ELECTROPHYSIOLOGICAL FOUNDATIONS OF CARDIAC ARRHYTHMIAS 1st edition by Andrew Wit, Hein Wellens, Mark Josephson – Ebook PDF Instant Download/Delivery: 0979016452, 978-0979016455
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ISBN 10: 0979016452
ISBN 13: 978-0979016455
Author: Andrew Wit, Hein Wellens, Mark Josephson
This book teaches the fundamental concepts of cardiac electrophysiology with an emphasis on the relationship of basic mechanisms to clinical arrhythmias.
Understanding this relationship and the underlying mechanisms of arrhythmogenesis will be valuable to medical students in general and physicians entering the fields of cardiology and clinical electrophysiology, as well as those scientists and clinicians already working in this field.
The foundations of electrophysiology are explained in a way that will enable the student/reader to go on to more advanced texts such as Josephson s Clinical Cardiac Electrophysiology by Mark E. Josephson (Wolters Kluwer), who is one of the authors of this book. It is not a complete review of basic cellular electrophysiology and only focuses on aspects that are relevant to the arrhythmogenic mechanisms. Similarly, it is not a complete compendium on electrophysiology of clinical arrhythmias. Only selected arrhythmias are described that best illustrate the translation of the basic electrophysiological mechanism to the clinic.
The book is divided into three parts that cover the major mechanisms of arrhythmogenesis: Part I Automaticity, Part II Afterdepolarizations and Triggered Activity, and Part III Abnormal Impulse Conduction and Reentry. Each part starts with a chapter that describes the basic science principles related to that particular mechanism. Topics include: impulse initiation and rate control, membrane currents, conduction, and the effects of programmed electrical stimulation and pharmacologic agents. Subsequent chapters in each part are organized around examples of clinical arrhythmias and then focus on the relevant EP mechanisms and the characteristic responses to interventions. The characteristics of the three different mechanisms are compared and contrasted throughout the text.
Each example works through these three key questions:
1. What are the ECG characteristics of the arrhythmia?
2. What is the underlying electrophysiological mechanism?
3. What are the characteristic properties of the arrhythmia that point to its mechanism?
Throughout the book, the aspects of basic EP mechanisms and examples from EP studies and pharmacologic interventions are paired with clinical examples. The end result is enhanced understanding of how EP mechanisms and testing relate to arrhythmogenesis in a way that can be applied broadly to a variety of situations in a clinical setting.
This definitive book also includes:
More than 300 figures, including ECGs and original diagrams that illustrate essential electrophysiology concepts.
Case studies of clinical arrhythmias with explanations of how ECG characteristics and the responses to electrical stimulation denote arrhythmogenic mechanisms.
Electrophysiological Foundations of Cardiac Arrhythmias by Wit, Josephson, and Wellens is a long overdue text bridging basic science and clinical medicine, thus providing basic scientists, clinical investigators and practicing physicians, unique insights into the mechanisms underlying cardiac arrhythmias. The complex mechanisms responsible for the development of clinical arrhythmias are discussed in detail, but with clarity and appreciation of continuing gaps in our knowledge.
–Charles Antzelevitch, PhD, FACC, FAHA, FHRS; Lankenau Institute for Medical Research; Philadelphia, Pennsylvania
ELECTROPHYSIOLOGICAL FOUNDATIONS OF CARDIAC ARRHYTHMIAS 1st Table of contents:
Introduction
Abbreviations and Ion Currents Involved in Arrhythmogenesis
PART I – AUTOMATICITY
Abnormal and Normal Automaticity Defined
CHAPTER 1: Basic Principles of Normal Automaticity
Control of Rate of Automatic Impulse Initiation
Relationship Between Sinus Node and Latent Pacemakers
Electrophysiological Causes of Ectopic Automatic Arrhythmias
General ECG Characteristics of Automatic Arrhythmias
Electrical Stimulation and Pharmacological Agents: The Effects on Normal Automaticity
Chapter Summary
Figure and Text Sources
CHAPTER 2: Sinus Node Normal Automaticity and Automatic Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Sinus Node Anatomy
Sinus Node Electrophysiology
Electrical Stimulation of the Sinus Node
Explanation of Case ECGs and Other Arrhythmias
Sinus Tachycardia
Sinus Bradycardia
Additional Sinus Node Bradycardias
Chapter Summary
Answers to Questions about Cases
Figure and Text Sources
