Advances in Arrhythmia Analyses: A Case-Based Approach, An Issue of Cardiac Electrophysiology Clinics

Masood Akhtar, Melvin M. Scheinman

Description

This issue is a valuable tool to help electrophysiologists interpret complex ECGs so they can better understand arrhythmia mechanisms. Organized by cases, this issue illustrates many of the classic electrocardiographic findings and phenomena that every electrophysiologist should know. Study of this issue demonstrates a systematic way to analyze arrhythmia mechanisms.

Sujets

• Médecine
• Spécialités médicales
• Medical
• Cardiology

Informations

• Publié par: Saunders
• Date de parution: 22 juin 2010
• Nombre de lectures: 0
• EAN13: 9781455700189
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Cardiac Electrophysiology Clinics , Vol. 2, No. 2, June 2010
ISSN: 1877-9182
doi: 10.1016/S1877-9182(10)00047-X

Contributors
Cardiac Electrophysiology Clinics
Advances in Arrhythmia Analyses: A Case-Based Approach
Melvin Scheinman, MD
Electrophysiology Service, 500 Parnassus Avenue, Suite 433, San Francisco, CA 94143-1354, USA
Masood Akhtar, MD
Aurora Sinai Medical Center, 960 North 12th Street, Milwaukee, WI 52333, USA
CONSULTING EDITORS Ranjan K. Thakur, MD, MPH, FHRS Andrea Natale, MD, FACC, FHRS
ISSN  1877-9182
Volume 2 • Number 2 • June 2010

Contents
Cover
Contributors
Forthcoming Issues
Foreword
Preface
Syncope in Patient with Long-Standing Hypertension, Diabetes, and Mild Aortic Stenosis
Exercise-Induced Near Syncope
Abnormalities of Impulse Formation and Conduction
Introduction to Supraventricular Tachycardia
Bypass Tract in Patient with Palpitations
Patient with Long RP Tachycardia
Tachycardia-Mediated Cardiomyopathy
Paroxysmal Long R-P Tachycardia
Narrow Complex Tachycardia: What is the Mechanism?
Tachycardia-Induced Cardiomyopathy
Recurrent Accessory Pathway Conduction in a Patient with Wolff-Parkinson-White Syndrome: How to Ablate?
Supraventricular Tachycardia: Where to Ablate?
Rare Diagnosis of a Common Supraventricular Tachycardia
Persistent Long R–P Tachycardia
Supraventricular Tachycardia in a Patient with Repaired Congenital Heart Disease
Supraventricular Tachycardia and Atrioventricular Block
Changing QRS Morphology in a Patient with Wolff-Parkinson-White Syndrome
Ventricular Tachycardia
Approach to Cardiac Device Malfunction
Right Atrial Isolation After Maze Procedure Discovered at the Time of Pacemaker Implantation
The Path Less Taken
Ventricular Tachycardia After Implantable Cardioverter-Defibrillator Placement
Late Recognition of Malignant Vasovagal Syncope
An Unusual Case of Pacemaker Malfunction
Ablation of Complex Atrial Flutters
Multiple Interrelated Right Atrial Flutters
A Case of Atrial Arrhythmia After Lung Transplant
An Atrial Flutter Circuit Within the Cavotricuspid Isthmus
Ablation of Atrial Flutter in Congenital Heart Disease
Atrial Flutter Late After Remote Tetralogy of Fallot Repair
Supraventricular Tachycardia After Atrial Fibrillation Ablation
Supraventricular Tachycardia in Pulmonary Hypertension
Index
Cardiac Electrophysiology Clinics , Vol. 2, No. 2, June 2010
ISSN: 1877-9182
doi: 10.1016/S1877-9182(10)00051-1

Forthcoming Issues
Cardiac Electrophysiology Clinics , Vol. 2, No. 2, June 2010
ISSN: 1877-9182
doi: 10.1016/j.ccep.2010.02.008

Foreword

Ranjan Thakur, MD, MPH, FHRS
Thoracic and Cardiovascular Institute, Michigan State University, 405 West Greenlawn, Suite 400, Lansing, MI 48910, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Andrea Natale, MD, FHRS ,
Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David’s Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
Ranjan Thakur, MD, MPH, FHRS Consulting Editor

