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CLIMICAL CARDIOLOGY
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CLINICAL ASPECTS
OF CARDIAC
ARRHYTHMIAS
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CLINICAL CARDIOLOGY
CLINICAL ASPECTS
OF CARDIAC
ARRHYTHMIAS
Edited by
A. John Camm
Department of Cardiological Sciences
St. George's Hospital Medical School
Cranmer Terrace
London
and
David E. Ward
St. George's Hospital
Blackshaw Road
London
KLUWER ACADEMIC PUBLISHERS
DORDRECHT-BOSTON-LONDON
Distributors
for the United States and Canada: Kluwer Academic Publishers, PO Box 358, Accord Station,
Hingham, MA 02018-{)358, USA
for all other countries: Kluwer Academic Publishers Group, Distribution Center, PO Box 322,
3300 AH Dordrecht, The Netherlands
British Library Cataloguing in Publication Data
Clinical aspects of cardiac arrhythmias.
1. Man. Heart. Arrhythmia
I. Camm, A. John II. Ward, David E.
III. Series
616.1'28
Library of Congress Cataloging-in-Publication Data
Clinical aspects of cardiac arrhythmias.
(Current status of clinical cardiology)
Includes bibliographies and index.
1. Arrhythmia. I. Camm, A. John. II. Ward, David E.
III. Series. [DNLM: 1. Arrhythmia-physiopathology.
2. Electrocardiography. 3. Electrophysiology.
WG 330 C6405]
RC685.A65C541988 616.1'28 88-12801
JSBN-13:978-94-010-7073-7 e-JSBN-13:978-94-009-1289-2
001: I 0.1 007/978-94-009-1289-2
Copyright
© 1988 by Kluwer Academic Publishers
Softcover reprint of the hardcover 1s t edition 1988
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, without prior permission from the publishers, Kluwer Academic Publishers BY,
PO Box 17,3300 AA Dordrecht, The Netherlands.
Published in the United Kingdom by Kluwer Academic Publishers, PO Box 55, Lancaster, UK.
Kluwer Academic Publishers BY incorporates the publishing programmes of D. Reidel,
Martinus Nijhoff, Dr W. Junk and MTP Press.
Contents
Preface Xl
Series Editor's Note X1 11
List of Contributors xv
1 Mechanisms of tachycardia in the experimental setting 1
and their possible clinical importance
S.M. Cobbe
2 Metabolic factors in the genesis of ventricular arrhyth- 15
mlas
D. C. Russell
3 The electrophysiology of reperfusion-induced arrhyth- 33
mias following acute myocardial ischaemia
N. A. Flores and D.]. Sheridan
4 Autonomic tone modulation of cardiac arrhythmias 49
C. S. Butrous
5 Haemodynamic consequences of cardiac arrhythmias 59
C. Kaye and A.J. Camm
6 The morphological correlates of atrial and ventricular 77
tachycardias
M.J. Davies
7 Diagnosis of cardiac arrhythmias from the surface elec- 95
trocardiogram
D. W. Davies and W. D. Toff
v
CONTENTS
8 Ambulatory electrocardiographic monitoring the 119
In
diagnosis of arrhythmias
A.K. Brown
9 The role of electrophysiological study in the diagnosis 137
of arrhythmias
E. Rowland
10 Signal-averaged surface electrocardiography 163
R. Vincent
11 Arrhythmias in children 179
]. A. Till and D. E. Ward
12 Special aspects of arrhythmias in the elderly 201
A. Martin
13 Normal and abnormal responses of cardiac rhythm to 211
spontaneous physiological manoeuvres
D. Mehta, D.E. Ward and A.]. Camm
14 Ventricular arrhythmias in acute myocardial infarction 237
R. W. F. Campbell
15 Practical cardiac pacing 247
E.]. Perrins
16 External electrical defibrillation and cardioversion 263
]. C. P. Crick
17 Drugs used for the treatment of tachycardias 285
R. S. Bexton
18 The arrhythmogenic effects of antiarrhythmic drugs. 301
Types, mechanisms and predisposing factors
c.]. Garratt and A.]. Camm
19 Digitalis and arrhythmias 311
R. Hayward
vi
CONTENTS
20 Implantable electrical devices for the treatment of tachy- 337
arrhythmias
D. B. O'Keef{e
21 The high energy catheter ablation technique in the man- 359
agement of tachyarrhythmias
P. Holt and E. Boyd
22 Surgery for the treatment of tachycardias 375
A. W. Nathan
23 Cardiopulmonary resuscitation 403
D. A. Zideman
Index 415
vii
Current Status of Clinical Cardiology Series
Drugs in the Management of Heart Disease
Edited by A. Breckenridge
Heart Muscle Disease
Edited by f. F. Goodwin
Congenital Heart Disease
Edited by F. J. Macartney
Ischaemic Heart Disease
Edited by K. M. Fox
Immunology and Molecular Biology of Cardiovascular Diseases
Edited by C. f. F. Spry
Clinical Aspects of Cardiac Arrhythmias
Edited by A. f. Camm and D. E. Ward
ix
Preface
We were particularly pleased to compile this volume entitled 'Clinical
Aspects of Cardiac Arrhythmias'. Recent years have seen the publication
of many textbooks on cardiac arrhythmias, some of which concentrate
on one particular aspect such as drug management, electrocardiographic
