Jason Andrade - The Clinical Cardiac Electrophysiology Handbook

THE CLINICAL CARDIAC
ELECTROPHYSIOLOGY
HANDBOOK Jason G. Andrade, MD Matthew T. Bennett, MD Marc W. Deyell, MD, MSc Nathaniel Hawkins, MD Andrew D. Krahn, MD Laurent Macle, MD Stanley Nattel, MD 2016 Jason Andrade Cardiotext Publishing, LLC 3405 W. 44th Street Minneapolis, Minnesota 55410 USA www.cardiotextpublishing.com Any updates to this book may be found at:
www.cardiotextpublishing.com/clinical-cardiac-electrophysiology-handbook Comments, inquiries, and requests for bulk sales can be directed to the publisher at:
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All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. All trademarks, service marks, and trade names used herein are the property of their respective owners and are used only to identify the products or services of those owners. This book is intended for educational purposes and to further general scientific and medical knowledge, research, and understanding of the conditions and associated treatments discussed herein. This book is not intended to serve as and should not be relied upon as recommending or promoting any specific diagnosis or method of treatment for a particular condition or a particular patient. It is the readers responsibility to determine the proper steps for diagnosis and the proper course of treatment for any condition or patient, including suitable and appropriate tests, medications, or medical devices to be used for or in conjunction with any diagnosis or treatment.

Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in government regulations, the information contained in this book may not reflect the latest standards, developments, guidelines, regulations, products, or devices in the field. Readers are responsible for keeping up to date with the latest developments and are urged to review the latest instructions and warnings for any medicine, equipment, or medical device. Readers should consult with a specialist or contact the vendor of any medicine or medical device where appropriate. Except for the publishers website associated with this work, the publisher is not affiliated with and does not sponsor or endorse any websites, organizations, or other sources of information referred to herein. The publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this book. Unless otherwise stated, all figures and tables in this book are used courtesy of the authors.

Library of Congress Control Number: 2015956425 ISBN: 978-1-942909-00-2 Printed in The United States of America We are extremely grateful to our colleagues and technical staff at the Montreal Heart Institute and Vancouver General Hospital, without whom this book would not have been possible.For Becky, Amlie, and Noah

Jason G. Andrade, MDMontreal Heart Institute Universit de Montral, Montreal, Canada University of British Columbia, Vancouver, Canada Matthew T. Bennett, MDUniversity of British Columbia, Vancouver, Canada Marc W. Deyell, MD, MScUniversity of British Columbia, Vancouver, Canada Nathaniel Hawkins, MDUniversity of British Columbia, Vancouver, Canada Andrew D. Krahn, MDUniversity of British Columbia, Vancouver, Canada Laurent Macle, MDMontreal Heart Institute Universit de Montral, Montreal, Canada Stanley Nattel, MDMontreal Heart Institute Universit de Montral, Montreal, Canada The clinical science of interventional cardiac electrophysiology is a rapidly evolving area. In the early days, it was referred to as His bundle electrophysiology, because about the only procedure available was to record the electrical potential arising in the common bundle of His with a catheter electrode and use the results to localize/quantify conduction abnormalities to identify patients needing pacemakers.

But a lot has changed since then: Programmed stimulation produced a revolution in the 1970s, followed in the 1980s by ablation and more advanced recording methods (beginning with the recording of potentials from accessory pathways). Progress advanced to include sophisticated invasive and noninvasive mapping systems and complex access and intervention approaches. Implantable devices were introduced as simple right ventricular pacemakers implanted by surgeons, developing over time into implantable defibrillators, and from there to highly sophisticated units capable of complex data recording and acquisition, high levels of programmability and interrogation capacity, complex antitachycardia pacing algorithms combined with intelligent defibrillation maneuvers, and even leadless devices. Basic science advances have revolutionized our understanding of arrhythmia mechanisms and created exciting new therapeutic possibilities. Large, randomized clinical trials have provided solid bases for clinical decision-making. One consequence of these formidable developments has been the challenging mass of information that needs to be mastered in order to understand and apply clinical cardiac electrophysiology interventions.

This volume of knowledge is particularly daunting to trainees and paramedical personnel, who perform vital functions requiring high-level skills but who lack the extensive training, knowledge base, and experience of established clinical electrophysiologists. This was the reason to create TheClinical Cardiac Electrophysiology Handbook: to offer in a succinct presentation all the practical information needed to understand the subtleties of a wide range of cardiac electrophysiology problems and approaches. Our focus is on the how to, with the goal of providing key knowledge about approaches to identify, diagnose, and manage a broad range of cardiac rhythm disorders. However, the user will also find a lot of information on the whythe underlying fundamental and clinical science basis for clinical electrophysiology decision-making. We took the approach that our book should look like what you might expect to find if a brilliant clinical electrophysiology fellow had transcribed notes about all that he or she was taught and was able to obtain from the literature, including all the most important information without any filler in between. It is intended to be a quick source for information in the EP lab or on the wards, as well as a guide to learningoffering the ability to quickly review the essential components prior to a case or to rapidly reinforce new notions and practices encountered during a case.

Overall, we hope users will find that The Clinical Cardiac Electrophysiology Handbook constitutes a valuable new tool, occupying an important niche that was largely empty prior to its completion and offering readers a key contribution to the learning material in this area. Stanley Nattel, MD

A	atrial
AAD	antiarrhythmic drug
ABG	arterial blood gasses
ACI	average complex interval
ACLS	advanced cardiac life support
ACT	activated clotting time
AD	autosomal dominant
AEAT	automatic ectopic atrial tachycardia
AERP	atrial effective refractory period
AF	atrial fibrillation
AFL	atrial flutter
AMVL	anterior mitral valve leaflet
AP	accessory pathway
APD	action potential duration

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