Index

Aα-cardiac actin, 235accessory pathways

evaluation of, 56Adenocard, see adenosineadenosine, 61, 76, 285–287alpha agonist agents, 192amiodarone, 75, 87, 106, 130, 249, 277antiarrythmic medications, 30, 65–66, 148,

267defibrillation thresholds, effects on, 287pharmacology of

β-blockers, 275–277class IA, 268–271class IB, 271–273class IC, 273–275class III, 277–283class IV, 283–285other agents, 285

anticholinergic agents, 193arrhythmogenic right ventricular dysplasia (ARVD),

229, 236–237arterial cannulation, for monitoring systemic blood

pressure, 46atenolol, 276atrial fibrillation

associated disease, 115incidence, 115mechanism related to, 116–117therapy of, 117–118, 262

atrial flutter, 95–113, 157–158atypical

ECG characteristics, 95–96mechanism of, 95treatment of, 96–97

IARTECG characteristics, 98–99electrophysiologic evaluation, 100–102etiology of, 99–100incidence of, 97–98

mapping of, 102–106prevention of, 111prognosis of, 111–112treatment of, 106–111

atrial pacing, 57atrial switch procedure, 263atriofascicular fiber, 55atrioventricular (AV) node, 3, 7, 9, 34, 65, 163

ablation, 79in patients with abnormal cardiac anatomy, 80

atrioventricular blockclass II, indications of, 179ECG characteristics, 164–168electrophysiologic features, 168–169first degree, 165, 253prognosis and treatment, 169–170second degree, 165–198, 253third degree, 173

clinical manifestation of, 174–177disorders causing, 177etiology, 173–174Fetal, 253prognosis of, 178–180treatment, 177–178

atrioventricular delay, 5atrioventricular discordance, 10atrioventricular nodal reentrant tachycardia (AVNRT)

cryotherapy, 79–80drugs used for treatment of, 75electrocardiogram, 70–75electrophysiology study, 75–79incidence of, 69radiofrequency ablation, 75–79symptoms of, 69treatment of

antiarrythmic medications, 65–66cryotherapy, 79–80drugs used for treatment of, 75electrocardiogram, 70–75electrophysiology study, 75–79

327

328 INDEX

atrioventricular nodal reentrant tachycardia (Cont.)incidence of, 69observation, 65prognosis of, 66–67radiofrequency ablation, 75–79symptoms of, 69transcatheter ablation, 66

atrioventricular reentrant tachycardia (AVRT), 51, 248diagnostic testing of

electrophysiology study, 56–65exercise treadmill testing, 56

mechanism of, 53–54atrioventricular septal defects, 10atropine, 35, 160α-tropomyosin, 235automatic atrial tachycardia (AAT)

clinical presentation, 119–120criteria for, 120diagnosis of, 120–121treatment of, 121–122

automaticity, of cells, 27

Bbasket contact mapping, 102Bazett’s formula, 222beta blockers, 192beta-blockade treatment, 219β-mMHC, 235Betapace, see sotalolbreath-holding spells, 187Brevibloc, see esmololBrugada syndrome, 141, 222bundle branch block pattern, 62bystander, 54

Ccalcium channels, 23–24

L-type, 25cardiac conduction system

abnormalitiescomplete heart block, 237–238defects management, 238–239genetic testing to detect, 239Kearns-Sayre syndrome, 238progressive cardiac conduction defect, 238short QT syndrome, 238

development ofanatomy of, mature, 8anatomy of, in congenital heart disease, 10–13anatomic development, of conduction tissue, 7–8impulse generation, development of, 5impulse propagation, development of, 5nodal cell development, 7

electrophysiologic study of, 33anesthesia, role of, 47conduction through excitable tissue, 36

considerations in, 41–42in developing children, 37–38properties of, 34SA node evaluation, 34techniques in, 42

physiology ofaction potential, 25–29arrythmia formation mechanism, 29–30ion channels, 18–25resting membrane potential, 17–

