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Practical Cardiac Electrophysiology Kartikeya Bhargava, Samuel J Asirvatham

SECTION A: INTRODUCTION AND BASICS OF CARDIAC ELECTROPHYSIOLOGY
CHAPTER 1:Electrophysiology Study: Indications, Hardware and Set-up, Catheter Placement
- INTRODUCTION
- INDICATIONS FOR ELECTROPHYSIOLOGY STUDIES
- HARDWARE AND SET-UP FOR ELECTROPHYSIOLOGY STUDY AND RADIOFREQUENCY ABLATION
- ELECTRODE CATHETERS
  - Ablation Catheters
  - Connecting Cables
- CATHETER PLACEMENT FOR ELECTROPHYSIOLOGY STUDIES
- REFERENCES
CHAPTER 2:Electrophysiology Study: Technical Details, Electrograms, Noise and Filtering
- INTRODUCTION
- DIFFICULTIES WITH SIGNAL ACQUISITION
- POSSIBLE APPROACHES TO ARTIFACT-FREE SIGNAL ACQUISITION
- ARTIFACT
- UNIPOLAR AND BIPOLAR ELECTROGRAMS
  - Unipolar Electrograms
  - Bipolar Electrograms
- CONCLUSION
- REFERENCES
CHAPTER 3:Measurements of Basic Intervals, Refractory Periods and Programmed Electrical Stimulation
- INTRODUCTION
- THE BASIC ELECTROPHYSIOLOGY STUDY
- PROGRAMMED ELECTRICAL STIMULATION
  - Continuous Pacing
  - Refractory Periods
- PROGRAMMED ELECTRICAL STIMULATION: MECHANISTIC INSIGHTS
- REFERENCES
CHAPTER 4:Sinus Node Function Evaluationand Abnormalities
- INTRODUCTION
- SINUS NODE ABNORMALITIES:TACHYCARDIAS
- SINUS NODE ABNORMALITIES:BRADYCARDIAS
  - Intermittent Bradycardias
    - Bradycardia–Pauses
    - Tachycardia-bradycardia Syndrome
  - Persistent Bradycardias
    - Chronotropic Incompetence
- ELECTROPHYSIOLOGY STUDY
- CONCLUSION
- REFERENCES
CHAPTER 5:Atrioventricular Conduction and Block
- INTRODUCTION
- ATRIOVENTRICULAR CONDUCTION SYSTEM
- ATRIOVENTRICULAR JUNCTION: STRUCTURAL AND FUNCTIONAL CORRELATIONS
  - Molecular and Ionic Mechanisms
  - Gap Junctional Channels
- ATRIOVENTRICULAR BLOCK: CLASSIFICATION, SITE AND DEGREE OF BLOCK—ECG AND EP CORRELATION
- SPECIAL CATEGORIES OF ATRIOVENTRICULAR BLOCK
- ATRIOVENTRICULAR CONDUCTION AND RELATED PHENOMENA
- PRINCIPLES OF MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION DISTURBANCES
SECTION B: FUNDAMENTALS OF CARDIAC ANATOMY, IMAGING, MAPPING AND ABLATION
CHAPTER 6:Cardiac Anatomy for Electrophysiologists
- INTRODUCTION
- SPATIAL LOCATIONS OF THE CARDIAC CHAMBERS DURING AN ELECTROPHYSIOLOGICAL STUDY
- THE COMPONENTS OF THE ATRIA
- THE RIGHT AND LEFT VENTRICLES
  - Anatomy of the Outflow Tracts: Implication for Ablation of Ventricular Tachycardias
- THE PERICARDIAL SPACE, AUTONOMIC NERVOUS SYSTEM AND THE EXTRACARDIAC ANATOMIC STRUCTURES RELEVANT FOR ABLATION
- REFERENCES
CHAPTER 7:Imaging in Cardiac Electrophysiology
- INTRODUCTION
- CARDIAC MAGNETIC RESONANCE IMAGING
- CARDIAC COMPUTERIZED TOMOGRAPHY
  - Atrial Fibrillation
  - Other Applications of Computerized Tomography
- PET SCANNING IN CARDIAC SARCOIDOSIS
- INTRACARDIAC ULTRASOUND
- CONCLUSION
- REFERENCES
CHAPTER 8:Conventional MappingTechniques: Fundamentals
- INTRODUCTION
- ACTIVATION MAPPING
  - Unipolar Mapping
  - Bipolar Mapping
- PACE MAPPING
  - Pace Mapping for Ventricular Arrhythmias
  - Pace Mapping for Atrial Arrhythmias
- ENTRAINMENT MAPPING
- CONCLUSION
- REFERENCES
CHAPTER 9:Three-dimensional Mapping of Cardiac Arrhythmias: Techniques, Principles and Application
- INTRODUCTION
- BRIEF REVIEW OF DIFFERENT MAPPING SYSTEMS
- HOW TO OBTAIN AN ACCURATE ANATOMICAL MAP?
