Josephson's Clinical Cardiac Electrophysiology
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Josephson's Clinical Cardiac Electrophysiology

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Cod produs/ISBN: 9781451187410

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Editura: LWW

Limba: Engleza

Nr. pagini: 890

Coperta: Hardback

Dimensiuni: 1.2 x 9 x 11 inches

An aparitie: October 2, 2015

Description:

Turn to this updated, classic text for a thorough understanding of the mechanisms of cardiac arrhythmias and the therapeutic interventions used to treat them. Josephson's Clinical Cardiac Electrophysiology, 5th Edition delivers Dr. Mark Josephson's unparalleled guidance on the electrophysiologic methodology required to define the mechanism and site of origin of arrhythmias – enabling you to choose the safest and most effective therapy for each patient.

Features:

• Get comprehensive coverage of mechanisms, clinical implications, and limitations of current therapeutic interventions, including drugs, and catheter and surgical ablation.

• Gain a better visual understanding thanks to more than 1,100 illustrations (over 100 are new!),  an increased number of 3-D color anatomical mapping images, ECG examples, photographs of equipment, and procedural diagrams.

• Stay up to date with information on new technologies of ablation and pitfalls of interpreting data; innovative new catheters; new drug information; and new tables summarizing SVT and VT criteria.

• Benefit from Dr. Josephson's decades of experience as "the father of clinical cardiac electrophysiology," and learn from his proven approaches and methods in this challenging area. Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to:

 • Complete content with enhanced navigation.

 • Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web.

 • Cross-linked pages, references, and more for easy navigation.

 • Highlighting tool for easier reference of key content throughout the text.

 • Ability to take and share notes with friends and colleagues.

• Quick reference tabbing to save your favorite content for future use.

 

 

Table of contents:

 

Chapter 1: Electrophysiologic Investigation: Technical Aspects

Personnel

Equipment

Electrode Catheters

Laboratory Organization

Recording and Stimulation Apparatus

Junction Box

Recording Apparatus

Stimulator

Cardioverter/Defibrillator

Figure 1-1

Figure 1-2

Figure 1-3

Figure 1-4

Figure 1-5

Figure 1-6

Figure 1-7

Figure 1-8

Figure 1-9

Figure 1-10

Figure 1-11

Figure 1-12

Figure 1-13

Figure 1-14

Figure 1-15

Figure 1-16

Figure 1-17

Cardiac Catheterization Technique

Femoral Vein Approach

Inadvertent Puncture of the Femoral Artery

Upper Extremity Approach

Right Atrium

Left Atrium

Right Ventricle

Left Ventricle

His Bundle Electrogram

Table 1-1: Catheter Approach for Electrophysiologic Study

Figure 1-18

Figure 1-19

Figure 1-20

Figure 1-21

Figure 1-22

Figure 1-23

Figure 1-24

Risks and Complications

Significant Hemorrhage

Thromboembolism

Phlebitis

Arrhythmias

Complications of Left Ventricular Studies

Tamponade

Artifacts

Figure 1-25

References

Chapter 2: Electrophysiologic Investigation: General Concepts

Chapter 2 Introduction

Electrogram Recordings

Measurement of Conduction Intervals

His Bundle Electrogram

Assessment of “H”-V Interval

Establishing Relationship of the His Bundle Deflection to other Electrograms: Role of Catheter Position

Simultaneous Left-sided and Right-sided Recordings

His Bundle Pacing

A-H Interval

H-V Interval

Intra-atrial Conduction

Intraventricular Conduction

Figure 2-1

Figure 2-2

Figure 2-3

Figure 2-4

Figure 2-5

Figure 2-6

Figure 2-7

Figure 2-8

Table 2-1: Normal Conduction Intervals in Adults

Figure 2-9

Figure 2-10

Figure 2-11

Figure 2-12

Figure 2-13

Figure 2-14

Figure 2-15

Figure 2-16

Description of Electrograms

Descriptive Characteristics

Quantitative Characteristics

Left Ventricular Endocardial Activation

Table 2-2: Summary of Electrogram Characteristics in Normal Left Ventricles

Table 2-3: Electrogram Amplitude and Duration Characteristics in Normal Left Ventricles by Left Ventricular Sitea Number

Figure 2-17

Figure 2-18

Programmed Stimulation

Incremental Pacing

Refractory Periods

Cycle Length Responsiveness of Refractory Periods

Dispersion of Refractoriness

Patterns of Response to Atrial Extrastimuli

The Atrium as a Limiting Factor in A-V Conduction

Patterns of Response to Ventricular Extrastimuli

Comparison of Antegrade and Retrograde Conduction

Figure 2-19

Figure 2-20

Figure 2-21

Figure 2-22

Figure 2-23

Figure 2-24

Figure 2-25

Figure 2-26

Figure 2-27

Figure 2-28

Table 2-4: Definition of Terms

Figure 2-29

Figure 2-30

Figure 2-31

Figure 2-32

Figure 2-33

Figure 2-34

Figure 2-35

Figure 2-36

Figure 2-37

Table 2-5: Normal Refractory Periods in Adults

Figure 2-38

Figure 2-39

Figure 2-40

Figure 2-41

Figure 2-42

Figure 2-43

Figure 2-44

Figure 2-45

Figure 2-46

Figure 2-47

Figure 2-48

Figure 2-49

Figure 2-50

Figure 2-51

Figure 2-52

Figure 2-53

Figure 2-54

Figure 2-55

Figure 2-56

Figure 2-57

Figure 2-58

Figure 2-59

Figure 2-60

Figure 2-61

References

Chapter 3: Sinus Node Function

Chapter 3 Introduction

Electrocardiographic Features of Sinus Node Dysfunction

Sinus Bradycardia

Sinoatrial Block and Sinus Arrest

Bradycardia–tachycardia Syndrome

Electrocardiographic Monitoring of Patients Suspected of Having Sinus Node Dysfunction

Assessment of Autonomic Tone

Figure 3-1

Electrophysiologic Evaluation of Sinus Node Function

Sinoatrial Conduction Time

Sinus Node Electrogram

Sinoatrial Conduction Time in Patients with Sick Sinus Syndrome

Sinus Node Recovery Time

Effect of Atropine and Autonomic Blockade on Sinus Node Recovery Time in Normal Persons

