BOOK
Normal Electrophysiology, Substrates, and the Electrocardiographic Diagnosis of Cardiac Arrhythmias: Part I, An Issue of the Cardiac Electrophysiology Clinics, E-Book
Luigi Padeletti | Giuseppe Bagliani
(2017)
Additional Information
Book Details
Abstract
This issue of Cardiac Electrophysiology Clinics, edited by Drs. Luigi Padeletti and Giuseppe Bagliani, will cover the latest in Normal Electrophysiology, Substrates, and the Electrocardiographic Diagnosis of Cardiac Arrhythmias. Topics covered in this issue include History of Arrhythmias; P wave and arrhythmias originating in the atria; PQ interval and Junctional zone; QRS complex; Ventricular repolarization during arrhythmias; Classification and specific electrocardiographic pattern of Cardiac Arrhythmias; and Electrocardiographic practice of cardiac arrhythmias.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| CARDIAC ELECTROPHYSIOLOGY CLINICS\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITORS | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | v | ||
| Foreword: On the Shoulder of Giants\r | v | ||
| Preface: Normal Electrophysiology, Substrates, and the Electrocardiographic Diagnosis of Cardiac Arrhythmias | v | ||
| Arrhythmias in the History: Lovesickness | v | ||
| General Introduction, Classification, and Electrocardiographic Diagnosis of Cardiac Arrhythmias | v | ||
| P Wave and the Substrates of Arrhythmias Originating in the Atria | v | ||
| Arrhythmias Originating in the Atria | v | ||
| PR Interval and Junctional Zone | vi | ||
| Arrhythmias Involving the Atrioventricular Junction | vi | ||
| The QRS Complex: Normal Activation of the Ventricles | vi | ||
| General Approach to a Wide QRS Complex | vi | ||
| Normal Ventricular Repolarization and QT Interval: Ionic Background, Modifiers, and Measurements | vii | ||
| CARDIAC ELECTROPHYSIOLOGY CLINICS\r | viii | ||
| FORTHCOMING ISSUES | viii | ||
| December 2017 | viii | ||
| March 2018 | viii | ||
| June 2018 | viii | ||
| RECENT ISSUES | viii | ||
| June 2017 | viii | ||
| March 2017 | viii | ||
| December 2016 | viii | ||
| Foreword:\rOn the Shoulder of Giants | ix | ||
| Preface:\rNormal Electrophysiology, Substrates, and the Electrocardiographic Diagnosis of Cardiac Arrhythmias | xi | ||
| Arrhythmias in the History | 341 | ||
| Key points | 341 | ||
| CLASSICAL TIMES | 341 | ||
| MIDDLE AGES | 342 | ||
| MODERN ART | 342 | ||
| MODERN INSTRUMENTS | 343 | ||
| REFERENCES | 344 | ||
| General Introduction, Classification, and Electrocardiographic Diagnosis of Cardiac Arrhythmias | 345 | ||
| Key points | 345 | ||
| THE NORMAL CARDIAC RHYTHM | 345 | ||
| THE ELECTROCARDIOGRAPH AS A TOOL FOR DETECTION OF THE ELECTRICITY OF THE HEART: “CONDUCTION” AND “CONTRACTION” CURRENTS | 346 | ||
| Dispersion of Electrical Charges to the Body Surface | 346 | ||
| Fusion of the Currents Produced by Various Structures | 346 | ||
| Morphology of the Signals | 346 | ||
| THE STANDARD ELECTROCARDIOGRAM | 348 | ||
| Units of Measurement in Electrocardiography | 348 | ||
| Unit of Amplitude of the Signals | 348 | ||
| Unit of Time | 349 | ||
| Meaning and the Practical Usefulness of the Electrocardiogram Leads | 349 | ||