- HOW TO OBTAIN AN ACCURATE 3D ACTIVATION MAP OF A CARDIAC ARRHYTHMIA?
- SUBSTRATE MAPPING
  - How to Perform an Accurate Substrate Map?
- MULTIELECTRODE CATHETERS FOR FAST ANATOMICAL, VOLTAGE AND ACTIVATION MAPPING
- CONCLUSION
CHAPTER 10:Radiofrequency Ablation: Principles and Biophysics
- INTRODUCTION
- PHYSICS
- PATHOPHYSIOLOGY OF LESION FORMATION BY RADIOFREQUENCY ABLATION
  - Cellular Mechanisms of Thermal Injury
    - Calcium Overload and Cellular Injury
    - Conduction Velocity
- DETERMINANTS OF EFFECTIVE LESION FORMATION
- MONITORING AND TITRATION OF RADIOFREQUENCY ENERGY DELIVERY
- COMPLICATIONS AND THEIR PREVENTION
- ENERGY DELIVERY IN SPECIFIC ANATOMICAL LOCATIONS
  - Power Titration during Epicardial Ablation
  - Power Titration during Ablation within the Coronary Sinus
- CONCLUSION
- REFERENCES
CHAPTER 11:Non-Radiofrequency Sources of Ablation
- INTRODUCTION
- CRYOENERGY
- HIGH INTENSITY FOCUSED ULTRASOUND
- VISUALLY GUIDED LASER ABLATION (VGLA)
- MICROWAVE ENERGY
- THERMAL BALLOON CATHETER SYSTEM
- LOW INTENSITY COLLIMATED ULTRASOUND
- REFERENCES
SECTION C: SUPRAVENTRICULAR TACHYARRHYTHMIAS: AV NODE-DEPENDENT TACHYCARDIAS
CHAPTER 12:Supraventricular Tachyarrhythmias: AV Node-dependent Tachycardias
- INTRODUCTION
- ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA
- ATRIOVENTRICULAR RECIPROCATING TACHYCARDIA
- ATRIAL TACHYCARDIA
- ATRIAL FLUTTER
- ATRIAL FIBRILLATION
CHAPTER 13:Supraventricular Tachycardias: Approach during Electrophysiology Study
- INTRODUCTION
- BASELINE STUDY
- SUPRAVENTRICULAR TACHYCARDIA STUDY
- CONCLUSION
- REFERENCES
CHAPTER 14:Supraventricular Tachycardias: Baseline Features during Sinus Rhythm and Tachycardia
- INTRODUCTION
- EPIDEMIOLOGY
- MECHANISMS AND PATHOPHYSIOLOGY
- CLINICAL PRESENTATION
- ELECTROCARDIOGRAPHIC FINDINGS
- BASELINE INTRACARDIAC ELECTROGRAM FINDINGS
- CONCLUSION
- REFERENCES
CHAPTER 15:Supraventricular Tachycardias: Ventricular Pacing Maneuvers
- INTRODUCTION
- SITE OF PACING: GENERAL CONSIDERATIONS
- VENTRICULAR PACING MANEUVERS DURING SINUS RHYTHM
- VENTRICULAR PACING MANEUVERS DURING TACHYCARDIA
- REFERENCES
CHAPTER 16:Supraventricular Tachycardias: Atrial Pacing Maneuvers
- INTRODUCTION
- ATRIAL EXTRASTIMULUS PACING
- ATRIAL OVERDRIVE PACING
- CONCLUSION
- REFERENCES
CHAPTER 17:Atrioventricular Nodal Reentrant Tachycardia: Classification, Electrophysiological Features, and Ablation
- CLASSIFICATION