Results of Atrial Pacing in Patients Suspected of Having Sinus Node Dysfunction

Figure 3-2

Figure 3-3

Figure 3-4

Figure 3-5

Figure 3-6

Figure 3-7

Figure 3-8

Table 3-1: Normal Upper Limits for Sinoatrial Conduction Time (SACTa, msec)

Figure 3-9

Figure 3-10

Figure 3-11

Figure 3-12

Table 3-2: Diagnostic Evaluation of Sinus Node Function

Table 3-3: Normal Values (msec) for Maximum Sinus Node Recovery Time (SNRTmax) and Maximum Corrected Sinus Node Recovery Time (CSNRTmax)

Figure 3-13

Figure 3-14

Figure 3-15

Figure 3-16

Figure 3-17

Figure 3-18

Figure 3-19

Effect of Drugs on Sinus Node Recovery Time and Sinoatrial Conduction Time

Digoxin

Propranolol

Calcium Blockers

Antiarrhythmic Agents

Vagal Hypersensitivity (Neurocirculatory) Syndromes

Figure 3-20

Figure 3-21

Therapeutic Implications

References

Chapter 4: Atrioventricular Conduction

Chapter 4 Introduction

Table 4-1: Atrioventricular Block

Table 4-2: Sites of Atrioventricular Block

Atrium

Figure 4-1

Figure 4-2

Figure 4-3

Figure 4-4

Figure 4-5

Figure 4-6

Atrioventricular Node

Figure 4-7

Figure 4-8

Figure 4-9

Figure 4-10

Figure 4-11

Figure 4-12

His Bundle

Figure 4-13

Figure 4-14

Figure 4-15

Figure 4-16

Figure 4-17

Infra-His Conduction System

Figure 4-18

Figure 4-19

Figure 4-20

Figure 4-21

Figure 4-22

Figure 4-23

Table 4-3: Site of 2:1 A-V Block

Figure 4-24

Table 4-4: Significance of Retrograde Conduction in the Presence of Antegrade Block

Figure 4-25

Paroxysmal A-V Block

Figure 4-26

Value of Intracardiac Studies in the Evaluation of A-V Conduction Disturbances

Figure 4-27

Figure 4-28

Figure 4-29

Figure 4-30

Suppression of A-V Conduction by Ventricular Stimulation

Figure 4-31

Therapeutic Considerations

Table 4-5: Indications for Cardiac Pacing in Chronic Heart Block

Figure 4-32

References

Chapter 5: Intraventricular Conduction Disturbances

Chapter 5 Introduction

Figure 5-1

Figure 5-2

Figure 5-3

Definitions

Site of “Block” or Conduction Delay during Bundle Branch Block

Chronic Right Bundle Branch Block

Left Bundle Branch Block

Transient Bundle Branch Block

Figure 5-4

Figure 5-5

Figure 5-6

Figure 5-7

Figure 5-8

Figure 5-9

Figure 5-10

Figure 5-11

Figure 5-12

Figure 5-13

Figure 5-14

Figure 5-15

Table 5-1: Relationship between QRS Axis and Activation Sequence

Table 5-2: Results of Left Ventricular Mapping

Figure 5-16

Figure 5-17

Figure 5-18

Figure 5-19

Figure 5-20

Figure 5-21

Figure 5-22

Figure 5-23

Figure 5-24

Figure 5-25

Figure 5-26

Figure 5-27

Figure 5-28

Figure 5-29

Figure 5-30

Figure 5-31

Figure 5-32

Figure 5-33

Clinical Relevance of Intraventricular Conduction Disturbances

Role of Electrophysiologic Studies in Predicting Risk of Heart Block

Methods to Identify Patients at Risk of Developing A-V Block

Alternating Bundle Branch Block

Syncope and Sudden Death in Patients with Bundle Branch Block

Figure 5-34

Figure 5-35

Figure 5-36

Figure 5-37

Figure 5-38

Figure 5-39

Figure 5-40

Figure 5-41

Figure 5-42

Therapeutic Implications

Table 5-3: Intraventricular Conduction Disturbances: Assessment of HPS Reserve

Table 5-4: Intraventricular Conduction Disturbances: Recommendations for Clinical Cardiac Pacing

References

Chapter 6: Miscellaneous Phenomena Related to Atrioventricular Conduction

Chapter 6 Introduction

Concealed Conduction

Figure 6-1

Figure 6-2

Figure 6-3

Figure 6-4

Figure 6-5

Figure 6-6

Figure 6-7

Figure 6-8

Figure 6-9

Gap Phenomenon

Table 6-1: Classification of Gap Phenomena in the Human Heart

Figure 6-10

Figure 6-11

Figure 6-12

Figure 6-13

Figure 6-14

Supernormality

Figure 6-15

Figure 6-16

Figure 6-17

Figure 6-18

Figure 6-19

Figure 6-20

References

Chapter 7: Ectopic Rhythms and Premature Depolarizations

Chapter 7 Introduction

Atrial Depolarizations

Figure 7-1

Figure 7-2

Figure 7-3

Figure 7-4

Figure 7-5

Figure 7-6

Junctional (His Bundle or A-V Nodal) Depolarizations

Figure 7-7

Figure 7-8

Figure 7-9

Figure 7-10

Figure 7-11

Figure 7-12

Figure 7-13

Figure 7-14

Figure 7-15

Fascicular Depolarizations

Figure 7-16

Figure 7-17

Figure 7-18

Figure 7-19

Ventricular Depolarizations

Figure 7-20

Figure 7-21

Figure 7-22

Figure 7-23

References

Chapter 8: Supraventricular Tachycardias

Chapter 8 Introduction

Mechanisms of Supraventricular Tachycardia

Methods of Evaluation

Table 8-1: Electrophysiologic Evaluation of Supraventricular Tachycardia

Table 8-2: Mechanisms of SVT (2,789 Patients)

Supraventricular Tachycardia Resulting from Atrioventricular Nodal Reentry

Mechanisms of Initiation of Atrioventricular Nodal Reentry

Determinants for the Induction of Atrioventricular Nodal Reentry

Atrial Activation Sequence and the P–QRS Relationship During Supraventricular Tachycardia

