Electrophysiological Maneuvers for Arrhythmia Analysis

By: George J. Klein, MD; Lorne J. Gula, MD; Peter Leong-Sit, MD; Jaimie Manlucu, MD; Allan C. Skanes, MD; Raymond Yee, MD; Paul D. Purves, BSc, RCVT

Foreword by Mark E. Josephson, MD

Publication Details:
Published May 2014
ISBN: 9781935395898
Trim size: 11 x 8.5 inches, landscape
208 pages
Format: Paperback and eBook set; eBook

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Featured title on IBHRE's Cardiac Electrophysiology Core Reading List Recommendations for the Physician and Allied Professional - more information

About:

• From senior electrophysiologist and world-class educator George Klein, a fully illustrated guide with over 100 intracardiac tracings and figures that allow the physician to approach electrophysiologic problems effectively and systematically.

• The book is especially focused on electrophysiological maneuvers and provides a clear and understandable guide to their proper selection and interpretation using abundant clinical examples.

• Defines the integral role for "traditional" electrogram (EGM) analysis in order to understand the mechanism of a tachycardia.

It goes without saying that a correct arrhythmia diagnosis is a prerequisite to catheter ablation regardless of the presence of sophisticated mapping and imaging technologies. Electrophysiological maneuvers are fundamental to this process, and proper selection and interpretation of maneuvers constitute a core skill of the electrophysiologist. In this volume, we make the case that most maneuvers are fundamentally similar in principle and can be understood by appreciating a few basic physiological and anatomical principles. The art lies not in a comprehensive knowledge by rote of every maneuver or its application, but rather a systematic approach using common principles. We illustrate this by showing abundant examples and emphasizing the "game plan," including checklists that can be applied to virtually any maneuver.

—George J. Klein

In my opinion, this book should be on the shelf of every electrophysiologist trainee as well as every clinical cardiac electrophysiologist. It is a classic, like its editor. Dr. Klein deserves high praise for organizing his and his colleagues’ clinical experiences and thought processes into a concise, practical text that should be part of all training programs in electrophysiology.

—From the foreword by Mark E. Josephson, MD

Authors:

George J. Klein, MD, FRCP(C); Professor of Medicine, Division of Cardiology, Western University, London, Ontario, Canada

Lorne J. Gula, MD, FRCP(C); Associate Professor of Medicine, Division of Cardiology, Western University, London, Ontario, Canada

Peter Leong-Sit, MD, FRCP(C); Assistant Professor of Medicine, Division of Cardiology, Western University, London, Ontario, Canada

Jaimie Manlucu, MD, FRCP(C); Division of Cardiology, Western University, London, Ontario, Canada

Allan C. Skanes, MD, FRCP(C); Associate Professor of Medicine, Division of Cardiology, Western University, London, Ontario, Canada

Raymond Yee, MD, FRCP(C); Professor of Medicine, Director, Arrhythmia Service, Division of Cardiology, Western University, London, Ontario, Canada

Paul D. Purves, BSc, RCVT, CEPS; Senior Electrophysiology Technologist, Cardiac Investigation Unit, London Health Sciences Centre, London, Ontario, Canada

Table of Contents:

1) Principles of the Electrophysiological Maneuver
 
•    The Importance of “Geography”
•    Fusion and Reset: a Key Concept
 
2) Maneuvers During Sinus or Paced Rhythm

•    Para-Hisian Pacing
•    Assessing a Line of Block
•    Assessing a Line of Block: Tricuspid-caval Isthmus
•    Assessing a Line of Block: Left Atrial Roof Line
•    Assessing a Line of Block: Mitral Isthmus Line
•    Verifying Pulmonary Vein Isolation
•    Mapping Gaps in Conduction
•    Differential Pacing to Identify Near- vs. Far-field Electrograms
•    Challenges Confirming Exit Block From the PV
 
3) Extrastimuli During Supraventricular  Tachycardia

•    Rationale for Programming Extrastimuli into Tachycardia
•    Relationship of Extrastimuli to Entrainment
•    Diagnostic Utility of Programmed PVC, PAC: Specific Examples
 
4) Overdrive Pacing and Entrainment: Supraventricular Tachycardia

•    The Distinction between Overdrive Pacing and Entrainment
•    Avoidance of Common Mistakes: the Entrainment “Check-list”   
•    Practical Usage of Overdrive Pacing/Entrainment

5) Overdrive Pacing and Entrainment: Ventricular Tachycardia, Atrial tachycardia and Flutter
 
•    Ventricular Tachycardia
•    Atrial Tachycardia and Flutter
 
6) Non-stimulation Based Maneuvers

•    Isoproterenol
•    Adenosine
•    Confirming Existence of a Tachycardia Substrate
•    Wide QRS Complex Tachycardia Diagnosis
•    SVT Responses to Adenosine
•    Differentiating AVNRT from JT
•    Adenosine and Recovery of Conduction:
•    Miscellaneous Non-pacing Maneuvers

Doody's Review Service Book Review:

Reviewer
Saima Karim,  D.O.  (Ochsner Clinic Foundation)

Description
This book presents a comprehensive approach to electrophysiological maneuvers starting with a simplified explanation of basic concepts of intracardiac electrograms and then progressing to specific pacing maneuvers during sinus rhythm as well as various arrhythmias.

Purpose
The purpose is to detail the principles of electrophysiological maneuvers, explain how to perform the maneuvers, and to help readers master the interpretation of the intracardiac electrograms.

Audience
The audience includes technicians, nurses, and clinicians who have been exposed to the electrophysiology laboratory and have to either use the stimulator or interpret intracardiac findings.

Features
The book covers the physiological concepts behind the maneuvers used in electrophysiology, the methods for execution of the maneuvers, the subsequent intracardiac electrograms generated, and their interpretation. The benefits and pitfalls of these maneuvers are described as well. Unique to this book is the simplification of the basic principles in electrophysiological maneuvering and their interpretation.

Assessment
This book comprehensively discusses the principles behind electrophysiology studies. The importance of understanding cardiac anatomy, the physiology behind the maneuvers, the study of arrhythmias, and the benefits as well as the shortcomings of specific maneuvers are well elucidated.