- ELECTROPHYSIOLOGICAL FEATURES
- ABLATION
- CONCLUSION
- REFERENCES
CHAPTER 18:Wolff-Parkinson-White Syndrome and Atrioventricular Accessory Pathway-related Arrhythmias: Localization, Mapping and Ablation
- INTRODUCTION
- ELECTROCARDIOGRAPHIC CHARACTERISTICS AND LOCALIZATION
- ATRIOVENTRICULAR ACCESSORY PATHWAYS AND RELATED ARRHYTHMIAS
- NONINVASIVE EVALUATION
- ELECTROPHYSIOLOGICAL EVALUATION
- MAPPING AND ABLATION
- CRYOABLATION FOR SEPTAL PATHWAYS: ADVANTAGES AND DISADVANTAGES
- RESULTS: SUCCESS RATE BY SITE; COMPLICATION RATE, RECURRENCE RATE
- CONCLUSION
- REFERENCES
CHAPTER 19:Mahaim Fiber Accessory Pathways and Other Variants of Preexcitation
- INTRODUCTION
- ETIOPATHOGENESIS
- MAHAIM PHYSIOLOGY
- ATRIOFASCICULAR BYPASS TRACT
- OTHER VARIANTS OF PREEXCITATION WITH MAHAIM PHYSIOLOGY
- CONCLUSION
- REFERENCES
CHAPTER 20:Junctional Tachycardia
- INTRODUCTION
- GENERAL CONSIDERATIONS
  - The AV Junction
  - Rhythm Characterization and Differential Diagnosis
- CLINICAL SYNDROMES
- CONCLUSION
- REFERENCES
SECTION D: SUPRAVENTRICULAR TACHYARRHYTHMIAS: ATRIAL TACHYCARDIA, FLUTTER AND FIBRILLATION
CHAPTER 21:Focal Atrial Tachycardia and its Differentiation from Macroreentrant Atrial Tachycardia
- INTRODUCTION
- FOCAL VERSUS MACROREENTRANT AT
- COMMON SITES OF FOCAL ATRIAL TACHYCARDIA
- CONCLUSION
- REFERENCES
CHAPTER 22:Atrial Flutter: Classification, Mechanisms and Management
- INTRODUCTION
- HISTORY OF NONPHARMACOLOGIC TREATMENT IN PATIENTS WITH ATRIAL FLUTTER
- TYPES OF ATRIAL FLUTTER AND THEIR CLINICAL IMPLICATIONS
- CONCLUSION
- REFERENCES
CHAPTER 23:Atrial Fibrillation:Classification and Mechanisms of Initiation and Maintenance
- DEFINITION
- CLASSIFICATION
- MECHANISMS OF AF INITIATION AND MAINTENANCE
- RECENT ADVANCES IN MAPPING AF MECHANISMS
- REFERENCES
CHAPTER 24:Atrial Fibrillation Ablation: Pulmonary Vein Isolation Techniques, Strategies and Principles
- INTRODUCTION
- RATIONALE FOR PULMONARY VEIN ISOLATION
- PULMONARY VEIN ABLATION/ISOLATION TECHNIQUES
- INTERPRETING ELECTROGRAMS DURING PV ISOLATION
- STRATEGIES TO ACHIEVE DURABLE PULMONARY VEIN ISOLATION
- STRATEGIES TO REDUCE COMPLICATIONS OF ATRIAL FIBRILLATION ABLATION
- NEW TOOLS FOR AF ABLATION
  - Multielectrode Ablation Catheters for Pulmonary Vein Isolation
  - Balloon-based Technologies for PVI
- CONCLUSION AND FUTURE DIRECTIONS
- REFERENCES
CHAPTER 25:Atrial Fibrillation Ablation: Substrate Modification and Other Strategies