| The Cardiac Axis on the Frontal and Horizontal Plane | 349 | ||
| Cardiac axis on the horizontal plane | 349 | ||
| Cardiac axis on the horizontal plane | 350 | ||
| The D2 Lead and Atrial Activation as a Whole | 351 | ||
| The V1 Lead and Ventricular Activation | 351 | ||
| HOW TO SEARCH FOR THE INDIVIDUAL POINTS TO DEFINE THE CRITERIA OF NORMALITY IN A STANDARD 12-LEAD ELECTROCARDIOGRAM | 351 | ||
| Analysis of the Basal Electrocardiogram | 353 | ||
| SYSTEMS FOR ALTERNATIVE AND COMPLEMENTARY ELECTROCARDIOGRAPHIC DETECTION | 353 | ||
| The Endocavitary Electrocardiogram | 353 | ||
| The Endoesophageal Electrocardiogram | 354 | ||
| Bipolar Chest Lead | 355 | ||
| Devices and Implanted Loop Recorders | 355 | ||
| THE GREAT CHALLENGE OF THE ELECTROCARDIOGRAPHY: IDENTIFYING THE ELECTROGENETIC MECHANISMS OF CARDIAC ARRHYTHMIAS | 355 | ||
| Bradycardias | 355 | ||
| Automatic Arrhythmias | 355 | ||
| Reentrant Arrhythmias | 355 | ||
| ELECTROCARDIOGRAPHIC PATTERNS OF ACTIVATION OF CARDIAC ARRHYTHMIAS | 356 | ||
| Bradycardia | 356 | ||
| Escaping Beat | 356 | ||
| Extrasystolic Beat | 356 | ||
| Tachycardia | 356 | ||
| Flutter | 357 | ||
| Fibrillation | 357 | ||
| ANATOMIC AND ELECTROPHYSIOLOGIC CLASSIFICATION OF CARDIAC ARRHYTHMIAS | 357 | ||
| Atria | 357 | ||
| Atrioventricular Junction | 358 | ||
| Supraventricular and Ventricular Origin of the Rhythm | 358 | ||
| Ventricles | 358 | ||
| ELECTROCARDIOGRAPHIC SUMMARY OF CARDIAC ARRHYTHMIAS | 358 | ||
| Bradycardias | 358 | ||
| Extrasystoles | 359 | ||
| Tachycardia | 359 | ||
| THE LADDERGRAM: A RATIONAL APPROACH TO THE ELECTROCARDIOGRAPHY OF THE ARRHYTHMIAS | 359 | ||
| Analysis of the QRS Complexes | 359 | ||
| QRS duration | 359 | ||
| QRS morphology | 360 | ||
| Rhythmicity of the QRS complexes | 360 | ||
| Analysis of the P Waves | 360 | ||
| Identification of P waves | 360 | ||
| P wave morphology | 361 | ||
| The Relationship Between P Waves and QRS Complexes | 361 | ||
| Effect of Vagal Maneuvers (and Drugs Equivalent) on the Atrioventricular Ratio | 362 | ||
| REFERENCES | 362 | ||
| P Wave and the Substrates of Arrhythmias Originating in the Atria | 365 | ||
| Key points | 365 | ||
| INTRODUCTION | 365 | ||
| SINUS ATRIAL NODE | 366 | ||
| Sinoatrial Node Central Zone | 366 | ||
| Paranodal Zone and Atrial Connection | 367 | ||
| ATRIAL ACTIVATION AND NORMAL P WAVE | 367 | ||
| Normal P Wave Characteristics | 368 | ||
| IMPAIRED ATRIAL CONDUCTION OF THE SINUS NODE DEPOLARIZATION | 368 | ||
| Impaired Interatrial Conduction and Anomaly of the Left Atrial Activation | 369 | ||
| Right Atrial Activation Anomalies | 371 | ||
| ECTOPIC P WAVE | 371 | ||
| RETROGRADE ACTIVATION OF THE ATRIA | 371 | ||
| WANDERING PACEMAKER | 372 | ||
| PACED P WAVE | 374 | ||
| ELECTROCARDIOGRAM AND ALTERNATIVE METHODS FOR THE STUDY OF ATRIAL ACTIVATION | 374 | ||
| Vectorcardiography | 374 | ||
| Esophageal Recording | 374 | ||
| THE SUBSTRATES OF ATRIAL ARRHYTHMIAS: CORRELATION BETWEEN SPECIAL STRUCTURAL BASES AND THE POTENTIAL DEVELOPMENT OF ARRHYTHMIAS | 377 | ||
| Ionic Channels, Anatomic Structures, and Innervation | 377 | ||
| Cardiac Nervous System | 377 | ||
| Automaticity | 378 | ||
| Re-entry | 379 | ||
| REFERENCES | 380 | ||
