Fogoros' Electrophysiologic Testing

Cover
Title Page
Copyright
Contents
Preface to the Seventh Edition
Part I Disorders of the Heart Rhythm: Basic Principles
Chapter 1 The Cardiac Electrical System
The anatomy of the heart's electrical system
The cardiac action potential
Depolarization
Repolarization
The resting phase
Localized variations in the heart's electrical system
Localized differences in the action potential
Localized differences in autonomic innervation
Relationship between action potential and surface ECG
Chapter 2 Abnormal Heart Rhythms
Bradyarrhythmias
Failure of impulse generation
Failure of impulse propagation
Tachyarrhythmias
Automaticity
Reentry
Triggered activity
Chapter 3 Treatment of Arrhythmias
Pharmacologic therapy
Channels and gates
Classification of antiarrhythmic drugs
Effects of antiarrhythmic drugs
Proarrhythmia
Drug toxicity
Nonpharmacologic therapy
Reversing the underlying cause for arrhythmias
Surgical and ablation therapy
Device therapy
Part II The Electrophysiology Study in the Evaluation and Therapy of Cardiac Arrhythmias
Chapter 4 Principles of the Electrophysiology Study
Recording and pacing
Cycle length
Coupling interval
The electrode catheter
Recording intracardiac electrograms
Pacing
Performance of the electrophysiology study
The physical setup of the electrophysiology laboratory
Preparation of the patient
Insertion and positioning of electrode catheters
The basic electrophysiology protocol
Evaluation of the electrophysiologic properties of the heart
Automaticity
Conduction velocity
Refractory periods
The effect of cycle length and autonomic tone on refractory periods and conduction velocity
Evaluation of reentrant arrhythmias
Programmed stimulation in reentrant arrhythmias
Recording electrograms during reentrant arrhythmias
Effect of autonomic maneuvers, antiarrhythmic drugs, and devices on reentry
Complications of electrophysiologic testing
Chapter 5 The Electrophysiology Study in the Evaluation of Bradycardia: The SA Node, AV Node, and His–Purkinje System
Evaluation of SA nodal abnormalities
Anatomy of the SA node
SA nodal dysfunction
Evaluating SA nodal function in the electrophysiology laboratory
Sinus node recovery time (SNRT)
Measuring SNRT
An interesting but not surprising observation
Intrinsic heart rate (IHR)
Interpreting SA nodal tests: when to carry out electrophysiologic testing
Evaluation of AV conduction disorders
Symptoms of AV conduction disorders
The site of the conduction disorder
AV nodal block
His–Purkinje block
The degree of AV block
First‐degree AV block
Second‐degree AV block: Mobitz classification
Third‐degree AV block
AV dissociation
Treatment of AV block
Localizing the site of AV block
The electrophysiology study in the evaluation of AV conduction disorders
Overt AV conduction disturbances
Inapparent AV conduction disturbances
The extrastimulus technique
Incremental pacing
Bundle branch block
Right bundle branch block (RBBB)
Left bundle branch block (LBBB)
A brief overview of permanent pacemakers
Major indications for pacemakers
Pacemaker nomenclature
Common modes of pacing
VVI or AAI pacing
DDD pacing
CRT pacing
Complications intrinsic to pacemaker therapy
Pacemaker syndrome
Pacemaker tachycardia
Inappropriate rate tracking
Ventricular dyssynchrony
Other complications of pacemaker therapy
Leadless pacemakers
Deciding which pacemaker to implant
Is the electrophysiology study helpful in selecting the right pacemaker?
Chapter 6 The Electrophysiology Study in the Evaluation of Supraventricular Tachyarrhythmias
General classification of supraventricular tachyarrhythmias
Automatic supraventricular tachyarrhythmias
Automatic atrial tachycardia
Digitalis toxicity
Multifocal (or chaotic) atrial tachycardia
Inappropriate sinus tachycardia (IST)
Reentrant supraventricular tachyarrhythmias
AV nodal reentrant tachycardia
Bypass tract‐mediated macroreentrant tachycardia
Intraatrial reentry
SA nodal reentry
Atrial flutter and atrial fibrillation
General outline of the EP study in reentrant supraventricular tachyarrhythmias
Positioning the catheters
Evaluation of supraventricular tachyarrhythmias
What is the mode of initiation and termination of the tachycardia?