Effect of Bundle Branch Block During Atrioventricular Nodal Reentrant Supraventricular Tachycardia

Requirement of the Atrium and Ventricle

Requirement of the Atrium in AVNRT

Responses to Stimulation During AVNRT—Role in Defining Atrial and Subnodal Participation

Role of Atrial Activation Patterns in Evaluating the Role of the Atrium

Requirement of Subnodal Structures in AVNRT

The Role of Atrial or Ventricular Pacing in Analyzing Upper and Lower Final Common Pathways

Pharmacologic and Physiologic Maneuvers

Figure 8-1

Figure 8-2

Figure 8-3

Figure 8-4

Figure 8-5

Figure 8-6

Figure 8-7

Figure 8-8

Figure 8-9

Figure 8-10

Figure 8-11

Figure 8-12

Figure 8-13

Figure 8-14

Figure 8-15

Figure 8-16

Figure 8-17

Figure 8-18

Figure 8-19

Figure 8-20

Figure 8-21

Figure 8-22

Figure 8-23

Figure 8-24

Figure 8-25

Figure 8-26

Figure 8-27

Figure 8-28

Figure 8-29

Figure 8-30

Figure 8-31

Figure 8-32

Figure 8-33

Figure 8-34

Figure 8-35

Figure 8-36

Figure 8-37

Figure 8-38

Figure 8-39

Table 8-3: AVNRT: Evidence That the Atrium is not Necessary

Figure 8-40

Figure 8-41

Figure 8-42

Figure 8-43

Figure 8-44

Figure 8-45

Figure 8-46

Figure 8-47

Figure 8-48

Figure 8-49

Figure 8-50

Figure 8-51

Figure 8-52

Figure 8-53

Figure 8-54

Figure 8-55

Figure 8-56

Figure 8-57

Figure 8-58

Figure 8-59

Figure 8-60

Figure 8-61

Figure 8-62

Figure 8-63

Figure 8-64

Figure 8-65

Figure 8-66

Figure 8-67

Figure 8-68

Figure 8-69

Figure 8-70

Figure 8-71

Figure 8-72

Table 8-4: AVNRT: Evidence That the His Bundle is not Involved

Figure 8-73

Figure 8-74

Figure 8-75

Figure 8-76

Figure 8-77

Figure 8-78

Table 8-5: Criteria for A-V Nodal Reentrant SVT

Supraventricular Tachycardia Resulting from Concealed Atrioventricular Bypass Tracts

Mechanism of Initiation

Atrial Activation Sequence and P–QRS Relationship During Supraventricular Tachycardia

Effect of Bundle Branch Block During Supraventricular Tachycardia Using Concealed Bypass Tracts

Requirement of Atrium and Ventricle During Supraventricular Tachycardia Using Concealed Bypass Tracts

Electrical Stimulation During Supraventricular Tachycardia Using a Concealed Bypass Tract

Effects of Pharmacologic and Physiologic Maneuvers During Supraventricular Tachycardia

Figure 8-79

Figure 8-80

Figure 8-81

Figure 8-82

Figure 8-83

Figure 8-84

Figure 8-85

Figure 8-86

Figure 8-87

Figure 8-88

Figure 8-89

Figure 8-90

Figure 8-91

Figure 8-92

Figure 8-93

Figure 8-94

Figure 8-95

Figure 8-96

Figure 8-97

Figure 8-98

Figure 8-99

Figure 8-100

Figure 8-101

Figure 8-102

Figure 8-103

Figure 8-104

Figure 8-105

Table 8-6: Location of Concealed Bypass Tracts (1,349 Patients)

Figure 8-106

Figure 8-107

Figure 8-108

Figure 8-109

Figure 8-110

Figure 8-111

Figure 8-112

Figure 8-113

Figure 8-114

Figure 8-115

Figure 8-116

Figure 8-117

Figure 8-118

Figure 8-119

Figure 8-120

Figure 8-121

Figure 8-122

Figure 8-123

Figure 8-124

Figure 8-125

Figure 8-126

Figure 8-127

Figure 8-128

Table 8-7: Criteria for A-V Reentrant SVT

Figure 8-129

Figure 8-130

Figure 8-131

Figure 8-132

Figure 8-133

Figure 8-134

Figure 8-135

Figure 8-136

Figure 8-137

Figure 8-138

Supraventricular Tachycardia Resulting from Intra-Atrial or Sinus Node Reentry

Mechanism of Initiation of Supraventricular Tachycardias Resulting from Intra-atrial Reentry

Atrial Activation Sequence in P–QRS Relationship During Supraventricular Tachycardias with Intra-atrial Reentry

Requirement of the Atrium and Ventricles and Influence of Bundle Branch Block on Supraventricular Tachycardia Resulting from Intra-atrial Reentry

Effects of Stimulation During Supraventricular Tachycardias Resulting from Intra-atrial Reentry

Physiologic and Pharmacologic Maneuvers During Supraventricular Tachycardias Resulting from Intra-atrial Reentry

Table 8-8: Criteria for “Sinus Node” Reentrant SVT

Table 8-9: Criteria for Intra-atrial Reentrant SVT (Distant from the Sinus Node)

Figure 8-139

Figure 8-140

Figure 8-141

Figure 8-142

Figure 8-143

Figure 8-144

Figure 8-145

Figure 8-146

Figure 8-147

Figure 8-148

Automatic Atrial Tachycardia

Figure 8-149

Figure 8-150

Figure 8-151

Figure 8-152

Figure 8-153

Figure 8-154

Figure 8-155

Table 8-10: Criteria for Automatic Atrial Tachycardia

Atrial Tachycardia due to Triggered Activity

Figure 8-156

Figure 8-157

Figure 8-158

Figure 8-159

Distinguishing Atrial Tachycardia from AVNRT and AVRT

Figure 8-160

Figure 8-161

Table 8-11: Methods to Distinguish AVNRT versus AVRT

Multiple SVT Mechanisms in Individual Patients

Figure 8-162

Figure 8-163

Figure 8-164

Figure 8-165

Figure 8-166

Figure 8-167

Overview

Table 8-12: Criteria for Atrial Tachycardia Resulting from Triggered Activity

Figure 8-168

Figure 8-169

Figure 8-170

References

Chapter 9: Atrial Flutter and Fibrillation

Chapter 9 Introduction

Electrophysiologic and Anatomic Substrates of Macroreentrant Atrial Tachycardia (Typical and Atypical Atrial Flutter) and Fibrillation