| Arrhythmias Originating in the Atria | 383 | ||
| Key points | 383 | ||
| INTRODUCTION | 383 | ||
| ECG and Electrophysiology: The Advantage of Intracardiac Recordings | 383 | ||
| From Intracardiac Recording to Surface ECG: A Confirmation of Arrhythmia's Mechanisms | 385 | ||
| Radiofrequency Ablation as Complicating Factor | 388 | ||
| How to Use the ECG in the Era of Ablation | 390 | ||
| ATRIAL FLUTTER | 390 | ||
| Introduction | 390 | ||
| Classification of Atrial Flutter | 390 | ||
| ECG characteristics | 390 | ||
| Isthmus-dependent and non–isthmus-dependent atrial flutter | 390 | ||
| Isthmus Dependent Atrial Flutter or Typical Atrial Flutter | 391 | ||
| Counterclockwise flutter | 391 | ||
| Clockwise flutter | 392 | ||
| Left atrial activation in typical atrial flutter | 393 | ||
| ECG variants of isthmus-dependent flutter | 395 | ||
| Non Isthmus Dependent Atrial Flutter | 397 | ||
| Upper loop reentry | 397 | ||
| Scar-related flutters | 397 | ||
| Right atrium scar-related atrial flutter | 398 | ||
| Left atrial scar-related atrial flutter | 398 | ||
| How to Read a Flutter ECG | 399 | ||
| ATRIAL TACHYCARDIAS | 400 | ||
| Automatic Atrial Tachycardia | 400 | ||
| Sinus Node Reentry | 401 | ||
| Scar-Related Atrial Tachycardia | 401 | ||
| ATRIAL FIBRILLATION | 403 | ||
| Atrial Activation in Atrial Fibrillation | 403 | ||
| Ventricular Response of Atrial Fibrillation | 406 | ||
| Electrocardiographic Classification | 406 | ||
| Mechanisms of Atrial Fibrillation Analyzed by 12-Lead ECG | 408 | ||
| REFERENCES | 408 | ||
| PR Interval and Junctional Zone | 411 | ||
| Key points | 411 | ||
| INTRODUCTION | 411 | ||
| THE PR INTERVAL | 411 | ||
| ANATOMY OF THE ATRIOVENTRICULAR JUNCTION | 412 | ||
| ELECTROPHYSIOLOGY OF THE ATRIOVENTRICULAR JUNCTION | 414 | ||
| PR Variation, the Result of Preferential and Concealed Conduction | 414 | ||
| Continuous Conduction: Progressive PR Prolongation and Wenckebach Periodicity as a Paraphysiologic Phenomenon | 415 | ||
| Discontinuous Conduction: Dual Pathway and the Substrate of Nodal Re-entry | 417 | ||
| Retrograde Conduction in the Atrioventricular Junction | 419 | ||
| CARDIAC PRE-EXCITATION | 419 | ||
| Electrocardiogram of Typical Cardiac Pre-excitation | 422 | ||
| Pre-excited Atrial Fibrillation | 424 | ||
| Localization of the Accessory Pathway | 424 | ||
| Rare Variants of Cardiac Pre-excitation | 427 | ||
| REFERENCES | 433 | ||
| Arrhythmias Involving the Atrioventricular Junction | 435 | ||
| Key points | 435 | ||
| THE ATRIOVENTRICULAR JUNCTION | 435 | ||
| ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA | 436 | ||
| Electroanatomic Substrate | 436 | ||
| Electrocardiogram | 436 | ||
| ATRIOVENTRICULAR REENTRY TACHYCARDIA | 445 | ||
| Electroanatomic Substrate | 445 | ||
| Atypical Accessory Pathways | 446 | ||
| Electrocardiogram | 446 | ||
| JUNCTIONAL TACHYCARDIA | 448 | ||
| DIFFERENTIAL DIAGNOSIS OF ARRHYTHMIAS INVOLVING THE ATRIOVENTRICULAR JUNCTION | 450 | ||
| REFERENCES | 452 | ||
| The QRS Complex | 453 | ||
| Key points | 453 | ||
| INTRODUCTION | 453 | ||
| THE VENTRICULAR CONDUCTION SYSTEM | 453 | ||
| THE NORMAL QRS | 454 | ||
| INTRINSICOID DEFLECTION | 457 | ||