CHAPTER 3: Atrial, A-V Junctional, and Ventricular Normal Automaticity, and Automatic Arrhythmias
SECTION 3A. Atrial Normal Automaticity and Automatic Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Location of Atrial Pacemakers with Normal Automaticity
Electrophysiology of Normal Automaticity in the Atria
Electrical Stimulation of Atrial Pacemakers
Response of Automaticity to Pharmacological Agents
Explanation of Case ECGs and Other Arrhythmias Caused by Atrial Automaticity
Automatic Atrial Escape Rhythms
Automatic Atrial Tachycardia
Summary
Answers to Questions about Cases
SECTION 3B. Atrioventricular (A-V) Junctional Normal Automaticity and Automatic Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Location of A-V Junctional Pacemakers with Normal Automaticity
Electrophysiology of Normal Automaticity in the A-V Junction
Relationship of Automaticity to Conduction Block in the A-V Junction
Electrical Stimulation of A-V Junctional Pacemakers
Explanation of Case ECGs and Other Arrhythmias Caused by Alterations in A-V Junctional Automaticity
Automatic A-V Junctional Escape Rhythms
Accelerated Automatic A-V Junctional Rhythms and Tachycardia
Junctional Ectopic Tachycardia (JET)
A-V Dissociation and Junctional Rhythms
Determining the Site of Origin of Junctional Arrhythmias
Comparison of A-V Node and His Bundle Pacemaker Characteristics
Bypass Tract Automaticity
Summary
Answers to Questions about Cases
SECTION 3C. Ventricular Normal Automaticity and Automatic Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Location of Ventricular Pacemakers with Normal Automaticity
Electrophysiology of Normal Automaticity in the Ventricles
Electrical Stimulation of Ventricular (Purkinje) Pacemakers
Pharmacological Agents and Ventricular Pacemakers
Explanation of Case ECGs and Other Arrhythmias Caused by Alterations in Ventricular Automaticity
Ventricular Escape Rhythms
Ventricular Premature Depolarizations and Accelerated Ventricular Rhythms
Idiopathic Focal Ventricular Tachycardia
Exercise-Induced Ventricular Tachycardia
Idiopathic Focal Ventricular Tachycardia Not Related to Exercise
Site of Origin of Idiopathic Focal Ventricular Tachycardias
Summary
Answers to Questions about Cases
Figure and Text Sources
Section 3A: Atrial Automaticity
Section 3B: A-V Junctional Automaticity
Section 3C: Ventricular Automaticity
CHAPTER 4: Abnormal Automaticity: Basic Principles and Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Electrophysiology of Abnormal Automaticity
The Effects of Electrical Stimulation
Pharmacology
Key Properties of Depolarization-Induced Abnormal Automaticity
Explanation of Case ECGs and Other Arrhythmias Caused by Abnormal Automaticity
Incessant Atrial Tachycardia
Accelerated Idioventricular Rhythm
Additional Arrhythmias Caused by Abnormal Automaticity
Chapter Summary
Answers to Questions about Cases
Figure and Text Sources
PART II – AFTERDEPOLARIZATIONS AND TRIGGERED ACTIVITY
CHAPTER 5: Basic Principles of Delayed Afterdepolarizations and Triggered Action Potentials
Characteristic Appearance of DADs and DAD-Triggered Action Potentials
Cellular Mechanisms of DADs and DAD-Triggered Activity: The Role of Calcium
Electrophysiological Properties of DADs and Triggered Activity
Identifying DAD-Triggered Activity as the Cause of Clinical Arrhythmias
Chapter Summary
Figure and Text Sources
CHAPTER 6: Delayed Afterdepolarizations: Triggered Arrhythmias
SECTION 6A. Atrial Delayed Afterdepolarizations and Triggered Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Location and Electrophysiology of DADs and Triggered Activity in the Atria
Explanation of Case ECGs and Other Arrhythmias Caused by DAD-Triggered Activity in the Atria
Triggered Atrial Tachycardia
Electrophysiological Characteristics of Triggered Atrial Tachycardia
Atrial Tachycardia Associated with Digitalis Toxicity
Relationship of Triggered Activity to Atrial Fibrillation
Summary
Answers to Questions about Cases
SECTION 6B. Atrioventricular (A-V) Junctional Delayed Afterdepolarizations and Triggered Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Electrophysiology of DADs and Triggered Activity in the A-V Junction
Explanation of Case ECGs and Other Arrhythmias Caused by DAD-Triggered Activity in the A-V Junction
Accelerated Junctional Rhythms and Nonparoxysmal Junctional Tachycardia
Electrophysiological Properties of Triggered Accelerated Junctional Arrhythmias
Junctional Ectopic Tachycardia (JET)
Properties of Junctional Ectopic Tachycardias Caused by Triggered Activity
Summary
Answers to Questions about Cases
SECTION 6C. Ventricular Delayed Afterdepolarizations and Triggered Arrhythmias
Case Examples
Basic Electrophysiological Mechanisms
