Clinical Arrhythmology

ANTONI BAYÉS DE LUNA Emeritus Professor of Cardiology, Universitat Autònoma de Barcelona, Barcelona; Honorary Director, Cardiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona; Senior Consultant, Hospital Universitari Quirón, Barcelona, Spain ADRIAN BARANCHUK MD FACC FRCPC FCCS Professor of Medicine, Queen's University, Kingston, Ontario, Canada; Editor-in-Chief, Journal of Electrocardiology; President, International Society of Electrocardiology

• Foreword by Dr. Valentin Fuster ixForeword by Dr. Pere Brugada i Terradellas xiPreface xiiiRecommended General Bibliography xviiPart I Anatomical and Electrophysiological Considerations, Clinical Aspects, and Mechanisms of Cardiac Arrhythmias 11 Clinical Aspects of Arrhythmias 3Definition of Arrhythmia 3Classification 3Clinical Significance and Symptoms 4The Importance of Clinical History and Physical Examination in Diagnosis and Assessment of Arrhythmias 18The Importance of Surface ECG and Other Techniques 21References 242 Anatomic and Electrophysiologic Basis 27Anatomic Basis 27Electrophysiologic Characteristics 34References 513 Electrophysiologic Mechanisms 53Mechanisms Responsible for Active Cardiac Arrhythmias 53Mechanisms Leading to Passive Arrhythmias 70References 80Part II Diagnosis, Prognosis and Treatment of Arrhythmias 834 Active Supraventricular Arrhythmias 85Premature Supraventricular Complexes 85Sinus Tachycardia 88Atrial Tachycardia 95Junctional Reentrant (Reciprocating) Tachycardia 105AV Junctional Tachycardia Due to Ectopic Focus 112Chaotic Atrial Tachycardia 115Atrial Fibrillation 115Atrial Flutter 139Supraventricular Tachyarrhythmias and Atrial Wave Morphology: Monomorphic and Polymorphic Morphology 148Differential Diagnosis of Supraventricular Tachyarrhythmias with Regular RR Intervals and Narrow QRS 149Electrocardiographic Diagnosis of the Paroxysmal Supraventricular Tachycardias: a Sequential Approach 151References 1555 Active Ventricular Arrhythmias 165Premature Ventricular Complexes 165Ventricular Tachycardias 174Ventricular Flutter 200Ventricular Fibrillation 201References 2056 Passive Arrhythmias 209Escape Complex and Escape Rhythm 209Sinus Bradycardia due to Sinus Automaticity Depression 209Sinoatrial Block 212Atrial Blocks 214Atrioventricular Block 216Ventricular Blocks 218Cardiac Arrest 226The Pacemaker Electrocardiography 226Clinical, Prognostic, and Therapeutic Implications of Passive Arrhythmias 234References 2407 Analytical Study of an Arrhythmia 245Determining the Presence of a Dominant Rhythm 245Atrial Wave Analysis 245QRS Complex Analysis 246Atrioventricular Relationship Analysis 248Premature Complex Analysis 249Pause Analysis 249Delayed Complex Analysis 249Analysis of the P Wave and QRS‐T Complexes of Variable Morphology 249Repetitive Arrhythmias Analysis: Bigeminal Rhythm 250Differential Diagnosis Between Several Arrhythmias in Special Situations 252References 255Part III The ECG and Risk of Arrhythmias and Sudden Death in Different Heart Diseases and Situations 2578 Ventricular Pre-Excitation 259Concept and Types of Pre-Excitation 259WPW-type Pre-Excitation (Type 1) 259Atypical Pre-Excitation 268Short PR Interval Pre-Excitation 268References 2709 Inherited Heart Diseases 273Introduction 273Cardiomyopathies 273Specific Conduction System Involvement: Lenegre Syndrome 285Ionic Channel Disorders in the Absence of Apparent Structural Heart Disease: Channelopathies 285References 30510 Other ECG Patterns of Risk 313Severe Sinus Bradycardia 313Third-Degree (Advanced) Interatrial Block 313High-Risk Ventricular Block 317Advanced Atrioventricular Block 319The Presence of Ventricular Arrhythmias in Chronic Heart Disease Patients 321Acquired Long QT 322Electrical Alternans 325Other Electrocardiographic Patterns of Risk for Sudden Death 326Early Repolarization (ER) Pattern (J Wave) and Sudden Death 326Risk of Serious Arrhythmias and Sudden Death in Patients with Normal or Nearly Normal ECG 329References 33111 Arrhythmias in Different Heart Diseases and Situations 335Ischemic Heart Disease 335Heart Failure 341Valvular Heart Disease 345Congenital Heart Disease 346Hypertensive Heart Disease 348Myocarditis 348Cor Pulmonale 348Pericardial Disease 348Sudden Death in Other Heart Diseases 349Sudden Infant Death Syndrome 349Athletes 349Alcohol Intake 351Special Situations 351Sudden Death in Apparently Healthy People 354References 354Appendix 359Introduction 359Calculation of Sensitivity, Specificity, and Predictive Value 359Diagnostic Techniques 361Therapeutic Techniques 372Antiarrhythmic Agents 384Classification of the Recommendations for Diagnostic and Therapeutic Procedures and Level of Evidence (AHA/ESC/ACC Guidelines) 388References 389Index 395