| FUNCTIONAL AND ANATOMIC BUNDLE BRANCH BLOCK | 458 | ||
| Right Bundle Branch Block | 458 | ||
| Left Bundle Branch Block | 459 | ||
| REFERENCES | 460 | ||
| General Approach to a Wide QRS Complex | 461 | ||
| Key points | 461 | ||
| INTRODUCTION | 461 | ||
| CAUSES OF A WIDE QRS COMPLEX | 461 | ||
| ELECTROCARDIOGRAPHIC APPROACH TO A WIDE QRS COMPLEX | 465 | ||
| IDENTIFICATION OF ATRIAL ACTIVITY | 468 | ||
| RELATIONSHIP BETWEEN ATRIAL AND VENTRICULAR ACTIVITY | 471 | ||
| MORPHOLOGIC CHANGES OF THE WIDE QRS COMPLEX: CAPTURE AND FUSION BEATS | 471 | ||
| MORPHOLOGIC CHANGES OF THE QRS COMPLEX ACCORDING TO THE CYCLE LENGTH: ASHMAN PHENOMENON | 472 | ||
| MORPHOLOGIC ANALYSIS OF THE WIDE QRS COMPLEX: COMPARISON WITH SINUS RHYTHM | 478 | ||
| DETAILED MORPHOLOGIC ANALYSIS OF THE WIDE QRS COMPLEX | 478 | ||
| BRUGADA ALGORITHM | 481 | ||
| VERECKEI ALGORITHM | 483 | ||
| SUMMARY | 485 | ||
| REFERENCES | 485 | ||
| Normal Ventricular Repolarization and QT Interval | 487 | ||
| Key points | 487 | ||
| INTRODUCTION: SIGNIFICANCE AND ROLE OF VENTRICULAR REPOLARIZATION | 487 | ||
| ELECTROPHYSIOLOGICAL BASIS OF NORMAL VENTRICULAR REPOLARIZATION | 488 | ||
| Ionic Currents Determining the Cardiac Action Potential | 488 | ||
| Phase 0 | 488 | ||
| Phase 1 | 489 | ||
| Phase 2 | 489 | ||
| Phase 3 | 489 | ||
| Phase 4 | 489 | ||
| Intramural Differences in the Action Potential Duration | 489 | ||
| Correlation between AP Phases and QT Interval Components | 490 | ||
| J point and isoelectric ST segment | 490 | ||
| T wave | 490 | ||
| U wave and QTU complex | 491 | ||
| DYNAMICS OF VENTRICULAR REPOLARIZATION | 491 | ||
| Rate Dependence of Ventricular Repolarization | 491 | ||
| Effect of the Autonomic Nervous Activity on QT Dynamicity | 492 | ||
| The Hysteresis Effect on QT-RR Relation | 493 | ||
| Circadian Variation of Ventricular Repolarization | 493 | ||
| Age and Gender Effect on QT Interval Duration and QT Dynamicity | 494 | ||
| MORPHOLOGIC ASPECTS OF NORMAL VENTRICULAR REPOLARIZATION ON SURFACE ELECTROCARDIOGRAM | 494 | ||
| J Point and Early Repolarization | 494 | ||
| ST Segment | 495 | ||
| T Wave | 497 | ||
| U Wave and QTU Complex | 497 | ||
| MEASUREMENT OF QT INTERVAL ON SURFACE-RESTING ELECTROCARDIOGRAM | 497 | ||
| Methods to Calculate QT Duration from Standard Resting Electrocardiogram | 498 | ||
| Criteria to Define the T Wave End | 499 | ||
| Additional Parameters of Ventricular Repolarization | 499 | ||
| T wave peak | 499 | ||
| Terminal late repolarization | 500 | ||
| QT dispersion | 500 | ||
| Formula to Evaluate the Rate Dependence of QT Interval | 500 | ||
| Rate-correction formula | 500 | ||
| Predicted QT interval | 501 | ||
| MEASUREMENTS OF QT DYNAMICITY AND QT VARIABILITY | 501 | ||
| Circadian Pattern of Rate-Corrected QT Interval | 502 | ||
| Long-Term Evaluation of QT-RR Relation | 502 | ||
| QT Variability Index | 502 | ||
| Microvolt T-Wave Alternans | 502 | ||
| CONDITIONS PROVOKING REPOLARIZATION ABNORMALITIES | 503 | ||
| Electrolyte Disturbance | 503 | ||
| Cardiac and Noncardiac Drugs | 505 | ||
| Cardiac and Noncardiac Diseases | 505 | ||
| Genetic Background | 508 | ||
| SUMMARY | 510 | ||
| REFERENCES | 511 |