Mechanisms and Management of Cardiac Arrhythmias

185 Pages·2001·0.48 MB·English

by  Clifford Garratt

Mechanisms and
Management of
Cardiac
Arrhythmias
Clifford Garratt
Professor of Cardiology,
Manchester Heart Centre,Manchester Royal Infirmary,
Manchester M13 9WL,UK
© BMJ Books 2001
BMJ Books is an imprint of the BMJ Publishing Group
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 and/or otherwise,
without the prior written permission of the publishers.
First published in 2001
by BMJ Books,BMA House,Tavistock Square,
London WC1H 9JR
www.bmjbooks.com
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0-7279-1194-5
Typeset by Newgen Imaging Systems (P)Ltd.,Chennai,India
Printed and Bound by Selwood Printing Ltd,Burgess Hill,West Sussex
To Lucy
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Contents
Preface vii
PART I CELLULAR AND TISSUE
ELECTROPHYSIOLOGY
1 Ion channels and ion currents 3
2 The cardiac action potential and its relevance to arrhythmias 11
3 Propagation of electrical impulses through cardiac muscle 18
PART II CLINICAL TACHYCARDIAS
4 Classification and nomenclature of clinical tachycardias 29
5 Sinus tachycardia,atrial tachycardia,and atrial flutter 31
6 Atrial fibrillation 43
7 Junctional tachycardias 59
8 Ventricular tachycardia in the setting of a structurally
normal heart 70
9 Ventricular tachycardia and fibrillation in the setting of
ischaemic heart disease 77
10 Ventricular tachycardia and fibrillation in the setting of
dilated or hypertrophic cardiomyopathy 88
11 Ventricular fibrillation in the setting of a structurally
normal heart 93
12 The congenital long QT syndrome 97
13 Arrhythmogenic right ventricular dysplasia/
cardiomyopathy 104
PART III DIAGNOSIS AND MANAGEMENT
14 Clinical management of the patient presenting with
palpitation 115
v
CONTENTS
15 Diagnosis and management of acute episodes of tachycardia 121
16 Antiarrhythmic drug therapy 137
17 Electrophysiologic studies and radiofrequency catheter
ablation techniques 151
18 Implantable cardioverter defibrillators (ICDs) 161
19 Concluding remarks 168
Index 170
vi
Preface
My interest in cardiac arrhythmias stems from my time as a clinical medical
student and house physician at St Bartholomew’s Hospital in London.
A combination of the logical basis to therapy (at least relative to most other
medical disciplines) and the dramatic successes of some forms of treatment
drew me to the subject.I remember being surprised to find that,although
clinical textbooks on arrhythmia management would usually have a section
on “basic electrophysiology”or “the action potential”,there was invariably
no attempt made to explain the clinical arrhythmias in these terms.
Similarly, accounts of the ionic processes underlying activation of cardiac
cells would include a discussion of clinical arrhythmias as an afterthought if
at all.There have been dramatic advances in both fields since that time.My
impression is that this divide remains despite the recent publication of sev-
eral large multiauthored texts which address both areas in a single volume.
The aim of this monograph is to provide medical students,house physicians,
and cardiologists in training with a logical, scientifically based framework
for the management of arrhythmias in which the relevant aspects of basic
electrophysiology are put in the clinical context.The fundamental concepts
introduced in the first three chapters are expanded and illustrated in subse-
quent sections.Thereafter each arrhythmia is discussed in greater detail with
particular emphasis on mechanism,clinical setting,and long term or defin-
itive therapy. Finally the principles of clinical management of arrhythmias
are addressed, with chapters on presentation, acute diagnosis and therapy,
antiarrhythmic drugs, ablation techniques, and implantable cardioverter
defibrillators.
I would like to acknowledge my clinician teachers and colleagues,espe-
cially John Camm,Adam Fitzpatrick, Michael Griffith, Edward Rowland,
and David Ward for their ideas and advice which are contained in this vol-
ume.Finally,I am grateful to Maurits Allessie for an inspiring apprentice-
ship in experimental electrophysiology and to the British Heart Foundation
for allowing me to spend a year in his laboratory in Maastricht.
vii
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PART I
CELLULAR AND TISSUE
ELECTROPHYSIOLOGY