Download ELECTROPHYSIOLOGY for CARDIOLOGIST

CARDIAC ARRHYTHMIA
Charn Sriratanasathavorn, MD,FACC
Her Majesty Cardiac Center
Siriraj Hospital, Mahidol University
SIMPLIFIED CARDIAC SYSTEM
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
• Cardiac Bradyarrhythmia
• Cardiac Tachyarrhythmia
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
– Normal cardiac conduction system
NORMAL CARDIAC
CONDUCTION SYSTEM
• Impulse formation
• Impulse conduction
NORMAL CARDIAC
CONDUCTION SYSTEM
THE AUTOMACITY OF SINUS NODE
ANS and Sinus Node Function
NORMAL CARDIAC
CONDUCTION SYSTEM
• Impulse formation
• Impulse conduction
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
– Normal cardiac conduction system
– Cardiac arrhythmia mechanism
Mechanism of Bradyarrhythmias
• Abnormal impulse formation
–decrease impulse formation
• Abnormal impulse conduction
–conduction block
Mechanism of Tachyarrhythmia
Abnormal impulse formation
Automaticity
Enhanced
Abnormal
Abnormal impulse conduction
Reentry
Triggered
EADs
DADs
Anisotropy
Anatomic
Functional
Mechanism of triggered arrhythmias
Mechanism of triggered arrhythmias
Reentry arrhythmias
Reentry circuits
Re-entry circuit
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
– Normal cardiac conduction system
– Cardiac arrhythmia mechanism
– Cardiac arrhythmia evaluation in clinical
practice
RELATIONSHIP OF INTRACELLULAR
POTENTIAL TO SURFACE EKG
การตรวจคลื่นไฟฟ้าหั วใจ (EKG, ECG)
การตรวจคลื่นไฟฟ้าหั วใจ
(12 Lead Electrocardiogram, 12 Lead ECG)
SIMPLIFIED CARDIAC SYSTEM
ECG
คลื่นไฟฟ้าหั วใจขณะเกิดอาการ
CAROTID SINUS
HYPERSENSITIVITY
Holter Monitoring
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Cardiac Arrhythmia monitoring system
• Holter monitoring system
• Event recording system
• Loop recording system
– Non implantable
– Implantable
การตรวจสมรรถภาพหัวใจด้วยการออกกาลัง
(Exercise Stress Test)
ABNORMAL HEART RATE RESPONSE
Electrophysiologic study
Prolonged Sinus node recovery time
Atrioventricular Reciprocating
Tachycardia (AVRT)
Typical Atrioventricular Nodal
Reentry tachycardia ( AVNRT)
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
– Normal cardiac conduction system
– Cardiac arrhythmia mechanism
– Cardiac arrhythmia evaluation in clinical
practice
– Cardiac arrhythmia treatment concept
SIMPLIFIED CARDIAC SYSTEM
Treatment
Cardiac Bradyarrhythmia-Rx
• Treatment strategy
• Short term Rx
• Treat reversible /
underlying causes
• Medication to increase
heart rate
• Temporary pacemaker
• Long term Rx
• Permanent pacemaker
• Factors
• Type of bradyarrhythmia
• Severity of symptoms
• Severity of underlying
cardiac pathology
• Severity of co-morbid
diseases
Cardiac Tachyarrhythmia - Rx Strategies
Short term treatment
Electrical Therapy in unstable patients
Cardioversion, Defibrillation
Control ventricular rate
Ventricular rate control
Rhythm control: Medical / Electrical
Identify and treat reversible causes
Considering factors
Long term treatment
Type of tachyarrhythmia
RF ablation
Mechanism of tachyarrhythmia
Medication
Underlying Cardiovascular
Anticoagulation
Devices (pacemaker, AICD) pathology
Local expertise
Surgery
Patient factors
CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia in general
– Normal cardiac conduction system
– Cardiac arrhythmia mechanism
– Cardiac arrhythmia evaluation in clinical
practice
– Cardiac arrhythmia treatment concept
Thank you for your attention