Andrea Natale, MD, FHRS Consulting Editor

The practice of electrophysiology requires an understanding of theoretic principles, but beyond that, it needs cognitive application of those principles to solve electrophysiologic puzzles in the laboratory. In that respect, electrophysiology is unique in cardiology and among medical specialties.
Although one can learn the principles by reading a book, learning how and when to invoke those principles for solving problems comes through deliberate practice, getting it wrong at times, and then having someone show you how to get to the answer and by watching others do it. This was our thinking when we invited Dr Melvin Scheinman and Dr Masood Akhtar to edit this issue of Cardiac Electrophysiology Clinics devoted to interpretation of complex surface and intracardiac electrocardiographic tracings.
Dr Scheinman and Dr Akhtar are well-known pioneers in cardiac electrophysiology, and many of the principles that we take for granted were, in fact, first elucidated by them. In addition to their enormous contribution to electrophysiology, they are master teachers.
We were delighted when they accepted our invitation to edit this issue. Electrophysiologists at all levels will find this issue useful. Beginners should pore over these pages slowly and repeatedly. Practicing electrophysiologists will gain by reviewing these cases, which will remind them of many things they may have long forgotten. Teachers will find these cases useful for teaching their fellows and staff. The case slides are available in PowerPoint format on the Cardiac Electrophysiology Clinics Web site ( http://www.cardiacep.theclinics.com/ ) so they can be downloaded for educational purposes. Dr Scheinman and Dr Akhtar and the contributors have made an excellent effort and we hope that you, the reader, will gain from their wisdom and exposition. We intend to devote an issue of the Cardiac Electrophysiology Clinics every few years to a similar endeavor, edited by a master clinician/teacher.
We would like to receive your feedback and critique so that the Cardiac Electrophysiology Clinics can continually improve to meet your educational needs.
Cardiac Electrophysiology Clinics , Vol. 2, No. 2, June 2010
ISSN: 1877-9182
doi: 10.1016/j.ccep.2010.02.007

Preface

Melvin Scheinman, MD
Electrophysiology Service, 500 Parnassus Avenue, Suite 433, San Francisco, CA 94143-1354, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Masood Akhtar, MD, MACP ,
Aurora Sinai Medical Center, 960 North 12th Street, Milwaukee, WI 52333, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
Melvin Scheinman, MD Guest Editor

Masood Akhtar, MD, MACP Guest Editor

We are delighted to launch an educational endeavor that differs from the usual Cardiac Electrophysiology Clinics format. This issue is devoted to analyses of cardiac arrhythmias entirely using a case-based format. We have always thought that a case-based approach is a unique teaching technique, forcing readers to think along with the experts. Unfortunately, it has become difficult for arrhythmia journals to publish all the excellent case reports submitted. It was, therefore, felt that this issue of Cardiac Electrophysiology Clinics would provide a venue for readers to enjoy and learn from case vignettes from the masters.
This issue is designed for clinicians interested in cardiac rhythm analyses and for cardiac electrophysiology specialists. We have tried to collect case gems that span the gamut of arrhythmia experience. This issue is especially valuable for cardiology trainees reviewing material for board examinations.
We are greatly indebted to some of the most eminent authorities in the field of arrhythmias for their contributions to this issue. Dr William Nelson is a disciple of the Pick-Langendorf school and provided the introductory surface tracings together with their elegant analyses. We acknowledge the important contribution of Dr Mark Josephson. We are particularly indebted to colleagues at the University of California, San Francisco, who worked very hard as section editors to collate and integrate these cases. We sincerely hope that you enjoy this issue. Please let us know if you think this is a worthwhile approach.
Cardiac Electrophysiology Clinics , Vol. 2, No. 2, June 2010
ISSN: 1877-9182
doi: 10.1016/j.ccep.2010.02.002

Syncope in Patient with Long-Standing Hypertension, Diabetes, and Mild Aortic Stenosis

Mark E. Josephson, MD
Cardiovascular Division, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Baker 4, Boston, MA 02215, USA
E-mail address: [e-mail]

Abstract
This article presents a case study of a patient with long-standing hypertension, diabetes, and mild to moderate aortic stenosis presenting with syncope without premonitory symptoms. Electrophysiology confirmed intra-His block. After placement of a permanent pacemaker, the patient remains free of syncope and her high blood pressure is more readily controlled.

Keywords
• Syncope • Intra-His block • Hypertension
An 86-year-old Russian-speaking woman with long-standing hypertension, diabetes, and mild to moderate aortic stenosis presented with syncope without premonitory symptoms. She had no symptoms of congestive heart failure or chest pain. She had a prior episode of syncope the preceding year that was believed by her primary care physician to be vasovagal and was not specifically treated. She also had a history of atrial fibrillation that was intermittent, occurring one to two times per year, but no known sinus node.
Two weeks before the present syncopal episode she felt weak and tired. She was sent to the Outpatient Arrhythmia Clinic at the Beth Israel Deaconess Medical Center for evaluation. On physical examination she was an elderly woman, in no acute distress, resting comfortably. Her blood pressure was 180/65, her heart rate was 35 and regular, and respirations were 14 unlabored. Her physical examination was significant only for elevated jugular venous pressure with intermittent cannon a waves, a murmur of aortic stenosis, some mild edema, and diminished peripheral pulses. Her electrocardiogram is shown in Fig. 1 .

Fig. 1 What is the rhythm?
Carefully analysis of the tracing demonstrates sinus rhythm at about 70 beats per minute with no relationship to the QRS complexes, which have a right bundle branch block, left anterior hemiblock morphology. Complete atrioventricular (AV) block is present. Of note, the P-P intervals surrounding the QRS seem to be shorter than the PR intervals between the QRS. This phenomenon is called “ventriculoaphasic effect.” It is thought to be caused by baroreceptor responsiveness in the aorta to each of the conducted QR