Table Of Content1
2
Senior Acquisitions Editor: Sharon Zinner
Development Editor: Ashley Fischer
Editorial Coordinator: Emily Buccieri
Editorial Assistant: Nicole Dunn
Production Project Manager: David Saltzberg
Design Coordinator: Holly Reid McLaughlin
Manufacturing Coordinator: Beth Welsh
Prepress Vendor: Absolute Service, Inc.
2nd edition
Copyright © 2020 Wolters Kluwer
© 2010 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS
KLUWER business
All rights reserved. This book is protected by copyright. No part of this
book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or
utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this
book prepared by individuals as part of their official duties as U.S.
government employees are not covered by the above-mentioned
copyright. To request permission, please contact Wolters Kluwer at Two
Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via
email at [email protected], or via our website at shop.lww.com
(products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Ho, Reginald T., author.
Title: Electrophysiology of arrhythmias / Reginald T. Ho.
3
Description: Second edition. | Philadelphia : Wolters Kluwer, [2020] |
Includes bibliographical references and index.
Identifiers: LCCN 2019019636 | ISBN 9781975101107
Subjects: | MESH: Arrhythmias, Cardiac—diagnosis | Arrhythmias,
Cardiac—surgery | Catheter Ablation | Electrophysiological
Phenomena
Classification: LCC RC685.A65 | NLM WG 330 | DDC 616.1/28—dc23
LC record available at https://lccn.loc.gov/2019019636
This work is provided “as is,” and the publisher disclaims any and all
warranties, express or implied, including any warranties as to accuracy,
comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based on
health care professionals’ examination of each patient and consideration
of, among other things, age, weight, gender, current or prior medical
conditions, medication history, laboratory data, and other factors unique
to the patient. The publisher does not provide medical advice or
guidance, and this work is merely a reference tool. Health care
professionals, and not the publisher, are solely responsible for the use of
this work including all medical judgments and for any resulting
diagnosis and treatments.
Given continuous, rapid advances in medical science and health
information, independent professional verification of medical diagnoses,
indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made, and health care professionals should
consult a variety of sources. When prescribing medication, health care
professionals are advised to consult the product information sheet (the
manufacturer’s package insert) accompanying each drug to verify,
among other things, conditions of use, warnings, and side effects, and
identify any changes in dosage schedule or contraindications,
particularly if the medication to be administered is new, infrequently
used, or has a narrow therapeutic range. To the maximum extent
permitted under applicable law, no responsibility is assumed by the
publisher for any injury and/or damage to persons or property, as a
4
matter of products liability, negligence law or otherwise, or from any
reference to or use by any person of this work.
shop.lww.com
5
This book is dedicated to my family, especially to my
wife, Maromi, and sons, Ethan and Jeremy, whose love,
enduring patience, and encouragement made this book
possible, and to my parents who have always been a
source of love and inspiration to me.
6
Preface
Since the first catheter recording of the human His
bundle in 1960 and ablation in 1981, intracardiac
electrophysiology has been the cornerstone of
arrhythmia diagnosis and ablation. The ability to record
electrical activity within the heart and observe its
behavior to electrical stimulation has yielded valuable
insights into the mechanisms and pathogenesis of
arrhythmias. As a field where interpreting activation
patterns, electrogram morphologies, and responses to
pacing maneuvers are essential, electrophysiology is
better understood through demonstration rather than
description. This book is therefore purposefully
designed to provide an understanding of arrhythmia
diagnosis and ablation by using a comprehensive
collection of intracardiac recordings; color-coded
electro-anatomic maps; and fluoroscopy, intracardiac
echocardiography (ICE), and cardiac CT/MRI images
detailing the “life” of each arrhythmia in the
electrophysiology laboratory: induction, termination,
transition zones, diagnostic pacing maneuvers, classic
presentations, unique manifestations, mapping
techniques, and target site criteria for successful
7
ablation. Recordings were selected to emphasize
physiology and illustrate important principles. Short but
practical discussions systematically explain diagnostic
and ablation criteria while providing a conceptual
framework that puts each recording into context. It is
hoped that through this library of quality recordings, the
reader not only understands but also enjoys the
electrophysiology of arrhythmias.
R T. H , MD, FACC, FHRS
EGINALD O
8
Contents
Preface
1. Bradycardias
SINUS NODE FUNCTION
SINUS NODE RECOVERY TIME
SINO-ATRIAL CONDUCTION TIME
INTRINSIC HEART RATE
CAROTID SINUS MASSAGE
AVN–HIS-PURKINJE AXIS
AVN FUNCTION
AVN REFRACTORY PERIODS
WENCKEBACH CYCLE LENGTH
HIS-PURKINJE FUNCTION
PHYSIOLOGIC VERSUS PATHOLOGIC BLOCK
ATROPINE OR ISOPROTERENOL
PROCAINAMIDE
LOCALIZING THE SITE OF AV BLOCK
12-LEAD ECG
HIS BUNDLE RECORDINGS
Intranodal Block
Intrahisian Block
Infrahisian Block
UNUSUAL ELECTROPHYSIOLOGIC
PHENOMENA
9
