Table of Contents
Cover
Title Page
Copyright
Dedication
Contents
Contributors
Preface
Abbreviations
Section 1: Technology and Therapeutic Techniques
Section 1A: Electrophysiologic Techniques
Chapter 1: Fundamental Aspects of EP Procedures
Introduction
Informed Consent
History
External Defibrillators
Sedation
Vascular Access
Radiation
Imaging
Recordings
Catheters
Elements of a Comprehensive Electrophysiology Study
Provocative Drug Testing
Complications
Conclusion
References
Chapter 2: Electrocardiography for the Invasive EP
Introduction
Outflow Tract Ventricular Tachycardia
Fascicular Ventricular Tachycardia
Ventricular Tachycardia with Structural Heart Disease
Sinus Tachycardia and Automatic Atrial Tachycardia
Wolff–Parkinson–White Syndrome
Atrioventricular Nodal ReentryTachycardia
Atrial Flutter
Repolarization Abnormalities
Miscellaneous Arrhythmia Patterns
Conclusion
References
Chapter 3: Complex Catheter Recording and Mapping Techniques in the EP Lab
Introduction
Catheter Rigs Used for Complex Mapping
Recording Systems and Techniques
Supraventricular Tachycardia
Ventricular Tachycardia
Conclusion
References
Chapter 4: Advances in Electroanatomic Mapping Systems
Introduction
CARTO
EnSite Velocity Cardiac Mapping System
Radiation Safety
References
Video Legends
Chapter 5: Intraoperative Mapping for the Surgeon and EP
Introduction
Mapping
Preparation for Intraoperative Mapping
Atrioventricular Bypass Tracts: Wolff–Parkinson–White and Variants
Ventricular Tachycardia
Atrial Tachycardias
Macroreentrant Atrial Tachycardias
Atrial Fibrillation
Identifying the Normal Atrioventricular Conduction System
Limitations of Intraoperative Mapping
Conclusion
References
Chapter 6: Special Consideratins for Pediatric Electrophysiological Procedures
Introduction
Developmental and Psychosocial Considerations
Laboratory Setting
Sedation/Anesthesia Considerations
Diagnoses and Natural History
Indications and Complications
Access
Equipment
Biophysical Issues
Conclusion
References
Section 1B: Imaging Technology
Chapter 7: Fundamentals and Applications of Echocardiographic Methods and Systems in the EP Laboratory
Introduction
Catheter Ablation for Arrhythmias
Why Is There a Need for Echocardiography in the EP Lab?
Intracardiac Echocardiography
Echocardiography in Atrial Fibrillation
Assessment of Left Atrial Size and Function by Echocardiography
Assessment of Left Atrial Function
Use of Intracardiac Echocardiography in Atrial Fibrillation Ablation
Intracardiac Echocardiography for Ablation of Atrial Flutter
Real-Time 3D Transesophageal Echocardiography for Arrhythmias
Echocardiography in VentricularArrhythmia
Echocardiography for Cardiac Resynchronization Therapy
Conclusion
References
Video Legends
Chapter 8: The Role of 3D Transthoracic and Transesophageal Echocardiography in Interventional EP
Introduction
Atrial Appendage
Cardiomyopathies: Indications for ICD .0and/or CRT
Pericardial Effusions
Conclusions
References
Video Legends
Chapter 9: Intracardiac Echocardiography
Introduction
Currently Available ICE Technologies
Baseline Image Acquisition Using ICE
Use of ICE to Guide Electrophysiology Procedures
Use of ICE During Catheter Ablation
Three-Dimensional Imaging with ICE
Conclusion
References
Video Legends
Chapter 10: Radiological Principles of Cardiac CT and MRI and Fusion Imaging
Introduction
Computed Tomography Imaging Fundamentals and Technical Considerations
Magnetic Resonance Imaging Fundamentals and Technical Considerations
Integrating Cardiac Computed Tomography/Magnetic Resonance Images with 3D Mapping Systems
Clinical Applications for Image Fusion Using Computed Tomography/Magnetic Resonance Imaging and 3D Maps
Other Imaging Modalities Used for Image Fusion with 3D Mapping Systems
Future Applications for Image Fusion:Real-Time MRI-Guided Electrophysiology Procedures, Atrial Fibrosis, and Assessment of Ablation Lesions
Conclusions
References
Video Legends
Chapter 11: Cardiac Computed Tomography and Magnetic Resonance Image Interpretation During Interventional Procedures
Introduction
Basics of Cardiac Magnetic Resonance Imaging
Advantages of Each Modality in the Electrophysiology Setting
Cardiac MRI in the Setting of Implanted Cardiac Devices
Imaging the Arrhythmia Substrate
Conclusion
References
Video Legends
Chapter 12: Hybrid Operating Rooms
Concept
Hybrid Procedures