What are the patterns of antegrade and retrograde activation during sinus rhythm and during supraventricular tachycardia?
What is the evidence that atrial or ventricular myocardium is necessary to the reentrant circuit?
What are the effects of autonomic maneuvers and drugs on the tachycardia?
General procedure for performing the EP study in patients with supraventricular tachyarrhythmias
The EP Study in AV nodal reentrant tachycardia
Mechanism of AV nodal reentry
Mode of initiation and termination of AV nodal reentry
Patterns of activation with AV nodal reentry
Evidence that atrial and ventricular myocardium are not required for AV nodal reentry
Other observations in AV nodal reentry
Relationship of P Waves to QRS complexes during AV nodal reentry
Atypical AV nodal reentry
Treatment of AV nodal reentry
Bypass tract‐mediated supraventricular tachyarrhythmias
The EP study in bypass tract‐mediated macroreentry
The mechanism of macroreentrant supraventricular tachycardia
Mode of initiation and termination of macroreentry
Patterns of atrial and ventricular activation in bypass tract‐mediated reentry
Requirement of the atria and ventricles in macroreentry
Relationship of P to QRS during macroreentrant tachycardia
Treatment of macroreentrant supraventricular tachycardia
Localization of bypass tracts
Atrial flutter/fibrillation in patients with bypass tracts
Uncommon varieties of bypass tracts
AV nodal bypass tracts
Mahaim bypass tracts
Fasiculoventricular bypass tracts
Multiple Bypass Tracts
The EP study in intraatrial reentry
The EP study in SA nodal reentry
The EP study in atrial flutter and atrial fibrillation
Atrial flutter
Treatment of Atrial Flutter
Atrial fibrillation
Treatment of atrial fibrillation
Rhythm control versus rate control
Does rhythm control reduce hard outcomes?
Two clear reasons to pursue rhythm control
Evaluation of patients with supraventricular tachyarrhythmias – when is electrophysiologic testing necessary?
Chapter 7 The Electrophysiology Study in the Evaluation and Treatment of Ventricular Arrhythmias
Ventricular tachyarrhythmias and sudden death
The evaluation of ventricular tachyarrhythmias
The mechanisms of ventricular arrhythmias
Reentrant ventricular arrhythmias
Risk factors for reentrant ventricular arrhythmias
The role of ejection fraction
Clinical characteristics of reentrant ventricular tachyarrhythmias
The electrophysiologic study in the evaluation of reentrant ventricular tachyarrhythmias
The electrophysiology study in the treatment of reentrant ventricular tachyarrhythmias
Automatic ventricular arrhythmias
Triggered activity
Pause‐dependent triggered activity
Repolarization reserve
Catechol‐dependent triggered activity
Miscellaneous types of ventricular arrhythmia
Idiopathic left ventricular tachycardia
Outflow tract ventricular tachycardia
Arrhythmogenic right ventricular cardiomyopathy
Bundle branch reentry
Brugada syndrome and sudden unexpected nocturnal death syndrome
Catecholaminergic polymorphic ventricular tachycardia
Ventricular tachyarrhythmias associated with mitral valve prolapse
An overview of the treatment of ventricular arrhythmias
Four general truths we have learned about treating ventricular arrhythmias
Suppression of ventricular ectopy with antiarrhythmic drugs does not reduce risk
Empiric treatment with amiodarone does not sufficiently reduce risk
Ablation of reentrant foci is an effective way of treating some patients with ventricular tachycardia
In the majority of high‐risk patients, the ICD is the only treatment that reliably reduces the risk of death from ventricular arrhythmias
A brief overview of the ICD
Programming ICDs
Complications of ICDs
Subcutaneous ICDs
Wireless monitoring of ICDs
The Evidence‐based approach to using the ICD
Secondary prevention trials
Primary prevention trials
The all‐important DANISH trial
Evidence‐based indications for the ICD
Chapter 8 Transcatheter Ablation: Therapeutic Electrophysiology
The technology of transcatheter ablation
Direct‐current shocks
