Understanding Intracardiac EGMs: A Patient Centered Guide PDF
Preview Understanding Intracardiac EGMs: A Patient Centered Guide
Understanding Intracardiac EGMs APatientCenteredGuide ToHowardandSumikoKusumoto Understanding Intracardiac EGMs A Patient Centered Guide Fred Kusumoto MD ProfessorofMedicine MayoClinicCollegeofMedicine Jacksonville,Fl,USA Thiseditionfirstpublished2015©2015byJohnWiley&SonsLtd Registeredoffice:JohnWiley&Sons,Ltd,TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK Editorialoffices:9600GarsingtonRoad,Oxford,OX42DQ,UK 111RiverStreet,Hoboken,NJ07030-5774,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowtoapplyforpermissionto reusethecopyrightmaterialinthisbookpleaseseeourwebsiteatwww.wiley.com/wiley-blackwell TherightoftheauthortobeidentifiedastheauthorofthisworkhasbeenassertedinaccordancewiththeUKCopyright, DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inanyform orbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright, DesignsandPatentsAct1988,withoutthepriorpermissionofthepublisher. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.Allbrandnamesand productnamesusedinthisbookaretradenames,servicemarks,trademarksorregisteredtrademarksoftheirrespective owners.Thepublisherisnotassociatedwithanyproductorvendormentionedinthisbook.Itissoldontheunderstanding thatthepublisherisnotengagedinrenderingprofessionalservices.Ifprofessionaladviceorotherexpertassistanceis required,theservicesofacompetentprofessionalshouldbesought. Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding,anddiscussiononlyandare notintendedandshouldnotberelieduponasrecommendingorpromotingaspecificmethod,diagnosis,ortreatmentby healthsciencepractitionersforanyparticularpatient.Thepublisherandtheauthormakenorepresentationsorwarranties withrespecttotheaccuracyorcompletenessofthecontentsofthisworkandspecificallydisclaimallwarranties,including withoutlimitationanyimpliedwarrantiesoffitnessforaparticularpurpose.Inviewofongoingresearch,equipment modifications,changesingovernmentalregulations,andtheconstantflowofinformationrelatingtotheuseofmedicines, equipment,anddevices,thereaderisurgedtoreviewandevaluatetheinformationprovidedinthepackageinsertor instructionsforeachmedicine,equipment,ordevicefor,amongotherthings,anychangesintheinstructionsorindication ofusageandforaddedwarningsandprecautions.Readersshouldconsultwithaspecialistwhereappropriate.Thefactthat anorganizationorWebsiteisreferredtointhisworkasacitationand/orapotentialsourceoffurtherinformationdoesnot meanthattheauthororthepublisherendorsestheinformationtheorganizationorWebsitemayprovideor recommendationsitmaymake.Further,readersshouldbeawarethatInternetWebsiteslistedinthisworkmayhave changedordisappearedbetweenwhenthisworkwaswrittenandwhenitisread.Nowarrantymaybecreatedorextended byanypromotionalstatementsforthiswork.Neitherthepublishernortheauthorshallbeliableforanydamagesarising herefrom. LibraryofCongressDataappliedfor AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynotbeavailablein electronicbooks. Coverimage:istockphoto/lifeline-2408812©SciFXAnimationLtd. Typesetin8.5/12ptMeridienLTStdbyLaserwordsPrivateLimited,Chennai,India 1 2015 Contents Preface,vii 16 Supraventriculartachycardiacase16:atrial tachycardiaafteratrialfibrillationablation,195 Glossary,ix 17 Supraventriculartachycardiacase17:atrial 1 Basicelectrophysiology,1 tachycardiaafteratrialfibrillationablation,205 2 Supraventriculartachycardiacase1,17 18 Supraventriculartachycardiacase18:atrial 3 Supraventriculartachycardiacase2,45 tachycardiaafteratrialfibrillationablation,215 4 Supraventriculartachycardiacase3,55 19 Supraventriculartachycardiacase19:atrial 5 Supraventriculartachycardiacase4,67 tachycardiaafteratrialfibrillationablation,227 6 Supraventriculartachycardiacase5,83 20 Widecomplextachycardiacase1,237 7 Supraventriculartachycardiacase6: 21 Widecomplextachycardiacase2,253 baselinepreexcitation,97 22 Widecomplextachycardiacase3: 8 Supraventriculartachycardiacase7: prematureventricularcontractions,263 baselinepreexcitation,111 23 Widecomplextachycardiacase4,273 9 Supraventriculartachycardiacase8,125 24 Widecomplextachycardiacase5,281 10 Supraventriculartachycardiacase9,135 25 Widecomplextachycardiacase6,291 11 Supraventriculartachycardiacases10and 26 Syncope,297 11,143 27 Multiplechoicequestionsandanswers,303 12 Supraventriculartachycardiacase12,153 Appendix,323 13 Supraventriculartachycardiacase13,163 Index,331 14 Supraventriculartachycardiacase14:atrial fibrillation,177 15 Supraventriculartachycardiacase15:atrial tachycardiaafteratrialfibrillationablation,187 v Preface