Clinical Electrophysiology Review by George Klein, Eric Prystowsky

By George Klein, Eric Prystowsky

A clinically suitable method of the translation of electrophysiograms

Clinical Electrophysiology Review, moment version is a different method of EP, serving in part as a case consultant and in part as a workbook to tough reports in complicated electrodiagnostics. It offers physicians with a clinically appropriate method of the translation of electrophysiograms (used to degree middle rhythm disorders).

Clinical Electrophysiology Review, additionally serves as a superb source for applicants taking the electrophysiology board exam. It comprises liberal use of illustrations to assist the reader realize universal rhythym disturbances and unusual arrhythmias, comparable to tachycardia and bradycardia. the recent variation will comprise thoroughly up-to-date instances and tracings, and may mirror advances in expertise because the first variation published.

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A PVC interrupts the tachycardia and the following beat has an upright P wave (S) compatible with sinus rhythm before tachycardia resumes. The PVC is late coupled and interrupts the inverted P wave that has already started resulting in merging of the inverted P wave and the PVC. The PVC interrupts the tachycardia without conduction to the atrium, making atrial tachycardia untenable. This PVC is very late coupled but nonetheless is able to penetrate the circuit, thus making AVNRT untenable. AVRT utilizing an accessory pathway with a long 46 VA time could provide good access of the PVC if the PVC were relatively close to the pathway that in this case was an RV PVC with a septal accessory pathway.

The end of the tracing shows a supraventricular tachycardia with a 1:1 AV relationship. The P wave vector is “low to high” and compatible with a septal pattern of atrial activation. The SVT ends with a P wave, making atrial tachycardia now even more unlikely since one would have to postulate AV block occurring at the same instant as tachycardia termination. In addition, there is cycle length variability (“wobble”) with change in both the PR and the RP interval. The change in V-to-V interval precedes the change in P-to-P interval, now making atrial tachycardia as a mechanism untenable.

It is important to remember that the first atrial complex of the second tachycardia could have fortuitously started shortly after the last ANALYSIS OF COMPLEX ELECTROPHYSIOLOGIC DATA narrow QRS complex. Introduction of a relatively late-coupled PVC into the cardiac cycle at the time of His bundle refractoriness (Fig. 1–6) advances the next atrial cycle and terminates the tachycardia, verifying the existence of an AP and, for all practical purposes, the diagnosis of AV reentry. Advancement of the A (“reset”) with a relatively long coupling interval of 380 milliseconds with tachycardia CL of 420 suggests very easy “access” of the RV apical site to the tachycardia circuit, which would normally not be the case with a left-sided AP.

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