Conduction Defects in Patients with Atrial Fibrillation and Flutter

Atrial Refractoriness

Atrial Vulnerability

Figure 9-1

Figure 9-2

Figure 9-3

Figure 9-4

Figure 9-5

Figure 9-6

Figure 9-7

Figure 9-8

Figure 9-9

Figure 9-10

Table 9-1: Intra-atrial Conduction Velocity in Patients With and Without Atrial Fibrillation

Figure 9-11

Figure 9-12

Figure 9-13

Figure 9-14

Figure 9-15

Table 9-2: Effect of Stimulation Frequency on Effective Refractory Period

Figure 9-16

Atrial Flutter

Induction of Atrial Flutter

Activation Mapping and Programmed Stimulation During Flutter

Characterization of the Reentrant Circuit in Atrial Flutter

Termination of Atrial Flutter

Effects of Pharmacologic Agents on Reentrant Atrial Flutter

Atrioventricular Conduction During Flutter

Figure 9-17

Figure 9-18

Figure 9-19

Figure 9-20

Figure 9-21

Figure 9-22

Figure 9-23

Figure 9-24

Figure 9-25

Figure 9-26

Figure 9-27

Figure 9-28

Figure 9-29

Figure 9-30

Figure 9-31

Figure 9-32

Figure 9-33

Figure 9-34

Figure 9-35

Figure 9-36

Figure 9-37

Figure 9-38

Figure 9-39

Figure 9-40

Figure 9-41

Figure 9-42

Figure 9-43

Figure 9-44

Figure 9-45

Figure 9-46

Atrial Fibrillation

Mapping During Atrial Fibrillation

Stimulation During Atrial Fibrillation

Relationship Between Atrial Flutter and Fibrillation

Miscellaneous Uses of Electrophysiology Studies

Figure 9-47

Figure 9-48

Figure 9-49

Figure 9-50

Figure 9-51

Figure 9-52

Figure 9-53

Figure 9-54

Table 9-3: Source of Atrial Activation Wavefronts on the Right Atrial Free Wall in Patients with Chronic and Nonsustained Atrial Fibrillation (mean)

Figure 9-55

Figure 9-56

Table 9-4: Fibrillation Intervals in Patients with Chronic and Nonsustained Atrial Fibrillation (ms; mean + SD)

Table 9-5: Incidence and Length of Conduction Block in Patients with Chronic and Nonsustained Atrial Fibrillation (mean ± SD)

Figure 9-57

Figure 9-58

Figure 9-59

Figure 9-60

Figure 9-61

Figure 9-62

Figure 9-63

Figure 9-64

Summary

References

Chapter 10: Preexcitation Syndromes

Chapter 10 Introduction

Figure 10-1

Atrioventricular Bypass Tracts

Figure 10-2

Electrophysiologic Properties of A-V Bypass Tracts

Figure 10-3

Figure 10-4

Figure 10-5

Electrophysiologic Evaluation in Patients with Wolff–Parkinson–White Syndrome

Diagnosis of an A-V Bypass Tract

Figure 10-6

Figure 10-7

Figure 10-8

Figure 10-9

Figure 10-10

Figure 10-11

Figure 10-12

Mode of Initiation of Tachycardias

Orthodromic Tachycardia

Figure 10-13

Figure 10-14

Figure 10-15

Figure 10-16

Figure 10-17

Figure 10-18

Figure 10-19

Figure 10-20

Figure 10-21

Figure 10-22

Figure 10-23

Figure 10-24

Figure 10-25

Preexcited Tachycardias

Table 10-1: Mechanisms of Regular Preexcited Tachycardias

Figure 10-26

Table 10-2: Electrophysiologic Substrate of Antidromic Tachycardia

Table 10-3: Characteristics of A-V Nodal Reentry with an Innocent Bystander Atrioventricular Bypass Tract

Figure 10-27

Figure 10-28

Figure 10-29

Figure 10-30

Figure 10-31

Figure 10-32

Figure 10-33

Figure 10-34

Figure 10-35

Figure 10-36

Figure 10-37

Figure 10-38

Table 10-4: Methods to Exclude A-V Nodal Reentry as a Cause of a Preexcited Tachycardia

Figure 10-39

Figure 10-40

Table 10-5: Rate Changes During Preexcited Tachycardias Due to Changes in Retrograde Conduction

Table 10-6: Rate Changes During Regular Preexcited Tachycardias Due to Changes in Anterograde Conduction

Table 10-7: Effect of Carotid Sinus Pressure on Preexcited Tachycardias

Figure 10-41

Figure 10-42

Figure 10-43

Atrial Fibrillation

Figure 10-44

Localization of the Bypass Tract

Figure 10-45

Relation of Local Ventricular Electrograms to Delta Wave

Figure 10-46

Figure 10-47

Figure 10-48

Figure 10-49

Pacing from Multiple Atrial Sites

Figure 10-50

Retrograde Atrial Activation

Figure 10-51

Figure 10-52

Figure 10-53

Figure 10-54

Figure 10-55

Figure 10-56

Figure 10-57

Figure 10-58

Figure 10-59

Table 10-8: Methods of Distinguishing a Bypass Tract from Normal Retrograde Conduction Due to A-V Nodal Reentry