- INTRODUCTION
- LINEAR ATRIAL ABLATION
- ABLATION OF COMPLEX FRACTIONATED ATRIAL ELECTROGRAMS
  - Complex Fractionated Atrial Electrograms Ablation Procedure
  - Outcome of CFAE Ablation
- GANGLIONATED PLEXI ABLATION
- ROTOR ABLATION
- COMBINED ABLATION APPROACH
  - The Stepwise Ablation Approach
  - STAR AF 2
- REFERENCES
CHAPTER 26:Atrioventricular Junction Ablation for Rate Control in Atrial Fibrillation
- INTRODUCTION
- APPLIED ANATOMY OF THE ATRIOVENTRICULAR NODE
- ATRIOVENTRICULAR JUNCTION MODIFICATION
- ATRIOVENTRICULAR JUNCTION ABLATION
- CONCLUSION
- REFERENCES
CHAPTER 27:Atrial Fibrillation Ablation: Clinical Studies, Efficacy and Complications
- INTRODUCTION
- CLINICAL STUDIES
- EFFICACY OF AF ABLATION PROCEDURES
- COMPLICATIONS OF AF ABLATION
- CONCLUSION
- REFERENCES
CHAPTER 28:Surgical Ablation for Atrial Fibrillation
- INTRODUCTION
- EARLY SURGICAL ABLATION
- THE COX-MAZE PROCEDURE
- SURGICAL ABLATION TECHNOLOGY
  - Cryoablation
  - Radiofrequency Energy
- INDICATIONS FOR SURGICAL ABLATION
- SURGICAL TECHNIQUES
- CONCLUSION
- REFERENCES
CHAPTER 29:Atrial Arrhythmias in Congenital Heart Disease and Postcardiac Surgery
- INTRODUCTION
- ATRIAL ARRHYTHMIAS IN PATIENTS WITH CONGENITAL HEART DISEASE
- ATRIAL ARRHYTHMIAS FOLLOWING OTHER CARDIAC SURGERY
- CONCLUSION
SECTION E: VENTRICULAR TACHYARRHYTHMIAS
CHAPTER 30:Introduction to Ventricular Arrhythmias
- INTRODUCTION
- ETIOLOGY AND PATHOPHYSIOLOGY
- ECG EVALUATION AND DIFFERENTIAL DIAGNOSIS
- TYPES OF VENTRICULAR ARRHYTHMIAS
- NONINVASIVE EVALUATION OF VENTRICULAR ARRHYTHMIAS
- CONCLUSION
- REFERENCES
CHAPTER 31:Monomorphic Ventricular Tachycardia: Mechanisms and Etiology
- INTRODUCTION
- AUTOMATICITY
- ABNORMAL AUTOMATICITY
  - Ventricular Tachycardias due to Abnormal Automaticity
- TRIGGERED ACTIVITY
  - Outflow Tract Triggered Monomorphic Ventricular Tachycardia
  - Triggered Activity due to Digitalis Toxicity
- REENTRY
- CHARACTERISTICS OF REENTRY
- TYPES OF REENTRANT VENTRICULAR ARRHYTHMIAS
- REFERENCES
CHAPTER 32:Ventricular Tachycardia in Ischemic and Nonischemic Cardiomyopathy: Reentrant Circuits, Mapping Techniques and Ablation Strategies
- INTRODUCTION
- PATHOPHYSIOLOGY
  - Coronary Artery Disease
  - Dilated Cardiomyopathy
- PROCEDURAL PLANNING
- MAPPING AND ABLATION
- REFERENCES
CHAPTER 33:Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
- INTRODUCTION
