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In Clinical Practice
DavidT.Huang· TravisPrinzi· SonjaKreckelEditors
Cardiac Electrophysiology in Clinical Practice
SecondEdition
In Clinical Practice
David T. Huang • Travis Prinzi Sonja Kreckel
Editors
Cardiac Electrophysiology in Clinical Practice
Second Edition
Editors
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David T. Huang Department of Medicine Cardiology, University of
Travis Prinzi University of Rochester
Rochester, NY, USA Rochester Medical Center Rochester, NY, USA
Sonja Kreckel Clinical Cardiology University of Rochester Medical Center Rochester, NY, USA
ISSN 2199-6652 ISSN 2199-6660 (electronic) In Clinical Practice ISBN 978-3-031-41478-7 ISBN 978-3-031-41479-4 (eBook)
https://doi.org/10.1007/978-3-031-41479-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023, Springer-Verlag London 2015 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my parents, Ko-En and
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Linda, for teaching me that “with diligence, nothing in the world is too difcult,” with much love and appreciation. —David T.Huang
To Tyanna, Sophie, Lily, Jack, and Ethan, whose love makes every day better. —Travis Prinzi
Book Introduction
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In our rst edition, we set out to produce an accessible EP book, informed by the experience of attending physicians, the learning process of EP fellows, and the day-to-day practical needs of EP nurses and technologists. In order to accomplish this, the book was edited by the Chief Electrophysiologist at the University of Rochester Medical Center (David Huang, MD) and the Lead EP Technologist (Travis Prinzi, MA, MS, CEPS) at the same institu­tion. Contributions were made both by attending physicians and EP Fellows working in the lab and clinic at that time.
In this new, revised edition, we’ve continued in that same model, but we have broadened our approach to include the clinical perspective of one of our Nurse Practitioners, Sonja Kreckel, MS, RN, NP-C, CCDS. Most signicantly, this contribution will be seen in the added discussion on various means of ambulatory car­diac monitoring, an aspect of EP that has grown tremendously since the rst edition.
While the foundational basics of EP remain the same, the tech­nology to assess and treat cardiac arrhythmias has moved along at a rapid pace, resulting in new understandings of arrhythmia cir­cuits and how to treat them. As of the writing of this book, the EP world is on the cusp of a potentially eld-changing development of a new treatment modality in pulsed eld ablation. By the time you are reading this book, we will likely already know far more about it than we do at its writing. Herein lies the challenge of producing an EP textbook. The eld is advancing quickly. We have provided here a book that focuses on the fundamentals that
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Book Introduction
will serve as an important learning tool for us all as students of cardiac electrophysiology in labs and classrooms. We have also pointed to advancing technology and promising developments on the horizon wherever possible.
We also like to pay tribute to all the teachers, both personal and virtual, who have pioneered and advanced the care of patients with cardiac dysrhythmia to where it is today. Specically, we would mention and remember Drs Mark E Josephson, Hein Wellens, and Arthur Moss for their boundless contributions. Herein we also impart our own advice to all readers to never stop learning while remembering the fundamentals in electrophysiol­ogy. We are all fortunate to be involved in a medical eld that has continued to advance rapidly.
Contents
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1 Cardiac Conduction and Bradycardia . . . . . . . . . . . . 1
Mehmet K. Aktas
2 Ambulatory Cardiac Rhythm Monitoring . . . . . . . . . 15
James Gallagher and Sonja Kreckel
3 Syncope, Tilt Table Testing, and Cardioversion . . . . . 31
Sarah Taylor
4 Implantable Cardiac Devices . . . . . . . . . . . . . . . . . . . . 47
Parag Patel, Erin Armenia, and Pina Spampanato
5 Diagnosis and Treatment of Supraventricular
Tachycardias
Spencer Rosero and Travis Prinzi
6 Wolff-Parkinson-White (WPW) Syndrome . . . . . . . . 103
Jeffrey M. Vinocur
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
7 Atrial Flutter, Typical and Atypical . . . . . . . . . . . . . . 129
David T. Huang and Travis Prinzi
8 A Practical Guide to Catheter Ablation of Atrial
Fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Joshua Haswell, Travis Prinzi, and Burr Hall
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Contents
9 Ventricular Tachyarrhythmias . . . . . . . . . . . . . . . . . . . 179
Amole Ojo, Sinan Tankut, Travis Prinzi, and David T. Huang
10 Hereditary Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . 219
Ido Goldenberg, Alon Barsheshet, and David T. Huang
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255