Hybrid Room Design
Radiation Measures
Operating Table
Imaging
Wireless Technologies
Equipment
Personnel
Management
Outcomes
Cost
Education
Illustrative Example of a Hybrid Procedure: Atrial Fibrillation
Periprocedural Evaluation and Care
Conclusion
References
Section 1C: Device Technology
Chapter 13: New Developments in Lead and Introducer Systems
Introduction
Overview of ICD Lead Developments
Overview of Left Ventricular Leads
Advances in Lead Delivery Systems
Advances in LV Pacing
Magnetic Resonance Imaging of Patients with Cardiac Implantable Electronic Devices
Conclusions
References
Chapter 14: New Innovations in Implantable Pulse Generators and Heart Failure Devices
New Developments and Trends in DeviceTherapy of Cardiac Arrhythmias
Limitations of Current Devices
Battery Technology
Lead Technology
Endocardial Leads
Programming and Physiologic Stimulation
Cardiac Stimulation During the Refractory Period
Monitoring Devices/ Remote Follow-Up
Problems of Electromechanic Interference
Acknowledgments
References
Chapter 15: Implantable and Remote Monitoring
Introduction
Remote Monitoring Systems
Review of Major Studies on Remote Monitoring
Legal Considerations
Reimbursement Considerations
Future Directions
References
Chapter 16: Percutaneous Left Atrial Appendage Occlusion
Introduction
Indications
Devices and Implantation Techniques
Safety and Results
Imaging
Summary
References
Video Legends
Chapter 17: Principles and Techniques for Lead Extraction and Device System Revision for the Surgeon and Interventionalist
History
Lead–Body Interaction
Lead Management
Definitions
Training
Indications
TLE Techniques and Tools
Conclusions
References
Video Legends
Section 1D: Ablation Technology
Chapter 18: Anatomy and Histopathology of Ablation Interventions
Introduction
Relationship of the Heart to theThoracic Structures
Relationships of the Cardiac Chambers
The Atria, Septum, Conduction System,and Atrioventricular Junctions
The Conduction Tissues
The Triangle of Koch, Location of the Atrioventricular Node, and the His Bundle
The Left Atrium
The Atrial Septum
The Left Atrioventricular Junction
The Coronary Sinus and Venous Tributaries
The Ventricles
Conclusions
References
Chapter 19: Physical and Experimental Aspects of Radiofrequency Energy, Generators, and Energy Delivery Systems
Introduction
The Biophysics of Radiofrequency Ablation
Determinants of Lesion Size
Coagulum Formation
RF Catheter Impedance for Determining the Status of the Delivered Lesion
Steam Popping
Improvements in Catheter Ablation
Contact Force
Duty-Cycled Phased RF Energy
Conclusions
References
Chapter 20: Cryothermal Ablation Technology and Catheter Delivery Systems
History of Cryotherapy
Pathophysiology of Lesion Formation, Histological Effects, and Determinants of Lesion Size
Advantages of Cryothermal Ablation
Disadvantages of Cryothermal Ablation
Delivery Systems
Conclusion
References
Chapter 21: Laser, Ultrasound, and Microwave Ablation
Introduction
Laser Ablation
Ultrasound Ablation
Microwave Ablation
References
Chapter 22: Ablation Technology for the Surgical Treatment of Atrial Fibrillation
Introduction
Requirements for Surgical Ablation
Anatomic Considerations
Cryoablation
Unipolar Radiofrequency Energy
Bipolar Radiofrequency Energy
Other Energy Sources
Conclusion
References
Chapter 23: Remote Navigation in Catheter Procedures
Introduction
Remote Robotic Navigation
Remote Magnetic Navigation
Advantages of Magnetic Systems
Robotic Catheter Manipulation
Conclusion
References
Section 1E: Drug Therapy
Chapter 24: How to Perform Drug Testing and Use Antiarrhythmic Drugs in Clinical EP
Introduction
Drug Testing in Channelopathies
Long QT Syndrome
Brugada Syndrome
Catecholaminergic Polymorphic Ventricular Tachycardia
Pharmacological Manipulation of Tachyarrhythmia
Assessing Accessory Pathway Risk for Rapid Antegrade Conduction
Diagnosing the Substrate for AV Node Reentry
Pharmacological Provocation in Bradycardia
Pharmacological Provocation for Interventional Procedure
Conclusion
References
Chapter 25: Clinical Pharmacology of Anesthetic Agents and Their Application in Cardiac EP Procedures
Introduction
Local Anesthetics
Intravenous Anesthetics
Muscle Relaxants
Inhalation Anesthetics
Interaction of Anesthetics
Types of Anesthesia
Anesthesia Considerations for EP Procedures
Summary
References