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Complete Heart Block
 Class 1 indication for pacemaker
Conduction system disease
RBBB, left axis deviation
 Bi or Tri Fascicular block with blackout
 2a indication for pacemaker if other causes excluded
Download after syncope
Class 1 indication for pacing
Syncope with Sinus node disease
24 male with palpitations and blackout:
a) Reassure? b) Emergency admission? c) Refer to Specialist?
29M blackout playing football
Left Ventricular Hypertrophy and T wave changes
©2011 by BMJ Publishing Group Ltd and British Cardiovascular Society
Wolff-Parkinson-White syndrome (WPW)
 Common
 0.1% prevalence
 Delta wave and short PR
 Palpitations: AVRT
 Sudden Cardiac Death:
- 0.15 – 0.25% per year
 Pre-excited AF
 VF induced by “R on T”
 Eliminated with Ablation
Hypertrophic cardiomyopathy
Brugada Syndrome
 ECG: Coved ST-elevation Vi and V2. “Sharks fin”
 Gene defect of cardiac Sodium Ion-channels (SCN5A)
 Associated with SCD
 Development of VF
 ICD:
 Syncope aborted SCD
 EPS inducibility
 Identification of families
©2011 by BMJ Publishing Group Ltd and British Cardiovascular Society
Thanks!
 [email protected]
 www.guidance.nice.org.uk/CG109
 www.arrhythmiaalliance.org.uk
 www.dft.gov.uk/dvla/medical/ataglance
 www.devicesurvey.com
Long QT-Syndrome
 QTc >450ms
 Genetic Ion-channel defect: LQT1/2/3
 Syncope (seizures) and SCD
 Drugs
 Treatment: Beta-blockers, ICD
Arrythmogenic Right Ventricular
Cardiomyopathy (ARVC)
 ECG
 T wave inverted V1-3
 Epsilon wave
 Arrhythmia!
 Multiple defects (AD):
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Desmosomes
Syncope
SCD
Palpitation
HF