appearances, electrophysiological evaluation etc; and others of which
are the collated reports of symposia, often dealing with detailed con
siderations of highly specialised problems. Most of the larger more
comprehensive texts have devoted a substantial proportion to basic
considerations and experimental observations, far removed from the
clinical arena. When asked to contribute to the series 'Current Status of
Clinical Cardiology' we felt that the clinical aspects of cardiac arrhyth
mias should be emphasized, and that the text should be as comprehensive
as possible within the limitations of a single volume in this series. This
comprehensive but clinical approach has necessitated the inclusion of
certain subjects such as the mechanisms of tachycardia, metabolic
aspects of cardiac arrhythmias and reperfusion arrhythmias, which are
not directly or exclusively clinical. However, the rapid advances in these
areas in recent years are likely to have increasingly important clinical
con seq uences.
Although the epidemiology of clinical arrhythmias is difficult to dis
cover, it is widely appreciated that arrhythmias are commonplace. For
example, the Wolff-Parkinson-White pattern is found in one in 500 live
births, sudden unexpected cardiac death occurs in approximately one per
1000 of the population each year; atrial fibrillation is the predominant
rhythm in 10% of the elderly population, and about 1 % of the total
population has significant paroxysmal supraventricular tachycardia.
The high prevalence of disabling or life threatening arrhythmias has
encouraged the development of many sophisticated techniques for their
investigation.
Each year many new anti-arrhythmic drugs, implantable devices and
anti-arrhythmic ablative procedures are introduced and described. The
investigation and treatment of cardiac arrhythmias have spawned an
enormous literature which constitutes one of the largest in cardiological
xi
PREFACE
journals. Those concerned with the management of cardiac arrhythmias
are, therefore, faced with an almost impossible task of keeping up to
date. We, therefore, asked the twenty-eight contributors, each working
in the United Kingdom, to provide current and comprehensive reviews.
In this multi-authored text we have tried to maintain consistent pres
entation, whilst preserving the individual approach.
Although written predominantly for physicians, we hope that this
book will interest all those involved in the care of patients with cardiac
arrhythmias.
A. John Camm
David E. Ward
London 1988
xii
Series Editor's Note
The last few decades have seen an explosion in our knowledge of
cardiovascular disease as a result of research in many disciplines. The
tempo of research is ever increasing, so that it is becoming more and
more difficult for one person to encompass the whole spectrum of the
advances taking place on many fronts.
Even more difficult is to include the advances as they affect clinical
practice in one textbook of cardiovascular disease. Fifty years ago all
that was known about cardiology could be included in one textbook of
moderate size and at that time there was little research so that a textbook
remained up to date for several years. Today all this has changed, and
books have to be updated at frequent intervals to keep up with the
results of research and changing fashions.
The present series has been designed to cover the field of cardio
vascular medicine in a series of, initially, eight volumes which can
be updated at regular intervals and at the same time give a sound basis
of practice for doctors looking after patients.
The volumes include the following subjects: heart muscle disease;
congenital heart disease, invasive and non-invasive diagnosis; ischaemic
heart disease; immunology and molecular biology of the heart in health
and disease; irregularities of the heart beat; and each is edited by a
distinguished British author with an international reputation, together
with an international panel of contributors.
The series will be mainly designed for the consultant cardiologist as
reference books to assist him in his day-to-day practice and keep him
up to date in the various fields of cardiovascular medicine at the same
time as being of manageable size.
]. P. Shillingford
British Heart Foundation
xiii
Description:We were particularly pleased to compile this volume entitled 'Clinical Aspects of Cardiac Arrhythmias'. Recent years have seen the publication of many textbooks on cardiac arrhythmias, some of which concentrate on one particular aspect such as drug management, electrocardiographic appearances, elect