Figure 10-60

Figure 10-61

Effect of Bundle Branch Block during Orthodromic Tachycardia

Figure 10-62

Figure 10-63

Figure 10-64

Figure 10-65

Figure 10-66

Figure 10-67

Figure 10-68

Figure 10-69

Figure 10-70

Direct Recording of Bypass Tract Potentials

Figure 10-71

Figure 10-72

Figure 10-73

Figure 10-74

Figure 10-75

Figure 10-76

Figure 10-77

Figure 10-78

Role of the Bypass Tract in Genesis of Arrhythmias

Figure 10-79

Figure 10-80

Figure 10-81

Figure 10-82

Figure 10-83

Figure 10-84

Figure 10-85

Figure 10-86

Figure 10-87

Determination of the Antegrade Refractory Period of the Bypass Tract

Intermittent Preexcitation

Figure 10-88

Effect of Antiarrhythmic Agents on Preexcitation

Figure 10-89

Exercise Testing in Wolff–Parkinson–White Syndrome

Determination of the Antegrade Refractory Period of the Bypass Tract by Programmed Stimulation

Figure 10-90

Figure 10-91

Termination of Orthodromic Tachycardia

Multiple Bypass Tracts

Figure 10-92

Figure 10-93

Table 10-9: Evidence of Multiple Bypass Tracts

Figure 10-94

Figure 10-95

Figure 10-96

Figure 10-97

Figure 10-98

Figure 10-99

Figure 10-100

Figure 10-101

Figure 10-102

Figure 10-103

Atrioventricular Nodal “Bypass Tracts”—The Lown–Ganong–Levine Syndrome

Electrophysiologic Properties

Atrial Pacing

Response to Atrial Premature Depolarizations

Ventriculoatrial Conduction

Response to Pharmacologic and Physiologic Maneuvers

Role of the Bypass Tract in Arrhythmias

Therapeutic Implications

Figure 10-104

Figure 10-105

Figure 10-106

Figure 10-107

Figure 10-108

Figure 10-109

Figure 10-110

Figure 10-111

Accessory Pathways with Anterograde Decremental Conduction and Fasciculoventricular Pathways

Slowly Conducting Accessory Pathways

Electrophysiologic Manifestations

Atriofascicular and Long Atrioventricular Bypass Tracts

Short Slowly Conducting Atrioventricular Bypass Tracts

Nodofascicular and Nodoventricular Bypass Tracts

Tachycardias Associated with Atriofascicular, Slowly Conducting A-V, Nodofascicular, and Nodoventricular Bypass Tracts

Therapeutic Implications

Fasciculoventricular Bypass Tracts

Table 10-10: Tachycardias Using Decremental (“Mahaim”) Fibers

Figure 10-112

Figure 10-113

Figure 10-114

Figure 10-115

Figure 10-116

Figure 10-117

Figure 10-118

Figure 10-119

Figure 10-120

Figure 10-121

Figure 10-122

Figure 10-123

Figure 10-124

Figure 10-125

Figure 10-126

Figure 10-127

Figure 10-128

Figure 10-129

Figure 10-130

Figure 10-131

Figure 10-132

Figure 10-133

Figure 10-134

Figure 10-135

Table 10-11: Tachycardia Types

Table 10-12: Electrophysiologic Features of Tachycardias Associated with Atrio/Nodofascicular Bypass Tracts and Atrio/Nodoventricular Bypass Tracts

Figure 10-136

Figure 10-137

Figure 10-138

Figure 10-139

Figure 10-140

Figure 10-141

Figure 10-142

Figure 10-143

Figure 10-144

Figure 10-145

Figure 10-146

Figure 10-147

References

Chapter 11: Recurrent Ventricular Tachycardia

Chapter 11 Introduction

Definitions of Ventricular Tachycardias

Morphology

Duration

Classification of Ventricular Tachycardia QRS Complexes

Diagnosis of Ventricular Tachycardia

Use of His Bundle Recordings in Diagnosing Ventricular Tachycardia

Limitations of His Bundle Recordings for the Diagnosis of Ventricular Tachycardia

Table 11-1: Characteristics of Wide Complex Tachycardia Favoring Diagnosis of VT

Figure 11-1

Figure 11-2

Figure 11-3

Figure 11-4

Figure 11-5

Figure 11-6

Figure 11-7

Figure 11-8

Figure 11-9

Figure 11-10

Figure 11-11

Figure 11-12

Pathophysiologic Substrate for Ventricular Tachyarrhythmias

Anatomic Substrate

Electrophysiologic Substrate

Figure 11-13

Figure 11-14

Figure 11-15

Figure 11-16

Figure 11-17

Figure 11-18

Table 11-2: Influence of Coronary Artery Disease and Clinical Arrhythmia

Figure 11-19

Figure 11-20

Figure 11-21

Figure 11-22

Figure 11-23

Figure 11-24

Figure 11-25

Table 11-3: Influence of Underlying Heart Disease

Figure 11-26

Table 11-4: Influence of Cardiomyopathy and Clinical Arrhythmia

Figure 11-27

Figure 11-28

Figure 11-29

Figure 11-30

Figure 11-31

Figure 11-32

Figure 11-33

Figure 11-34

Figure 11-35

Figure 11-36

Figure 11-37

Figure 11-38

Table 11-5: Definitions

Figure 11-39

Figure 11-40

Figure 11-41

Table 11-6: Data Based on Whole Left Ventricle Analysis

Table 11-7: Data Based on Adjacent Left Ventricle Sites

Mechanisms of Ventricular Tachycardia

Initiation of Ventricular Tachycardias

Protocol of Programmed Stimulation

Number of Extrastimuli

Influence of Drive Cycle Length

Multiple Sites of Stimulation

Role of Increasing Current

Initiation of Sustained Uniform Ventricular Tachycardia

Relationship of Coupling Intervals and Cycle Length Initiating Tachycardia to the Onset of Ventricular Tachycardia and the Initial Ventricular Tachycardia Cycle Length

Relationship of Stimulation Site to Initiation of Ventricular Tachycardia

Relationship of Initiation of VT to Conduction Delay, Block, and/or Continuous Activity

Role of the His–Purkinje System in Initiating and Maintaining Sustained Uniform Ventricular Tachycardia

Initiation of Polymorphic Ventricular Tachycardia-Ventricular Fibrillation

Initiation of Polymorphic Ventricular Tachycardia-Ventricular Fibrillation with Normal QT Intervals

Initiation of Polymorphic Ventricular Tachycardia-Ventricular Fibrillation in the Presence of Long QT Intervals