Radiofrequency (RF) energy
Other energy sources
Electroanatomic mapping systems
Magnetic field mapping (CARTO® mapping system, Biosense Webster)
Electrical field mapping (EnSite Precision® mapping system, Abbott)
Complications of ablation
Acknowledgment
Chapter 9 Ablation of Supraventricular Tachycardias
Ablation of the AV junction
Ablation of AV nodal reentrant tachycardia
Ablation of bypass tracts
Characteristics of bypass tracts
ECG localization of bypass tracts
Considerations for successfully mapping and ablating bypass tracts
The approach to bypass tracts according to location
Left free‐wall bypass tracts
Right free‐wall bypass tracts
Mahaim bypass tracts
Posterior septal (and paraseptal) bypass tracts
Anteroseptal and midseptal bypass tracts
Ablation of focal atrial tachycardias
Chapter 10 Ablation of PVCs and Ventricular Tachycardia
Modern treatment of PVCs
Activation mapping
Pace mapping
Anatomic considerations of the outflow tract
RV outflow tract (RVOT)
LV outflow tract
Epicardial and coronary sinus sites
Left ventricular summit
Mitral annulus and papillary muscle
Ablation of outflow tract PVCs and ventricular tachycardia
Mitral annular PVCs
Idiopathic left centricular PVCs and ventricular tachycardia
Bundle branch reentrant tachycardia
Ablation of reentrant VT in the presence of structural heart disease
Entrainment mapping
Ablation of hemodynamically nontolerated ventricular tachycardia
VT ablation in nonischemic cardiomyopathy
Epicardial mapping
Complications of ventricular tachycardia ablation
Chapter 11 Ablation of Atrial Fibrillation
History of atrial fibrillation ablation
Pulmonary vein isolation with RF ablation
Preparation
In the EP laboratory
Intracardiac echocardiography
3‐D mapping systems
Transseptal puncture
Pulmonary vein isolation – general
Left‐sided pulmonary vein isolation
Right‐sided pulmonary vein isolation
Ablation in the PV carina region
Waiting period, and confirmation of durable PV isolation
Confusing post‐PVI electrograms
Drug testing post PVI
Ablation beyond PVI
Re‐do AF ablation
Blanking period
Repeat PVI with reconnected pulmonary veins
Repeat PVI with isolated pulmonary veins
Cryoballoon AF ablation
How Do RF and cryoballoon ablation compare?
Pulsed field ablation
Atrial substrate modification
Chapter 12 Ablation of Atrial Flutter
“Typical” atrial flutter: CTI‐dependent flutter
Ablating CTI‐dependent flutter
Confirming conduction block at the CTI
Ablation of atypical or non‐CTI‐dependent atrial flutter
Non‐CTI‐dependent right atrial flutter
Left atrial flutter ablation
Perimitral flutter
Roof‐dependent LA flutter
Left atrial anterior wall flutter
Other left atrial flutters
De Novo left atrial flutter
Chapter 13 Conduction System Pacing
Standard RV pacing
The problem with RV pacing
The promise of conduction system pacing
His bundle pacing
Left bundle area pacing
Chapter 14 Cardiac Resynchronization: Pacing Therapy for Heart Failure
Cardiac resynchronization therapy
How it works
The effects of CRT
Hemodynamic effects
Contractility
Reverse remodeling
Clinical studies with CRT
Implanting CRT devices
Complications from CRT
Unresolved issues with CRT
Responders versus nonresponders
How much QRS delay is needed?
Right bundle branch block
Optimization of CRT
AV interval
VV interval
Should CRT be the standard mode of pacing?
Chapter 15 The Evaluation of Syncope
Causes of syncope
Bradyarrhythmias that cause syncope
Sinus nodal dysfunction
AV block
Tachyarrhythmias that cause syncope
Supraventricular tachycardias
Ventricular tachyarrhythmias
Vasodepressor syncope
Tilt‐table testing
Treating vasodepressor syncope
Evaluation of the patient with syncope
Chapter 16 Electrophysiologic Testing in Perspective: The Evaluation and Treatment of Cardiac Arrhythmias
The three steps in evaluating and treating cardiac arrhythmias
Step 1. Assess the severity of the arrhythmia to be treated
Step 2. Decide on the therapeutic endpoint
Step 3. Design the treatment plan
Treating to Relieve Symptoms
Treating to Prevent Sudden Death
Conclusion
Index
EULA