- CLINICAL PRESENTATION AND NATURAL HISTORY
- GENETIC BASIS OF ARVD/C
- PATHOPHYSIOLOGIC BASIS OF ARVD/C
- DIAGNOSTIC CRITERIA FOR ARVD/C AND DIAGNOSTIC APPROACH
- ROLE OF EXERCISE
- MANAGEMENT
- CONCLUSION
- REFERENCES
CHAPTER 34:Ventricular Tachycardia in Specific Cardiomyopathies: Sarcoidosis and Tuberculosis
- INTRODUCTION
- CARDIAC SARCOIDOSIS
- CARDIAC TUBERCULOSIS
- CLINICAL PRESENTATION
- DIAGNOSIS
- TREATMENT MODALITIES
- RESPONSE TO THERAPY
- CONCLUSION
- REFERENCES
CHAPTER 35:Idiopathic Left Ventricular Tachycardia
- INTRODUCTION
- CLASSIFICATION AND PATHOPHYSIOLOGY
- DIAGNOSTIC CRITERIA
  - Surface Electrocardiogram
  - Intracardiac Electrograms
- MAPPING AND ABLATION
- SUCCESS AND RECURRENCE RATES
- TROUBLESHOOTING THE DIFFICULT CASE
- REFERENCES
CHAPTER 36:Idiopathic Outflow Tract Ventricular Tachycardia
- INTRODUCTION
- MECHANISM OF ARRHYTHMIA
- EPIDEMIOLOGY
- CLINICAL PRESENTATION
  - Differentiating from Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
  - Tachycardia and PVC-induced Cardiomyopathy
- ANATOMY OF THE OUTFLOW TRACT REGION
- DIAGNOSIS: ELECTROCARDIO-GRAPHIC LOCALIZATION OF THE ARRHYTHMOGENIC FOCUS
- TREATMENT OF IDIOPATHIC OUTFLOW TRACT VENTRICULAR TACHYCARDIA
- CONCLUSION
- REFERENCES
CHAPTER 37:Idiopathic Ventricular Tachycardia from the Mitral Annulus, Papillary Muscles and Other Sites
- INTRODUCTION
- PAPILLARY MUSCLE VENTRICULAR ARRHYTHMIAS
- MITRAL ANNULAR VENTRICULAR ARRHYTHMIAS
- TRICUSPID ANNULAR VENTRICULAR ARRHYTHMIAS
- MODERATOR BAND VENTRICULAR ARRHYTHMIAS
- IDIOPATHIC EPICARDIAL VENTRICULAR ARRHYTHMIAS
- CRUX VENTRICULAR ARRHYTHMIAS
- LEFT VENTRICLE SUMMIT VENTRICULAR ARRHYTHMIAS
- REFERENCES
CHAPTER 38:Bundle Branch Reentry: Mechanisms, Diagnosis and Management
- INTRODUCTION
- MECHANISMS OF BUNDLE BRANCH REENTRY
- CLINICAL CHARACTERISTICS OF PATIENTS WITH BBR-VT
  - Clinical Presentation
  - ECG Findings
- ELECTROPHYSIOLOGIC CHARACTERISTICS OF PA TIENTS WITH BBR-VT
- DIFFERENTIAL DIAGNOSIS OF BBR-VT
- TREATMENT OF BBR-VT
- REFERENCES
CHAPTER 39:J Wave Syndromes
- INTRODUCTION
- J WAVE SYNDROMES: DEFINITIONS AND DESCRIPTIONS
- DIAGNOSIS OF BrS
  - Diagnostic Aids
  - Acquired Brugada Pattern and Syndrome
- DIAGNOSIS OF ERS
- SIMILARITIES AND DIFFERENCES BETWEEN BrS AND ERS
- GENETICS OF THE J WAVE SYNDROMES
- CELLULAR MECHANISMS UNDERLYING BrS AND ERS
  - Is it Possible to Distinguish between a Depolarization and a Repolarization Defect?