Mechanism of QRS Morphology in Polymorphic Ventricular Tachycardia

Initiation of Monomorphic Nonsustained Ventricular Tachycardia

Response of Sustained Uniform Ventricular Tachycardia to Stimulation

Protocol for Stimulation During Sustained VT

Manifest and Concealed Perpetuation of Ventricular Tachycardia

Resetting of Ventricular Tachycardia

Return Cycle Versus Ventricular Tachycardia Cycle Length

Resetting with Fusion

Site Specificity of Resetting

Resetting Response Curves

Response of Ventricular Tachycardia to Overdrive Pacing—Continuous Resetting (Entrainment)

Termination of Sustained Ventricular Tachycardia

Mechanism of Termination and Relationship to Resetting Phenomena

Modification of Factors Influencing Termination of Ventricular Tachycardia

Figure 11-42

Figure 11-43

Figure 11-44

Figure 11-45

Figure 11-46

Figure 11-47

Table 11-8: Relationship of Induction Mode to RVERPa

Figure 11-48

Table 11-9: Drive Cycle Lengths of Programmed Stimulation Required for VT Induction

Figure 11-49

Figure 11-50

Table 11-10: Site of Stimulation Required for Arrhythmia Conduction

Table 11-11: Protocol of Programmed Stimulation for VT

Figure 11-51

Figure 11-52

Figure 11-53

Figure 11-54

Figure 11-55

Figure 11-56

Figure 11-57

Figure 11-58

Figure 11-59

Table 11-12: Mode of Initiation of VT Compared with Cycle Length of the 126 Morphologically Distinct Tachycardias in 104 Patients

Figure 11-60

Figure 11-61

Figure 11-62

Figure 11-63

Figure 11-64

Figure 11-65

Figure 11-66

Figure 11-67

Figure 11-68

Figure 11-69

Figure 11-70

Figure 11-71

Figure 11-72

Figure 11-73

Figure 11-74

Figure 11-75

Figure 11-76

Figure 11-77

Figure 11-78

Figure 11-79

Figure 11-80

Figure 11-81

Figure 11-82

Figure 11-83

Figure 11-84

Figure 11-85

Figure 11-86

Figure 11-87

Figure 11-88

Figure 11-89

Figure 11-90

Figure 11-91

Figure 11-92

Figure 11-93

Figure 11-94

Figure 11-95

Figure 11-96

Figure 11-97

Figure 11-98

Figure 11-99

Figure 11-100

Figure 11-101

Figure 11-102

Figure 11-103

Figure 11-104

Table 11-13: Relationship of Mode of Termination of VT with VT Cycle Length (139 Patients)

Figure 11-105

Figure 11-106

Figure 11-107

Figure 11-108

Figure 11-109

Figure 11-110

Figure 11-111

Figure 11-112

Figure 11-113

Figure 11-114

Figure 11-115

Figure 11-116

Figure 11-117

Figure 11-118

Figure 11-119

Figure 11-120

Figure 11-121

Figure 11-122

Figure 11-123

Figure 11-124

Figure 11-125

Figure 11-126

Figure 11-127

Figure 11-128

Figure 11-129

Figure 11-130

Figure 11-131

Figure 11-132

Figure 11-133

Figure 11-134

Figure 11-135

Figure 11-136

Figure 11-137

Figure 11-138

Figure 11-139

Figure 11-140

Figure 11-141

Figure 11-142

Figure 11-143

Figure 11-144

Figure 11-145

Figure 11-146

Figure 11-147

Figure 11-148

Figure 11-149

Figure 11-150

Figure 11-151

Figure 11-152

Figure 11-153

Figure 11-154

Figure 11-155

Figure 11-156

Figure 11-157

Figure 11-158

Figure 11-159

Figure 11-160

Figure 11-161

Figure 11-162

Figure 11-163

Figure 11-164

Figure 11-165

Figure 11-166

Figure 11-167

Figure 11-168

Figure 11-169

Figure 11-170

Figure 11-171

Figure 11-172

Figure 11-173

Figure 11-174

Figure 11-175

Figure 11-176

Figure 11-177

Figure 11-178

Figure 11-179

Figure 11-180

Figure 11-181

Figure 11-182

Figure 11-183

Table 11-14: Effects of Programmed Ventricular Stimulation (PVS) During VT (123 Patients)

Figure 11-184

Figure 11-185

Figure 11-186

Figure 11-187

Figure 11-188

Figure 11-189

Figure 11-190

Figure 11-191

Figure 11-192

Figure 11-193

Figure 11-194

Figure 11-195

Figure 11-196

Figure 11-197

Figure 11-198

Figure 11-199

Figure 11-200

Figure 11-201

Figure 11-202

Figure 11-203

Figure 11-204

Table 11-15: Effect of Procainamide on Mode of Termination of VT (23 Patients)

Figure 11-205

Figure 11-206

Figure 11-207

Effect of Drugs on Ventricular Tachycardia

Figure 11-208

Figure 11-209

Figure 11-210

Figure 11-211

Figure 11-212

Localization of the Site of Origin of Ventricular Tachycardia

General Methods of Catheter Mapping

Acquisition and Interpretation of Activation Mapping During Ventricular Tachycardia

Continuous Activity and Diastolic Bridging

Role of Programmed Stimulation in Identifying the Critical Sites in a Reentrant Circuit

Relationship of Mapping Data to Heart Disease

Multiple Ventricular Tachycardia Morphologies: Relationship to Site of Origin

Validation of Catheter Mapping

Sinus Rhythm Mapping

Relationship of QRS Morphologies to Sites of Origin of Tachycardias

Relationship of QRS Patterns of Sites of Origin of Ventricular Tachycardia

Role of Pace Mapping in Determining the Site of Origin of Ventricular Tachycardia

