Clinical Cardiac Electrophysiology in the Young

331 Pages·2006·9.91 MB·English

by  Parvin Dorostkar M.D. (auth.)

Clinical Cardiac Electrophysiology
in the Young
Developments in Cardiovascular Medicine
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Mechanisms.2003 ISBN:1-4020-7438-7
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Mechanisms.2004 ISBN:1-4020-7857-9
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254. XanderH.T.Wehrens,AndrewR.Marks(eds.):RyanodineReceptors:Structure,functionand
dysfunctioninclinicaldisease.2005 ISBN:0-387-23187-0
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MagneticResonance.2005 ISBN:0-387-23632-5
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257. MacdonaldDickII:ClinicalCardiacElectrophysiologyintheYoung2006
ISBN:0-387-29164-4
Previousvolumesarestillavailable
Clinical Cardiac Electrophysiology
in the Young
Editedby
Macdonald Dick II M.D.
Withpastandpresent
FellowsandFaculty
ofthe
DivisionofPediatricCardiology
UniversityofMichigan
Macdonald Dick II, MD
Professor of Pediatrics
University of Michigan
C.S. Mott Children’s Hospital
Womens L1242, Box 0204
1500 East Medical Center Drive
Ann Arbor, MI 48109-0204
USA
Library of Congress Cataloging-in-Publication Data
Clinical cardiac electrophysiology in the young / edited by Macdonald Dick II; with past
and present fellows and faculty of the Division of Pediatric Cardiology, University of Michigan.
p. ; cm. – (Developments in cardiovascular medicine; v. 257)
Includes bibliographical references and index.
ISBN -13: 978-0-387-29164-2 (alk. paper) e-ISBN 978-0-387-29170-3
ISBN -10: 0-387-29164-4 (alk. paper) e-ISBN 0-387-29170-9
1. Pediatric cardiology. 2. Electrophysiology. 3. Heart conduction system 4.
Children—Diseases--Diagnosis. 5. Heart--Diseases--Diagnosis. I. Dick, MacDonald. II.
University of Michigan. Mott Children’s Hospital. Division of Pediatric Cardiology. III.
Series.
[DNLM: 1. Heart--physiology--Child. 2. Heart--physiology--Infant. 3.
Electrophysiology--methods--Child. 4. Electrophysiology--methods--Infant. 5. Heart
Conduction System--physiology--Child. 6. Heart Conduction System--physiology--Infant.
7. Heart Diseases—physiopathology--Child. 8. Heart Diseases--physiopathology--Infant.
WG 202 C641 2006]
RJ421.C555 2006
618.92’12--dc22 2005054106
Printed on acid-free paper.
© 2006 Springer Science+Business Media, LLC.
All rights reserved. This work may not be translated or copied in whole or in part without
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Printed in the United States of America.
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Thisbookwaswrittenbyallofus
becauseofourparentsandteachers,
withourspousesandpartners,
forourandallchildren.
Contributors
Mohamad Al-Ahdab, M.D., Lecturer, Uni- Ian H. Law, M.D., Associate Professor of
versity of Michigan Medical School, Ann Pediatrics, University of Iowa Medical
Arbor,Michigan School,IowaCity,Iowa
DavidBradley,M.D.,AssistantProfessorof Sarah Leroy, Clinical Nurse Specialist and
Pediatrics, Pediatric Cardiology, University Nurse Practitioner, Pediatric Electrophysiol-
ofUtahMedicalSchool,SaltLakeCity,Utah ogy and Anti-Arrhythmia Device Clinics,
UniversityofMichiganMedicalSchool,Ann
Burt Bromberg, M.D., Pediatric Cardiolo-
Arbor,Michigan
gistandElectrophysiologist,St.Louis,MO
MarkRussell,M.D.,AssociateProfessorof
Craig Byrum, M.D., Associate Professor
Pediatrics, University of Michigan Medical
of Pediatrics, Upstate Medical School, New
School,AnnArbor,Michigan
York University, State University of New