- THERAPY FOR THE J WAVE SYNDROMES
  - Pharmacologic Approach to Therapy
    - Approach to Therapy of BrS
    - Approach to Therapy of ERS
- REFERENCES
CHAPTER 40:Early Repolarization Syndrome and Risk of Sudden Cardiac Death
- INTRODUCTION
- DEFINITIONS AND NOMENCLATURE
- EPIDEMIOLOGY OF EARLY REPOLARIZATION
- GENETIC UNDERPINNINGS
- ASSOCIATION TO VENTRICULAR ARRHYTHMIAS AND SUDDEN DEATH
- MOLECULAR MECHANISMS OF THE J-WAVE, ST ELEVATION, AND VF
- RISK STRATIFICATION
- MANAGEMENT
- REFERENCES
CHAPTER 41:Idiopathic Ventricular Fibrillation: Mechanisms and Management Strategies
- INTRODUCTION
- WHAT IS IDIOPATHIC VENTRICULAR FIBRILLATION?
- EPIDEMIOLOGY
- CLINICAL CHARACTERISTICS
- THE ELECTROCARDIOGRAM
- ELECTROPHYSIOLOGICAL DATA
- POSSIBLE MECHANISMS
  - Role of Genetics
- DIAGNOSIS
  - Differential Diagnosis
- MANAGEMENT
- LIMITATIONS OF KNOWLEDGE
- REFERENCES
CHAPTER 42:Ventricular Arrhythmia Storm: Etiology, Mechanisms and Management
- INTRODUCTION
- ETIOLOGY AND MECHANISMS
- APPROACH TO A PATIENT PRESENTING WITH ELECTRICAL STORM
- ELECTRICAL STORM: CLINICAL TYPES
- PRINCIPLES OF MANAGEMENT OF ELECTRICAL STORM
- CONCLUSION
- REFERENCES
SECTION F: MISCELLANEOUS
CHAPTER 43:Entrainment: Principles and Clinical Applications
- INTRODUCTION
- DISCOVERING ENTRAINMENT
  - Entrainment of Atrial Flutter
  - Entrainment of Ventricular Tachycardia
- ENTRAINMENT: A PACING TECHNIQUE TO IDENTIFY REENTRANT ARRHYTHMIAS
- THE BREAKTHROUGH CASE IN UNDERSTANDING ENTRAINMENT, AND DEVELOPMENT OF THE FIRST THREE ENTRAINMENT CRITERIA
- THE FOURTH ENTRAINMENT CRITERION
- CONCEALED ENTRAINMENT
- CLINICAL APPLICATIONS OF ENTRAINMENT
  - Postpacing Interval
    - Pitfalls Regarding the Postpacing Interval
  - Entrainment in Specific Tachycardia
- CONCLUSION
- REFERENCES
CHAPTER 44:Wide QRS Complex Tachycardia: An Electrophysiologic Approach
- INTRODUCTION
- NARROW VERSUS WIDE QRS COMPLEX
- NARROW VERSUS WIDE QRS TACHYCARDIA: ECG DISTINCTION
  - Current Status of ECG Criteria for VT versus Aberrant Conduction Distinction
  - Intracardiac Electrophysiologic Studies
- REFERENCES
CHAPTER 45:Provocative Drug Testing in the Electrophysiology Lab
- INTRODUCTION
- PROVOCATIVE DRUG TESTING IN BRUGADA SYNDROME
  - Performing the Drug Challenge to Unmask Type 1 Brugada ECG Pattern
- PROVOCATIVE DRUG TESTING IN CPVT
- PROVOCATIVE DRUG TESTING IN LQTS
- OTHER USES OF PROVOCATIVE DRUG TESTING IN THE ELECTROPHYSIOLOGY LAB
- REFERENCES
CHAPTER 46:Catheter Ablation in Children
- INTRODUCTION
- CONSIDERATIONS PRIOR TO CATHETER ABLATION
- PEDIATRIC ABLATION SUCCESS RATES
- COMPLICATIONS
  - Atrioventricular Block
  - Radiation Exposure
- CONCLUSION
- REFERENCES
CHAPTER 47:Epicardial Ablation: Techniques and Applications
- INTRODUCTION
- INDICATIONS FOR EPICARDIAL ACCESS AND ABLATION
- TECHNIQUE OF EPICARDIAL ACCESS
- COMPLICATIONS
- CONCLUSION
- REFERENCES

INDEX

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