Catheter Ablation of Cardiac Arrhythmias
In humans, the typical range of the resting sinus heart rate is 50–90 beats per minute (bpm); most average healthy individuals have resting rates in the 60–70 bpm range. Bradycardia (slow heart beat) is a term used to refer to any heart rate
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Henri Roukoz, Fei Lü, and Scott Sakaguchi
Abstract
In humans, the typical range of the resting sinus heart rate is 50–90 beats per minute (bpm); most average healthy individuals have resting rates in the 60–70 bpm range. Bradycardia (slow heart beat) is a term used to refer to any heart rate 100 bpm. Disturbances of cardiac impulse formation and/or transmission comprise the principal mechanisms causing abnormalities of heart rhythm. In basic terms, these are classified as being either brady- or tachy-arrhythmias. The primary goals for treatment of arrhythmias are: (1) to alleviate symptoms and thus improve an individual’s quality of life; and (2) to prolong patient survival. Pharmacologic treatment has been the mainstay for management of most cardiac arrhythmias, although in recent years, implantable devices and ablations have become increasingly important. Therefore, nonpharmacologic therapies have begun to play an increasingly important role in curing many arrhythmias (catheter ablation), and preventing their life-threatening consequences [implantable cardioverter defibrillator (ICD) therapy for both primary and secondary prevention of sudden cardiac death (SCD)]. Keywords
Arrhythmias • Tachycardia • Bradycardia • Cardiac ablation • Defibrillator therapy
Abbreviations AFib AT AV AVNRT AVRT Bpm CFAE
Atrial fibrillation Atrial tachycardia Atrioventricular Atrioventricular nodal reentry tachycardia Atrioventricular reentry tachycardia Beats per minute Complex fractionated atrial electrogram
H. Roukoz, MD, FACC, FHRS (*) • F. Lü, MD, PhD S. Sakaguchi, MD Department of Medicine, Cardiovascular Division and Electrophysiology, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA e-mail: [email protected]
DC ECG EPS ICD IST LV PAC PSVT PVC RF RV SCD SND SVT TdP VT WPW
Direct current Electrocardiography Electrophysiologic study Implantable cardioverter defibrillator Inappropriate sinus tachycardia Left ventricular Premature atrial complex Paroxysmal supraventricular tachycardia Premature ventricular complex Radiofrequency Right ventricular Sudden cardiac death Sinus node dysfunction Supraventricular tachycardia Torsades de Pointes Ventricular tachycardia Wolff–Parkinson–White syndrome
© Springer International Publishing Switzerland 2015 P.A. Iaizzo (ed.), Handbook of Cardiac Anatomy, Physiology, and Devices, DOI 10.1007/978-3-319-19464-6_28
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28.1
Introduction
Since it is fundamentally important to understand the mechanisms underlying each individual cardiac arrhythmia that may be treated by catheter ablation therapy, the basics of cardiac electrophysiology and individual arrhythmias are first described in this chapter. The normal heartbeat is initiated by pacemaker cells in the sinus node located in the right atrium, adjacent to its junction with the superior vena cava. These cells comprise a specialized, albeit somewhat diffuse, region of the right atrium called the sinus node. The rate and regularity of sinus node activity is determined by the in
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