Clinical Arrhythmology

Foreword by Dr. Valentin Fuster ix
Foreword by Dr. Pere Brugada i Terradellas xi
Preface xiii
Recommended General Bibliography xvii
Part I Anatomical and Electrophysiological Considerations, Clinical Aspects, and Mechanisms of Cardiac Arrhythmias 1
1 Clinical Aspects of Arrhythmias 3
Definition of Arrhythmia 3
Classification 3
Clinical Significance and Symptoms 4
The Importance of Clinical History and Physical Examination in Diagnosis and Assessment of Arrhythmias 18
The Importance of Surface ECG and Other Techniques 21
References 24
2 Anatomic and Electrophysiologic Basis 27
Anatomic Basis 27
Electrophysiologic Characteristics 34
References 51
3 Electrophysiologic Mechanisms 53
Mechanisms Responsible for Active Cardiac Arrhythmias 53
Mechanisms Leading to Passive Arrhythmias 70
References 80
Part II Diagnosis, Prognosis and Treatment of Arrhythmias 83
4 Active Supraventricular Arrhythmias 85
Premature Supraventricular Complexes 85
Sinus Tachycardia 88
Atrial Tachycardia 95
Junctional Reentrant (Reciprocating) Tachycardia 105
AV Junctional Tachycardia Due to Ectopic Focus 112
Chaotic Atrial Tachycardia 115
Atrial Fibrillation 115
Atrial Flutter 139
Supraventricular Tachyarrhythmias and Atrial Wave Morphology: Monomorphic and Polymorphic Morphology 148
Differential Diagnosis of Supraventricular Tachyarrhythmias with Regular RR Intervals and Narrow QRS 149
Electrocardiographic Diagnosis of the Paroxysmal Supraventricular Tachycardias: a Sequential Approach 151
References 155
5 Active Ventricular Arrhythmias 165
Premature Ventricular Complexes 165
Ventricular Tachycardias 174
Ventricular Flutter 200
Ventricular Fibrillation 201
References 205
6 Passive Arrhythmias 209
Escape Complex and Escape Rhythm 209
Sinus Bradycardia due to Sinus Automaticity Depression 209
Sinoatrial Block 212
Atrial Blocks 214
Atrioventricular Block 216
Ventricular Blocks 218
Cardiac Arrest 226
The Pacemaker Electrocardiography 226
Clinical, Prognostic, and Therapeutic Implications of Passive Arrhythmias 234
References 240
7 Analytical Study of an Arrhythmia 245
Determining the Presence of a Dominant Rhythm 245
Atrial Wave Analysis 245
QRS Complex Analysis 246
Atrioventricular Relationship Analysis 248
Premature Complex Analysis 249
Pause Analysis 249
Delayed Complex Analysis 249
Analysis of the P Wave and QRS?]T Complexes of Variable Morphology 249
Repetitive Arrhythmias Analysis: Bigeminal Rhythm 250
Differential Diagnosis Between Several Arrhythmias in Special Situations 252
References 255
Part III The ECG and Risk of Arrhythmias and Sudden Death in Different Heart Diseases and Situations 257
8 Ventricular Pre-Excitation 259
Concept and Types of Pre-Excitation 259
WPW-type Pre-Excitation (Type 1) 259
Atypical Pre-Excitation 268
Short PR Interval Pre-Excitation 268
References 270
9 Inherited Heart Diseases 273
Introduction 273
Cardiomyopathies 273
Specific Conduction System Involvement: Lenegre Syndrome 285
Ionic Channel Disorders in the Absence of Apparent Structural Heart Disease: Channelopathies 285
References 305
10 Other ECG Patterns of Risk 313
Severe Sinus Bradycardia 313
Third-Degree (Advanced) Interatrial Block 313
High-Risk Ventricular Block 317
Advanced Atrioventricular Block 319
The Presence of Ventricular Arrhythmias in Chronic Heart Disease Patients 321
Acquired Long QT 322
Electrical Alternans 325
Other Electrocardiographic Patterns of Risk for Sudden Death 326
Early Repolarization (ER) Pattern (J Wave) and Sudden Death 326
Risk of Serious Arrhythmias and Sudden Death in Patients with Normal or Nearly Normal ECG 329
References 331
11 Arrhythmias in Different Heart Diseases and Situations 335
Ischemic Heart Disease 335
Heart Failure 341
Valvular Heart Disease 345
Congenital Heart Disease 346
Hypertensive Heart Disease 348
Myocarditis 348
Cor Pulmonale 348
Pericardial Disease 348
Sudden Death in Other Heart Diseases 349
Sudden Infant Death Syndrome 349
Athletes 349
Alcohol Intake 351
Special Situations 351
Sudden Death in Apparently Healthy People 354
References 354
Appendix 359
Introduction 359
Calculation of Sensitivity, Specificity, and Predictive Value 359
Diagnostic Techniques 361
Therapeutic Techniques 372
Antiarrhythmic Agents 384
Classification of the Recommendations for Diagnostic and Therapeutic Procedures and Level of Evidence (AHA/ESC/ACC Guidelines) 388
References 389
Index 395