18cardiac myocytes, 17cardiac rhythm, in left atrial isomerism, 12cardiac ryanodine receptor type 2 (RYR2), 229cardiomyopathies, 232

dilated (DCM), 234–236hypertrophic (HCM), 231–234

CARTOMERGETMImage Integration Module, 296cell markers, 7C-fibers, 192channelopathies, 220chaotic atrial tachycardia, see multifocal atrial

tachycardiachick embryo, 3

Hamburger Hamilton (HH) stage 3 of, 3chloride channels, 24concealed pathways, 51, 58congenital heart block, 174

in childhood, 176–177in neonate, 175–176in utero, 175, 253

connexins, 3, 7contact three-dimensional mapping, 103–104contractile proteins, 3Cordarone, see amiodaroneCorgard, see nadololCorvert, see ibutilideCovera, see verapamilCox maze procedure, 118cryotherapy, 66, 79–80, 118cystic fibrosis transmembrane conductance regulator

(CFTR), 24cytoskeletal proteins, 3, 7

DDAD, see delayed afterdepolarization, 29δ-sarcoglycan, 235desmin, 235device implants

choices inbipolar versus unipolar electrode usage,

199–201cardiac resynchronization devices, 203dual versus single chamber pacemakers, 201epicardial versus endocardial placement, 198ICDs, 203

INDEX 329

follow up ofclinic evaluation, 210–212CRT follow up, 212–213ICD, 213–214transtelephonic monitoring, 213

implantation techniquesacute electrode testing, 208–209coronary sinus lead placement, 206–208endocardial electrode placement, 205–206epicardial implant techniques, 204–205ICD placement, 209–210

indications forbradyarrhythmias, 195–196heart failure, 197tachyarrhythmias, 196–197

pacemaker implantin children, 178

digitalis glycosides, 285digoxin, 65, 75, 249, 285diltiazem, 284–285disopyramide, 192D-loop ventricles, 10dofetilide, 281–282drug–device interactions, 287dystrophin, 235

EEAD, see early afterdepolarization, 29Ebstein’s anomaly, 12, 53echocardiogram, 85ectopic atrial tachycardia

electrocardiogram, 33electrode threshold testing, 211embolism, 263entrainment mapping, 102esmolol, 276ET-1 (endothelin-1) signaling, 8exercise treadmill testing, 56

Ffamilial atrial fibrillation, 230familial ventricular fibrillation, see ion channel disordersfetal arrhythmia

cardiace lesions, associated with fetal artial flutter, 249diagnosis techniques, 242–244drugs for treatment of, 250specific, 244

atrioventricular conduction block, 253–255bradyarrhythmias, 252–253extrasystoles, 244–245supraventricular ectopy, 245–246tachyarrhythmias, 246–252ventricular ectopy, 246

flecainide, 66, 75, 249, 273–274Florinef, 192fludrocortisone, see Florinef

Fontan operation, 263

Ggap junctions, 7, 24

Hhead-up tilt (HUT) table test, 189

protocols of, 189–191hemi-Fontan procedure, 28heterotaxy syndromes, 12His bundle electrogram, 56His-Purkinje system, 3, 6, 8, 34, 64hypertrophic cardiomyopathy, 258–260hypoplastic left heart syndrome, 264

IIntra-atrial reentrant tachycardia, 95–113 see atrial

flutteributilide, 282–283ICD therapy, 150, 203impulse generation, development of, 5impulse propagation, development of, 5incisional IART, electrophysiologic evaluation goals for,

100inderal LA, see Propranololinderal, see Propranololintracatheter cooling system, 109intrinsic deflection, 34inwardly rectifying channels, 23ion channel disorders, that enhance automatically