York,Syracuse,NewYork. ElizabethV.Saarel,M.D.,AssistantProfes-
sor of Pediatrics, Cleveland Clinic Founda-
RobertM.Campbell,M.D.,AssociatePro-
tion,Cleveland,Ohio
fessorofPediatrics,Children’sHeartCenter,
EmoryUniversity,Atlanta,Georgia William A. Scott, M.D., Professor of Pedi-
atrics, Southwestern Texas Medical School,
Macdonald Dick II, M.D., Professor of
Dallas,Texas
Pediatrics, University of Michigan Medical
School,AnnArbor,Michigan Gerald Serwer, M.D., Professor of Pe-
diatrics, University of Michigan Medical
Parvin Dorostkar, M.D., Associate Profes-
School,AnnArbor,Michigan
sor of Pediatrics, Rainbow Babies and Chil-
dren’s Hospital, University Hospitals Health Christopher B. Stefanelli, M.D., Pediatric
Systems,Cleveland,Ohio Cardiologist,Tacoma,Washington
PeterS.Fischbach,M.D.,AssistantProfes- MargaretStrieper,D.O.,AssociateProfes-
sor of Pediatrics and Pharmacology, Univer- sor of Pediatrics, Children’s Heart Center,
sityofMichiganMedicalSchool,AnnArbor, EmoryUniversity,Atlanta,Georgia
Michigan
Stephanie Wechsler, M.D., Associate
CarlenGomez,M.D.,AssociateProfessorof Professor of Pediatrics, University of
Pediatrics, University of Michigan Medical Michigan Medical School, Ann Arbor,
School,AnnArbor,Michigan Michigan
vii
Preface
Ittakesacertainhubristocomeforthwitha This book emerges from the clinical
book entitled Clinical Cardiac Electrophys- practiceandresearchofthepediatriccardiac
iology in the Young. There are a number electrophysiology group in the Division of
of excellent texts, monographs, and reviews Pediatric Cardiology at the C.S. Mott Chil-
on cardiac arrhythmias in both adults and dren’s Hospital, the University of Michigan
children—Josephson’s and also Zipes and inAnnArbor,andtheformerpediatricelec-
Jalife’scomprehensivetextscometomind,as trophysiology fellows from Michigan, now
well as a number of others, including Deal, established electrophysiologists in their own
Wolff, and Gelband’s, the several volumes right.Itrepresentsacompilationoftheclini-
fromGillette,andtherecenttextfromWalsh, calcourse,electrocardiograms,electrophysi-
Saul,andTriedman,thelatterthreetextsfo- ologicstudies,pharmacologicalmanagement,
cusingonchildren. andtranscatheterablationtherapyinpatients
Nonethelessthepastthreedecadeshave frominfancythroughyoungadulthoodseenin
witnessed enormous advances in the under- AnnArborandatthecurrentclinicalsitesof
standing and management of human cardiac theformerMichiganfellows.Thus,whilethe
arrhythmias.Thisdevelopmentrepresentsthe productmaybeidiosyncratic,itisnotprovin-
fruitsofbothbasicandclinicalinvestigations cial.Weareinterestedin“howitisdone”but
incardiacimpulseformationandpropagation nottotheexclusionofotherapproaches.This
at the organ, tissue, and more recently, cel- is only one (or several) way to address the
lular and molecular levels. This information clinical problem of arrhythmias in children,
explosionmayresultininformationoverload andsurelynottheonlyway,especiallyasone
and frustrate the student, the young physi- viewsthefutureofemergingenergysources
cianintraining,aswellastheseasonedprac- for ablation, non-ionizing radiation imaging
titioner. This book focuses on the practical techniques, and molecular diagnostic possi-
(and theoretical when applicable) aspects of bilities.
clinicalelectrophysiologyofcardiacarrhyth- The book is divided into two parts.
mias in the young. Our intention is that the The first part, Background (Chapters 1–3),
younghouseofficerormaturephysicianwho discusses the cardiac conduction system—
is faced with a child with a cardiac arrhyth- development, anatomy, and physiology.