Figure 11-213

Figure 11-214

Figure 11-215

Figure 11-216

Figure 11-217

Figure 11-218

Figure 11-219

Figure 11-220

Figure 11-221

Figure 11-222

Figure 11-223

Figure 11-224

Figure 11-225

Figure 11-226

Figure 11-227

Figure 11-228

Figure 11-229

Figure 11-230

Figure 11-231

Figure 11-232

Figure 11-233

Figure 11-234

Figure 11-235

Figure 11-236

Figure 11-237

Figure 11-238

Figure 11-239

Figure 11-240

Figure 11-241

Figure 11-242

Figure 11-243

Figure 11-244

Figure 11-245

Figure 11-246

Figure 11-247

Figure 11-248

Figure 11-249

Figure 11-250

Figure 11-251

Figure 11-252

Figure 11-253

Figure 11-254

Figure 11-255

Figure 11-256

Figure 11-257

Figure 11-258

Figure 11-259

Figure 11-260

Figure 11-261

Figure 11-262

Figure 11-263

Figure 11-264

Figure 11-265

Figure 11-266

Figure 11-267

Figure 11-268

Figure 11-269

Figure 11-270

Figure 11-271

Figure 11-272

Figure 11-273

Figure 11-274

Figure 11-275

Ventricular Stimulation in Miscellaneous Disorders

References

Chapter 12: Evaluation of Antiarrhythmic Agents

Chapter 12 Introduction

Classification of Antiarrhythmic Agents

In Vitro Classification of Antiarrhythmic Agents

Table 12-1: In Vitro Electrophysiologic Characteristics

Evaluation of Electrophysiologic Effects of Drugs in Humans

Table 12-2: In Vivo Electrophysiologic Characteristics of Antiarrhythmic Drugs Electrophysiologic Effects

Table 12-3: In Vivo Electrophysiologic Characteristics of Antiarrhythmic Drugs Electrocardiographic Effects

Table 12-4: Effects of Lidocaine on QRS Width and Electrogram Duration (msec)

Figure 12-1

Figure 12-2

Figure 12-3

Table 12-5: Effects of Procainamide on QRS Width and Electrogram Duration (msec)

Table 12-6: Amplitude (in mV)

Figure 12-4

Figure 12-5

Figure 12-6

Figure 12-7

Figure 12-8

Table 12-7: Limitations in Evaluating Antiarrhythmic Drug Action

Selection of Antiarrhythmic Drug Therapy for Reentrant Tachycardias

Use of Programmed Stimulation

Study Protocol

Selection of Pharmacologic Therapy for Ventricular Tachyarrhythmias

Factors Predicting Outcome of Electrophysiologic Study

Effect of Drugs on VT Cycle Length

Empiric Use of Antiarrhythmic Drugs in the Setting of Concurrent ICD Therapy

Predictability of Drug Effect on Tachycardia Cycle Length

Analysis of Drug Effects on Tachycardia Cycle Length Using Resetting and Entrainment

Mechanism of Drug Effect on Inducibility and Termination of VT

Selection of Antiarrhythmic Agents for Supraventricular Tachyarrhythmias

Proarrhythmic Effects of Antiarrhythmic Agents

Electrophysiologic Studies and Proarrhythmia

Figure 12-9

Table 12-8: Dosage and Therapeutic Serum Concentrations for Antiarrhythmic Agents

Figure 12-10

Figure 12-11

Figure 12-12

Figure 12-13

Figure 12-14

Figure 12-15

Figure 12-16

Figure 12-17

Figure 12-18

Figure 12-19

Figure 12-20

Figure 12-21

Figure 12-22

Figure 12-23

Figure 12-24

Figure 12-25

Figure 12-26

Figure 12-27

Figure 12-28

Figure 12-29

Figure 12-30

Figure 12-31

Figure 12-32

Figure 12-33

Figure 12-34

Figure 12-35

Figure 12-36

Figure 12-37

Figure 12-38

Figure 12-39

Figure 12-40

Figure 12-41

Figure 12-42

Figure 12-43

Figure 12-44

Figure 12-45

Figure 12-46

Figure 12-47

Table 12-9: Effect of Drugs on VT Cycle Length

Figure 12-48

Figure 12-49

Table 12-10: Correlation Between Efficacy and Magnitude of Change in QTC and ERP by Type lA Drugs

Figure 12-50

Figure 12-51

Figure 12-52

Figure 12-53

Figure 12-54

Figure 12-55

Figure 12-56

Figure 12-57

Figure 12-58

References

Chapter 13: Catheter and Surgical Ablation in the Therapy of Arrhythmias

Chapter 13 Introduction

Biophysics of Current Ablation Techniques

DC Ablation

Radiofrequency Energy

Laser Ablation

Cryoablation

Ultrasound

Figure 13-1

Figure 13-2

Figure 13-3

Figure 13-4

Figure 13-5

Figure 13-6

Control of Supraventricular Arrhythmias by Ablative Techniques

Ablation of Atrioventricular Bypass Tracts and Variants of Pre-excitation

Localization of Bypass Tracts

Catheter Ablation of Bypass Tracts

Ablation of Pre-excitation Variants

Complications of Procedures

Intraoperative Mapping and Surgical Ablation of Accessory Pathways

Ablation of the A-V Junction for Ventricular Rate Control during Atrial Tachyarrhythmias

Catheter Ablation Techniques to Treat A-V Nodal Tachycardia

Junctional Tachycardia

Surgical and Catheter Ablation Techniques to Manage other Atrial Arrhythmias

Ablation of Atrial Tachycardia

Ablation of Atrial Flutter and other Macroreentrant Atrial Arrhythmias

Ablative Techniques (Surgical and Catheter-Based) for Treatment of Atrial Fibrillation

Role of Linear Lesions to the Mitral Annulus and/or Across the Roof or Posterior Left Atrial Wall

Ablation/Modification of the Autonomic Nervous System for Control of AF

Stepwise Ablation (Ablation to Termination of Persistent AF)