Thefieldofelectrophysiologyhasevolvedrapidlyover theelectrophysiologicevaluationofthepatient.Where thepastthreedecadesfromanichefieldwithminimal applicable,Ihavetriedtoprovidethereaderwithinsight clinical impact to an essential part of cardiology that with situations where different tactics for the diagnos- warrants specialized training for two years and has a tic evaluation of tachyarrhythmias in the electrophys- separate board certification from the American Board iology laboratory might be pursued. I will be the first of Internal Medicine. This evolution in knowledge toacknowledgethatevaluationofintracardiacelectro- and clinical applicability has been accompanied by grams is an art that is often subjective and that expe- the development of many specialized tools that have rienced clinicians will have different interpretations of facilitated procedures in the electrophysiology labora- thesamesetofrecordings.Ifthetextprovidesaflash- tory.Althoughthesenewtoolsthatallowreproducible pointforargumentsanddiscussionatyourlaboratories, mapping of arrhythmias in the heart, mapping with thenmyoverarchinggoalofgettingpeopletoappreciate computerized algorithms, and advanced imaging, theimportanceofelectrograminterpretationevenwith amongothercapabilitieshavebecomealmostessential today’stechnologyhasbeenaccomplished. foranyfullyfunctioningelectrophysiologylaboratory,it This book can be read alone, but it also references remainsjustasimportantforthecliniciantohaveaclear concepts illustrated from Understanding the ECG and understanding of arrhythmias using the most funda- EGM (Wiley-Blackwell 2010). That first book takes mentalelectrophysiologictechnique–directmappingof the traditional approach of sequentially discussing a themyocardiumwithelectrodecathetersandevaluating known type of arrhythmia, for example, atrial flutter theresponseofcardiactissuetoelectricalstimulation. or atrioventricular node reentry. In addition, it starts Thisbookisdesignedasaseriesofcasesthatillustrate with basic but fundamental concepts such as filtering the process of evaluation of arrhythmias using stan- andevaluationofbasicintervalsandrefractoryperiods, dard electrophysiologic techniques. Although patients which are subjects that are not addressed or only may come to the electrophysiology laboratory with a cursorily discussed in this book. In contrast, this book tentativediagnosis,allexperiencedelectrophysiologists startsfromclinicalpresentationofanindividualpatient knowthattheseonlyrepresent“bestguesses”andmore where the exact type of arrhythmia is not known a often than not the guesses are partially or completely priori, the usual situation that confronts the clinical wrong. Like any good puzzle (and perhaps to our electrophysiologist. Although the book will be more frustration),therecanbemanytwistsandturnsduring easily read by the health professional that already an electrophysiology study due to misinterpretation of understands some of the basics of electrophysiology, I data and conflicting or confusing pieces of data that amhopefulthatthebookwillappealtoawideaudience must be cobbled together into a coherent (and accu- including experienced staff in the electrophysiology rate!) diagnosis. The cases in this book go in sequence laboratory, cardiology and electrophysiology fellows, from initial presentation of the patient, strategies for andelectrophysiologistswhoaretakingcareofpatients comprehensive evaluation in the electrophysiology with complex arrhythmias or are studying for their laboratory,andwhereappropriate,therapeuticoptions electrophysiologyboards. forablation. IwouldliketothankMelScheinman,who,overtwo It is important to note that there are many different decades ago, first taught me the fundamentals of elec- approaches and styles to electrophysiology studies, so trograminterpretationbutmoreimportantlyinstilledan therewillbesomedisagreementonthebestmethodfor appreciation of the nuances of intracardiac recordings vii viii Preface and the importance of curiosity, patience, and always thistakesmanylonghours,andasIamhunchedover putting the patient first during an electrophysiology my computer tapping out these last words in the late study. I can still fondly recall late evenings when Mel evening, I know that I am indebted to my daughters would find me at the end of the day and take time to Miya, Hana, and Aya for putting up with an occasion- reviewtheday’scases(doesthemanevertireofthinking ally distracted father and to my wife Laura for her aboutelectrophysiology?).Puttingabooktogetherlike understandingandpatienceover25wonderfulyears.
The list of books you might like