ARVD2, 229, 230CPVT, 229, 230FVT, 229, 230

ion channel disorders, that prolong action potentialAnderson syndrome, 228, 229Brugada syndrome, 222

diagnosis of, 227–228patient management of, 228

long QT syndrome, 217–218diagnosis of, 222, 224–225drugs avoided in treatment of, 223–224drug induced LQTS, 222IKr defects, 221IKs defects, 218patient management, 225–226SCN5A defects, 221–222

isoproterenol, 62, 76, 101, 160Isoptin, see verapamil

JJervell and Lange-Nielsen syndrome, 219J-shaped stylets, 206J-tipped guide wire, 45junctional tachycardias

accelerateddiagnosis, 129

330 INDEX

junctional tachycardias (Cont.)natural history, 129treatment, 130

congenital JET, 125–127junctional ectopic tachycardia (JET),

122post-operative JET, 123–125

KKCNA5 gene, 23Kearns-Sayre Syndrome, 238

Lleft anterior oblique (LAO), 295left heart obstructive lesions, 263–264lidocaine, 271–272line of block, criteria for, 108

MMagnesium sulfate, 287Mahaim fibers, 54

Feature of, 55role of, 54

manifest pathways, 51, 58mexiletine, 272–273Mexitil, see mexiletineMobitz I, 165, 254Mobitz II, 166–168Monckeberg’s sling, 12multifocal atrial tachycardia

antiarrhythmic therapy, 137clinical context, 135–136electrocardiographic features, 136–137incidence of, 136mechanism of, 137patient management, 137–138

Mustard operation, 28, 36, 98, 107, 110, 263myocardial bridge, 262–263myocardial contraction, 3

Nnadolol, 276neural marker (G1N2), 5nicorandil, 221non-contact endocardial mapping, 104–106normal sinus fetal heart rate, 241nursing management, of arrhythmic young patients

definitions and processes, 316nursing interventions, for pre-procedure preparation,

319nursing plan, 318nurse patient interaction, 320–322patient care planning, 320–322psychosocial rehabilitation, 323–

325role of, 316, 318scope of, 315

Ppacemaker activity, 4–5pacemaker management, 110pacemaker therapy, 193Pacerone, see amiodaronepathway location, role of, 53persistent junctional reciprocating tachycardia (PJRT)

ablation of, 87–88anatomy of, 83cycle length, 63diagnosis and treatment of, 247–249ECG findings, 83–86electrophysiology, 86–87mapping of, 87–88treatment of, 87

post orthostatic tachycardia syndrome (POTS), 91, 187potassium channels, 20–23, 65

voltage-gated, 22precardiac cells, positions of, 4procainamide, 249, 269–271Procan SR, see procainamideprogressive cardiac conduction defect, 238Pronestyl, see procainamidepropafenone, 274–275propranolol, 35, 275–276P-waves, 12, 96, 108, 137

QQRS transition, 53Quinidex, see quinidinequinidine, 249, 268–269

Rradiofrequency ablation, 75–79, 107, 290–292, 293refractory period, 27, 40

effective, accessory pathway, 60response cells

rapid, 25–26slow, 26

retrograde P-waves, 53right anterior oblique (RAO), 295Romano-Ward syndrome, 218Rythmol, see propafenone

Ssalt tablets, 191sarcoplasmic reticulum (SR) stores, 229SCN5A gene, 20, 221, 222seizures, 187, 261Senning procedures, 263serotonin reuptake inhibitors, 193short QT syndrome, 238sick sinus syndrome, 153

ECG characteristics, 153–157atrial flutter/fibrillation, 157–158sinus arrhythmia, 155sinus bradycardia, 154