Focal Impulse and Rotor Modulation for Ablation of Atrial Fibrillation

Role of Ablation in “Mother Flutter”–Induced Atrial Fibrillation

Role of Ablation in “Multiple Wavelet” Atrial Fibrillation

Figure 13-7

Figure 13-8

Figure 13-9

Figure 13-10

Figure 13-11

Figure 13-12

Figure 13-13

Figure 13-14

Figure 13-15

Figure 13-16

Figure 13-17

Figure 13-18

Figure 13-19

Figure 13-20

Figure 13-21

Figure 13-22

Figure 13-23

Figure 13-24

Figure 13-25

Figure 13-26

Figure 13-27

Figure 13-28

Figure 13-29

Figure 13-30

Figure 13-31

Figure 13-32

Figure 13-33

Figure 13-34

Figure 13-35

Figure 13-36

Figure 13-37

Figure 13-38

Figure 13-39

Figure 13-40

Figure 13-41

Figure 13-42

Figure 13-43

Figure 13-44

Figure 13-45

Figure 13-46

Figure 13-47

Figure 13-48

Figure 13-49

Figure 13-50

Figure 13-51

Figure 13-52

Figure 13-53

Figure 13-54

Figure 13-55

Figure 13-56

Figure 13-57

Figure 13-58

Figure 13-59

Figure 13-60

Figure 13-61

Figure 13-62

Figure 13-63

Figure 13-64

Figure 13-65

Figure 13-66

Figure 13-67

Figure 13-68

Figure 13-69

Figure 13-70

Figure 13-71

Figure 13-72

Figure 13-73

Figure 13-74

Figure 13-75

Figure 13-76

Figure 13-77

Figure 13-78

Figure 13-79

Figure 13-80

Figure 13-81

Figure 13-82

Figure 13-83

Figure 13-84

Figure 13-85

Figure 13-86

Figure 13-87

Figure 13-88

Figure 13-89

Figure 13-90

Figure 13-91

Figure 13-92

Figure 13-93

Figure 13-94

Figure 13-95

Figure 13-96

Figure 13-97

Figure 13-98

Figure 13-99

Figure 13-100

Figure 13-101

Figure 13-102

Figure 13-103

Figure 13-104

Figure 13-105

Figure 13-106

Figure 13-107

Figure 13-108

Figure 13-109

Figure 13-110

Figure 13-111

Figure 13-112

Figure 13-113

Figure 13-114

Figure 13-115

Control of Ventricular Arrhythmias by Ablative Techniques

Role of the ECG in Localization of Tachycardias

Mapping Techniques for Ventricular Tachycardia

Activation Mapping

Pace Mapping

Entrainment Mapping

Substrate Mapping

Additional Procedures after Failed Catheter Ablation

Catheter Ablation of Ventricular Tachycardia Associated with Coronary Artery Disease

Ablation of Unstable Ventricular Tachycardias

Role of Catheter Ablation in the Treatment of Ventricular Tachycardia Associated with Nonischemic Left Ventricular Tachycardia

Role of Catheter Ablation in the Treatment of Ventricular Tachycardia Associated with Right Ventricular Dysplasia

The Role of Catheter Mapping and Ablation of Idiopathic Ventricular Tachycardias

Catheter Ablation of Miscellaneous Ventricular Tachycardias

Intraoperative Mapping and Surgical Ablation of Ventricular Tachycardias

Intraoperative Mapping Techniques for Ventricular Tachycardia

Surgical Treatment for Ventricular Tachyarrhythmias

Results of Surgery

Ventricular Tachycardia Unassociated with Coronary Artery Disease

Figure 13-116

Figure 13-117

Figure 13-118

Figure 13-119

Figure 13-120

Figure 13-121

Figure 13-122

Figure 13-123

Figure 13-124

Figure 13-125

Figure 13-126

Figure 13-127

Figure 13-128

Figure 13-129

Figure 13-130

Figure 13-131

Figure 13-132

Figure 13-133

Figure 13-134

Figure 13-135

Table 13-1: Methods of Substrate-Based Ablation for Ventricular Tachycardia

Figure 13-136

Figure 13-137

Figure 13-138

Figure 13-139

Figure 13-140

Figure 13-141

Figure 13-142

Figure 13-143

Figure 13-144

Figure 13-145

Figure 13-146

Figure 13-147

Figure 13-148

Figure 13-149

Figure 13-150

Figure 13-151

Figure 13-152

Figure 13-153

Figure 13-154

Figure 13-155

Figure 13-156

Figure 13-157

Figure 13-158

Figure 13-159

Figure 13-160

Figure 13-161

Figure 13-162

Figure 13-163

Figure 13-164

Figure 13-165

Figure 13-166

Figure 13-167

Figure 13-168

Figure 13-169

Figure 13-170

Figure 13-171

Figure 13-172

Figure 13-173

Figure 13-174

Figure 13-175

Figure 13-176

Figure 13-177

Figure 13-178

Figure 13-179

Figure 13-180

Figure 13-181

Figure 13-182

Figure 13-183

Figure 13-184

Figure 13-185

Figure 13-186

Figure 13-187

Figure 13-188

Figure 13-189

Figure 13-190

Figure 13-191

Figure 13-192

Figure 13-193

Figure 13-194

Figure 13-195

Figure 13-196

Figure 13-197

Figure 13-198

Figure 13-199

Figure 13-200

Figure 13-201

Figure 13-202

Figure 13-203

Figure 13-204

Figure 13-205

Figure 13-206

Figure 13-207

Figure 13-208

Figure 13-209

Figure 13-210

Figure 13-211

Figure 13-212

Table 13-2: Distribution of Electrogram Type Pre- and Postsubendocardial Resection

Table 13-3: Effect of Experience on Outcome: Primary Success, Clinical Success, and Noninducibility

Table 13-4: Inducibility of VT Postsubendocardial Resection and Clinical Outcome

Table 13-5: Inducibility of VT on Drugs Postsubendo-cardial Resection and Clinical Outcome

Figure 13-213

Table 13-6: Operative Mortality (SER) in Patients with Ventricular Tachycardia Early (<2 Mo) After Infarction

Table 13-7: Outcome of Surgery in Patients with VT Early (<2 Mo) or Later (>2 Mo) After Infarction

Table 13-8: Clinical Outcome of Surgery (SER) for VT Early (<2 Mo) and Late (>2 Mo) After Infarction

Figure 13-214

Figure 13-215

Conclusion

References

Appendix

Remarks

 

 


ebookshop
An aparitie October 2, 2015
Autor Mark E. Josephson MD
Dimensiuni 1.2 x 9 x 11 inches
Editura LWW
Format Hardback
ISBN 9781451187410
Limba Engleza
Nr pag 890

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