tailieunhanh - Ebook Understanding intracardiac EGMs and ECGs: Part 2

(BQ) Part 2 book "Understanding intracardiac EGMs and ECGs" presents the following contents: Specific arrhythmias (Accessory pathways, AV node reentry, focal atrial tachycardia, ftrial flutter, atrial fibrillation, ventricular tachycardia, implantable cardiac devices-ECGs and electrograms. | PART 2 Specific Arrhythmias CHAPTER 9 Accessory pathways The existence of multiple connections between the atrium and ventricle was first proposed by Kent in the late nineteenth century although by the early twentieth century the AV node and His bundle had been identified as the pathway that electrically connected the atria to the ventricles. The concept that additional muscular connections between atria and ventricle existed was controversial until 1942 when Wood and colleagues described the first histologic evidence of three accessory pathways connecting the right atrium and right ventricle in a young boy who died suddenly. The properties of accessory pathways have fascinated electrophysiologists for many years particularly after seminal work by Sealy Scheinman and others that reported successful surgical and catheter-based ablation techniques to eliminate accessory pathways. Anatomy and electrophysiology The AV node generally forms the only connection between atrial and ventricular tissue with the remainder of the atrial tissue and ventricular tissue separated by the fibrous annulus that forms the scaffolding for the mitral and aortic valves. This arrangement along with the refractory properties of the AV node and His bundle reduces the likelihood of feedback between atrial and ventricular depolarization. There is a small but definite incidence of sudden cardiac death in patients with accessory pathways particularly in those patients with symptomatic arrhythmias 2 . It is more controversial whether asymptomatic patients share this magnitude of risk for sudden cardiac death. The electrophysiologic properties of accessory pathways can vary significantly Table . Most commonly accessory pathways are composed of tissue histologically and electrophysiologically like atrial or ventricular tissue with a rapid phase 0 upstroke and a plateau phase. Accessory pathways can usually conduct in both directions from atrium to ventricle and from ventricle to atrium. However

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• Understanding intracardiac EGMs and ECGs
• Specific arrhythmias
• Accessory pathways
• AV node reentry
• Focal atrial tachycardia
• Ventricular tachycardia
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