INDEX 331

sinoatrial node reentrant tachycardia, 157sinus pauses and sinus arrest, 156–157

electrophysiologic features, 158–159sinoatrial conduction time, 158–159sinus node recovery time, 159

prognosis of, 161–162treatment of, 159–161

sinoatrial (SA) node, 3, 7–8recovery time (SNRT), 34reentrant tachycardia, 157

sinoatrial conduction time, 158–159sinoatrial exit block, 156sinus arrhythmia, 155sinus bradycardia, 154, 252sinus node recovery time, 159sinus pauses and sinus arrest, 156–157sinus tachycardia, 247sodium channels, 19–20, 65sotalol, 66, 106, 249, 281spironolactone, 221splanchnic layer, of mesoderm, 4sudden infant death syndrome (SIDS), 257sudden unexpected cardiac death (SCD)

in acquired coronary artery anomalies, 263in Brugada syndrome patients, 261causes of, in young, 259in commotion cordis, 264in congenital long QT syndrome patients, 260–261in congenital coronary artery anomalies, 262–263definition of, 257in hypertrophic cardiomyopathic patients, 258–260in myocarditis patients, 260in pulmonary hypertension patients, 264statistics of, 257in structural congenital heart disease, 263–264in Wolff-Parkinson-White syndrome, 261–262

supraventricular tachycardia (SVT), 51, 247see atrial fibrillationsee atrioventricular nodal reentrant tachycardia

(AVNRT)see atrioventricular reentrant tachycardia (AVRT)see Intra-atrial reentrant tachycardia (IART)see persistent junctional reciprocating tachycardia

(PJRT)syncope, 230, 261

diagnosis of, 183–185neurocardiogenic, 185

clinical presentation of, 187–189pathophysiology of, 185–186prognosis of, 193–194treatment of, 191–193

Ttachycardia mapping, 64, 66tachycardia–bradycardia, 156tachycardias, development of

abnormal automaticity, 29

atrioventricular reentrant, see atrioventricularreentrant tachycardia

automatic atrial tachycardia (AAT), see automaticatrial tachycardia (AAT)

junctional tachycardias, see junctionaltachycardias

intra-atrial reentrant tachycardia (IART), see atrialflutter

multifocal atrial tachycardia (MAT), see multifocalatrial tachycardia

persistent junctional reciprocating tachycardia (PJRT)see persistent junctional reciprocatingtachycardia (PJRT)

reentry, 29sinoatrial reentrant, 91–93

criteria for diagnosis of, 92supraventricular tachycardia (SVT), see

supraventricular tachycardia (SVT)triggered activity, 29ventricular tachycardia (VT), see ventricular

tachycardia (VT)Tafazzin gene, 235Tambocor, see flecainideTendon of Todaro, 8Tenormin, see atenololtetralogy of Fallot, 263Thorel’s pathway, 9Tikosyn, see dofetilidetranscatheter ablation, 66, 149–150

of arrhythmic patients with CHD,311–313

of atrial flutter, 305–310of cardiac arrhythmias

approach to atrial ectopic tachycardias, 301–303approach to AVNRT, 304approach to leftsided pathways, 297–298approach to rightsided pathways,

298–301cryoablation, 292–293indications for, 289–290pericardial approach, 303radiofrequency ablation, 290–292, 310,

313techniques of, in children, 293–296

of non-ischemic ventricular tachycardia, 310transcutaneous pacing, 160transesophageal atrial pacing, 97transposition great arteries, 11transseptal catheter delivery, into superior vena cava,

46–47triangle of Koch, 9–11, 80, 100tricuspid atresia, 11troponin T, 235twin atrioventricular nodes, 11

Uutero detection, 175

332 INDEX

Vvagomimetic drugs, 285ventricular tachycardia (VT),

251clinical investigation of, 145–146

ventricular tachycardia (VT) (Cont.)clinical presentation of, 141definition of, 139–141diagnosis of, 143–145electrocardiographic findings, 141–143surgical management of, 148–151treatment of, 146–148

ventriculoatrial discordance, 11verapamil, 65, 249, 283

WWenchebach’s bundle, 9Wenckebach cycle length, 59, 61Wenckebach, see Mobitz IWolff-Parkinson White syndrome, 51–53, 60–61, 65,

67, 115, 234

XXylocaine, see lidocaine