mia will find this book useful in increasing Particularattentionisdirectedtotheclinical
their understanding, sparking their interest, electrophysiology of the cardiac conduction
and perhaps leading them to a therapeutic system and the techniques of electrophysio-
solution. logic study that are specific to children and
ix
x PREFACE
thathavebeendevelopedandpracticedatthe A text or technical book is rarely the
University of Michigan and at other centers. product of a single individual. With that in
The second part, Cardiac Electrophysiology mind,anyvalueorsensethatcanbemadeof
in Infants and Children (Chapters 4–23), this work is solely due to the terrific efforts
focuses on the clinical science of cardiac of the authors; any error or fault can be cor-
arrhythmiasininfantsandchildren. rectly attributed to me. I am deeply grateful
Chapters 4–12 discuss the mechanism, toalloftheauthorsfortheircontributions,as
the ECG characteristics, the electrophysio- well as their patience in bringing the project
logicfindings,thetreatment,andtheprogno- together.Iwanttorecognizethegenerosityof
sisoftachyarrhythmias.Chapters13–16focus mycolleaguesatMichiganinprovidingcov-
onbradyarrhythmias.Chapters17–20address eragewhenIwouldhideout(includingasab-
certain specialized subjects, including, syn- batical)toworkonthetext.Thanksalsotothe
cope, cardiac pacemakers, implantable car- medicalelectrophysiologygroupatMichigan
diac defibrillators, genetic disorders of the for encouragement and support for the pedi-
cardiac impulse, fetal arrhythmias, and sud- atric program. I also want to thank my local
den cardiac death as it occurs in the young. editor, Kathryn Clark, for all her efforts in
Chapters 21–22 center on the pharmacology keepingmeontask,endlesslyandrepeatedly
ofantiarrhythmicagents,indicationsforuse, formatting the multiple revisions of the text,
doses, side effects and toxicity, as well as andfindingandeliminatingtoomanyexam-
ontranscatheterarrhythmiaablation.Finally, plesof“nonsense”tocount.Finally,Iwantto
what the practitioner can expect to see from thankMelissaRamondettaatSpringerforher
theimpactofcardiacarrhythmiasonthelife greatpatience,greatgoodhumor,andsound
ofthepatientandfamilyisdiscussedfromthe advice throughout the course of the project.
nursingpointofviewinChapter23. Carolin,mywife,graciouslypermittedmeto
The intent of the book is practical and weedthebookofitsunwantedwordage(prob-
thus the suggested readings are selected and ablymissedabit)ratherthanouryardofun-
notencyclopedic.Theyaremeantasastarting wantedplantlifeonnumerousweekends.
placefortheinterestedreader.Examplesand
tablesareincludedintheanticipationthatthe MacdonaldDickII,M.D.
readerwillrapidlybeabletomatchtheclinical AnnArbor,MI
problemtotheexamplesandtheaccompany- August,2005
ingtext.
Foreword
The text of Clinical Cardiac Electrophysiol- professionals.Therapidadvancesinthefield
ogy in the Young provides a systematic ap- in such areas as interventional and surgical
proach to the anatomy, pathophysiology, ba- cryoablation techniques, complexity of rhy-
sic electrophysiology, diagnosis and therapy thmdisturbances,newmonitoringdevicesand
of atrial and ventricular arrhythmias as well pharmaceuticalsmakeitaninvaluabletext.
as conduction abnormalities in the young. It Dr.MacdonaldDickasanauthorandedi-
elucidatesthebroadspectrumofrhythmdis- torofthebookisaninternationallyrecognized
turbances that may occur from the fetus to scholar and clinical pediatric electrophysiol-
youngadult,asanisolatedabnormality,inthe ogist. A superb teacher and role model for
presence of underlying congenital heart dis- traineesandfacultyhisaffabilityanddiligent
ease,bothpriortoandsubsequenttosurgical efforthavebroughtaboutthecompilationand
repair.Theclinicalmanifestations,diagnosis publication of the book. The majority of the
andappropriatepharmacologicandinterven- knowledgeableandexperiencedcontributors
tionaltherapybyatrainedhealthcareteamare have received their training in pediatric car-
fully discussed. Science is consistently used diology at the University of Michigan. The
to explain the electrophysiologic diagnoses, authorsareindebtedtotheirmedicalandsur-
pharmacologic, interventional and surgical gicalcolleagues,fellows,familymembersand
treatment.Somepriorknowledgeandunder- respectiveinstitutionsforthesupportanden-
standingofelectrophysiologyandrhythmdis- couragementintheendeavor.
turbancesishelpfulandtheinformationpro-
vided here may be utilized as a guidebook, AmnonRosenthal,MD
resourceandreferenceforresidents,cardiol- ProfessorofPediatrics
ogy fellows, trained cardiologists and elec- UniversityofMichiganMedicalSchool
trophysiologistsaswellasotheralliedhealth AnnArbor,MI
xi