Practical Clinical Electrophysiology PDF
Preview Practical Clinical Electrophysiology
Practical Clinical Electrophysiology EDITORS Peter J. Zimetbaum, MD AssociateProfessorofMedicine HarvardMedicalSchool Director,ClinicalCardiology CardiovascularDivision BethIsraelDeaconessMedicalCenter Boston,Massachusetts Mark E. Josephson, MD HermanC.DanaProfessorofMedicine HarvardMedicalSchool ChiefoftheCardiovascularDivision ChiefMedicalOfficerandChiefAcademicOfficeroftheCardiovascularInstitute oftheBethIsraelDeaconessMedicalCenter Director,Harvard-ThorndikeElectrophysiologyInstitute andArrhythmiaService BethIsraelDeaconessMedicalCenter Boston,Massachusetts AcquisitionsEditor:FRANCESR.DESTEFANO ManagingEditor:CHRISPOTASH ProjectManager:ALICIAJACKSON ManufacturingCoordinator:KATHLEENBROWN ManufacturingManager:KIMBERLYSCHONBERGER DesignCoordinator:HOLLYMCLAUGHLIN CoverDesigner:LOUISFUIANO ProductionServices:LASERWORDSPRIVATELIMITED,CHENNAI,INDIA 2009byLIPPINCOTTWILLIAMS&WILKINS,aWOLTERSKLUWERbusiness 530WalnutStreet Philadelphia,PA19106USA LWW.com Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinany formorbyanymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrievalsystem withoutwrittenpermissionfromthecopyrightowner,exceptforbriefquotationsembodiedincriticalarticles andreviews.MaterialsappearinginthisbookpreparedbyindividualsaspartoftheirofficialdutiesasU.S. governmentemployeesarenotcoveredbytheabove-mentionedcopyright. PrintedintheUSA LibraryofCongressCataloging-in-PublicationData Practicalclinicalelectrophysiology/editors,PeterJ.Zimetbaum,MarkE.Josephson. p.;cm. Includesbibliographicalreferencesandindex. ISBN-13:978-0-7817-6603-6 ISBN-10:0-7817-6603-6 1. Arrhythmia.2. Heart—Electricproperties.3. Electrophysiology.I. Zimetbaum,PeterJ. II. Josephson,MarkE. [DNLM:1. Arrhythmias,Cardiac—physiopathology.2. CardiacElectrophysiology—methods. 3. Arrhythmias,Cardiac—diagnosis.4. Arrhythmias,Cardiac—therapy.WG330P89542009] RC685.A65P6932009 (cid:1) 616.128—dc22 2008028374 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribegenerallyaccepted practices.However,theauthors,editors,andpublisherarenotresponsibleforerrorsoromissionsorforany consequencesfromapplicationoftheinformationinthisbookandmakenowarranty,expressedorimplied, withrespecttothecurrency,completeness,oraccuracyofthecontentsofthepublication.Applicationofthe informationinaparticularsituationremainstheprofessionalresponsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselectionanddosage setforthinthistextareinaccordancewithcurrentrecommendationsandpracticeatthetimeofpublication. However,inviewofongoingresearch,changesingovernmentregulations,andtheconstantflowofinformation relatingtodrugtherapyanddrugreactions,thereaderisurgedtocheckthepackageinsertforeachdrugfor anychangeinindicationsanddosageandforaddedwarningsandprecautions.Thisisparticularlyimportant whentherecommendedagentisaneworinfrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodandDrugAdministration(FDA) clearanceforlimiteduseinrestrictedresearchsettings.Itistheresponsibilityofhealthcareprovidertoascertain theFDAstatusofeachdrugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030orfax ordersto(301)223-2320.Internationalcustomersshouldcall(301)223-2300. VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.LippincottWilliams&Wilkinscustomer servicerepresentativesareavailablefrom8:30amto6pm,EST. 10 9 8 7 6 5 4 3 2 1 To Ben, Molly, and Roberta—for your love, encouragement, and understanding To Sylvie Tessa, Elan Robert, Joan, Rachel, Todd, Stephanie, and Jesse—for their love and support. Contributing Authors David J. Callans, MD Director, Electrophysiology Laboratory Professor of Medicine Cardiovascular MedicineDivision Hospital of The University of Pennsylvania Philadelphia, Pennsylvania Atrial Flutter Daniel R. Frisch, MD Assistant Professor of Medicine Divisionof Cardiology Electrophysiology Section Thomas Jefferson University Philadelphia, Pennsylvania Supraventricular Tachycardia v vi • ContributingAuthors William H. Maisel, MD, MPH Assistant Professor of Medicine Harvard Medical School Director of the Pacemaker and ICD Service Beth Israel Deaconess Medical Center Boston, Massachusetts Permanent Pacemakers Clinical Management of Patients with Implantable Cardioverter Defibrillators Michael McLaughlin, MD Instructor in Medicine Harvard Medical School Divisionof Cardiology Beth Israel Deaconess Medical Center Boston, Massachusetts Sudden Death Syndromes Implantable Cardioverter Defibrillator Indications Christopher Pickett, MD Assistant Professor of Medicine University of Connecticut Divisionof Cardiology University of Connecticut Health Center Farmington, Connecticut Clinical Management of Patients with Implantable Cardioverter Defibrillators Heiko Schmitt, MD, PhD Assistant Professor of Medicine University of Connecticut Divisionof Cardiology University of Connecticut Health Center Farmington, Connecticut Permanent Pacemakers ContributingAuthors • vii John V. Wylie Jr., MD Instructor in Medicine Harvard Medical School, Director, ArrhythmiaMonitoringLaboratory Divisionof Cardiology Beth Israel Deaconess Medical Center Boston, Massachusetts Wolff-Parkinson-White Syndrome and Variants Preface Thelastdecadehas seenanexplosion inthetherapeutic options available for themanagementofcardiacarrhythmias.Asaresult,thefocusofelectrophys- iology training has turned toward acquiring the technical skills necessary to perform catheter ablation and complex device implantation and away from thediagnosticskillsrequiredforarrhythmiamanagement.Ourgoalinwriting thisbookistoprovideasuccinctandpracticalclinicalapproachtothemajor arrhythmia disorders encountered in the clinic as well as the electrophysiol- ogylaboratory.Wehavefocusedontheclinicalhistory,electrocardiogramand diagnostic electrophysiology study. More comprehensive texts are available, whichdelineatethedetailsofdiagnosticandtherapeuticinvasiveelectrophys- iology studies. Wehope it will prove equally useful to the internist evaluating syncope, the cardiologist deciding if apacemaker is needed during amyocar- dialinfarctioncomplicatedbycompleteheartblock,andtheelectrophysiology fellow learning how to differentiate the various forms of supraventricular tachycardiaintheelectrophysiologylaboratory. Asistrueformostfieldsofmedicinethereisasmuchartasthereisscience in electrophysiology. We and the contributing authors to this book share a common ‘‘style’’ of arrhythmia management and passion for the clinical care of patients with arrhythmia disorders, which we hope will prove helpful to physicianscaringforthesefascinatingpatients. PeterJ.Zimetbaum,MD MarkE.Josephson,MD ix
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