Locations, Mechanisms, and Properties of Triggered Arrhythmias in the Ventricles
Explanation of Case ECGs and Other Arrhythmias Caused by DAD-Triggered Activity in the Ventricle
Digitalis-Induced Ventricular Tachycardia
Properties of Digitalis-Induced DADs Causing Ventricular Arrhythmias
Exercise-Induced Ventricular Tachycardia
Properties of Exercise-Induced Ventricular Tachycardia
Catecholaminergic Polymorphic Ventricular Tachycardia
Properties of DAD-Induced CPVT
Triggered Activity and Ventricular Arrhythmias in the Setting of Heart Failure and/or Ischemia
Summary
Answers to Questions about Cases
Figure and Text Sources
CHAPTER 7: Basic Principles of Early Afterdepolarizations and Triggered Action Potentials
Characteristic Appearance of EADs and EAD-Triggered Action Potentials
Cellular Mechanisms of EADs and EAD-Triggered Activity
Electrophysiological Mechanisms and Properties of EADs and Triggered Activity
Identifying EAD-Triggered Activity as a Cause of Clinical Arrhythmias
Chapter Summary
Figure and Text Sources
CHAPTER 8: Early Afterdepolarizations: Triggered Arrhythmias
Case Examples of Clinical Arrhythmias Caused by Early Afterdepolarizations in the Ventricle
Explanation of Case 1 and Case 2: Congenital Long QT Syndromes
Arrhythmias Due to Congenital Long QT Syndromes and ECGs in Case 1 and Case 2
Genetic Mutations in Congenital Long QT Syndromes
Electrophysiology of Congenital LQT Syndromes—Relationship to EADs and Triggered Activity
Effects of Electrical Stimulation on Clinical EAD-Triggered Arrhythmias
Long QT Caused by Structural Heart Disease and/or Ischemia
Long QT and EAD-Triggered Arrhythmias in Structural Heart Disease
EADs Associated with Acute Ischemia
Explanation of Case 3: Acquired Long QT Syndromes
Arrhythmias Due to Acquired LQT: ECG in Case 3
Basic Electrophysiological Mechanisms Underlying Acquired LQT Syndromes
Identifying EAD-Triggered Activity in Acquired LQT Syndromes
Chapter Summary
Answers to Questions about Cases
Figure and Text Sources
PART III – ALTERED (ABNORMAL) IMPULSE CONDUCTION AND REENTRY
CHAPTER 9: Basic Principles of Reentry: Altered Conduction and Reentrant Excitation
Overview and General Principles
Necessary Electrophysiological Properties for Reentry
Classification of Reentrant Circuits
Identifying Reentrant Excitation as a Cause of Clinical Arrhythmias
Electrical Stimulation and Characteristics of Reentrant Arrhythmias
Chapter Summary
Figure and Text Sources
CHAPTER 10: Atrial Reentrant Arrhythmias
Case Examples of Clinical Atrial Arrhythmias Caused by Reentry
SECTION 10A. Macroreentrant Atrial Arrhythmias
Macroreentrant Circuits Around Obstacles Provided by Normal Atrial Structure (Cases 1 and 2)
Macroreentrant Circuits Around Obstacles Caused by Scars and/or Surgical Lesions
SECTION 10B. Microreentrant Atrial Arrhythmias
Focal Reentrant Atrial Tachycardia (Case 3)
SECTION 10C. Atrial Fibrillation
ECG of Atrial Fibrillation (Case 4)
Electrophysiological Mechanism(s) of Atrial Fibrillation
Electrical Stimulation
Pharmacology
Chapter Summary
Answers to Questions about Cases
Figure and Text Sources
CHAPTER 11: Atrioventricular (A-V) Junctional Reentrant Arrhythmias
Case Examples of Clinical A-V Junctional Arrhythmias Caused by Reentry
Reentrant Excitation in the Normal A-V Junction – Explanation of Case 1
A-V Nodal Reentrant Tachycardia (AVNRT)
Reentrant Excitation Utilizing an Accessory A-V Conducting Pathway – Explanation of Case 2
Preexcitation and SVT Using an Accessory A-V Pathway
Chapter Summary
Summary of Typical and Atypical AVNRT
Summary of Preexcitation and Circus Movement Tachycardia
Answers to Questions about Cases
Figure and Text Sources
CHAPTER 12: Ventricular Reentrant Arrhythmias
Case Examples of Clinical Ventricular Arrhythmias Caused by Reentry
Introduction to Reentrant Excitation in the Ventricles
Reentry Associated with Chronic Ischemic Heart Disease – Explanation of Case 1
Sustained Monomorphic Ventricular Tachycardia Due to Chronic Ischemic Heart Disease
Reentry Associated with Nonischemic Cardiomyopathy – Explanation of Case 2
Monomorphic Ventricular Tachycardia in Nonischemic Cardiomyopathy
Reentry in the Ventricular Conducting System – Explanation of Case 3
Bundle Branch Reentrant Ventricular Tachycardia
Interfascicular Tachycardia
Other Reentrant Arrhythmias
Verapamil-Sensitive Ventricular Tachycardia
Ventricular Premature Depolarizations Caused by Reentry
Polymorphic Ventricular Tachycardia/Ventricular Fibrillation
Acute Ischemic Arrhythmias
Chapter Summary
Reentry in Ventricular Muscle
Reentry in the Ventricular Conducting System
Other Reentrant Arrhythmias
Answers to Questions about Cases
Figure and Text Sources
Index
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