
| Radiation-Induced Carcinogenesis | 1064 | ||
| Prevention | 1064 | ||
| Reduction of Radiation Exposure | 1064 | ||
| Radiation Dosimetry | 1064 | ||
| Videos | 1065 | ||
| References | 1065 | ||
| Index | 1068 | ||
| A | 1068 | ||
| B | 1076 | ||
| C | 1077 | ||
| D | 1081 | ||
| E | 1081 | ||
| F | 1084 | ||
| G | 1085 | ||
| H | 1085 | ||
| I | 1086 | ||
| J | 1088 | ||
| K | 1088 | ||
| L | 1088 | ||
| M | 1089 | ||
| N | 1091 | ||
| O | 1091 | ||
| P | 1092 | ||
| Q | 1094 | ||
| R | 1095 | ||
| S | 1097 | ||
| T | 1099 | ||
| U | 1100 | ||
| V | 1101 | ||
| W | 1104 | ||
| Y | 1104 | ||
| Z | 1104 | ||
| Endsheet 7 | IBC1 |