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In Clinical Practice
DavidT.Huang· TravisPrinzi·
SonjaKreckelEditors
Cardiac
Electrophysiology
in Clinical Practice
SecondEdition

In Clinical Practice

Taking a practical approach to clinical medicine, this series of
smaller reference books is designed for the trainee physician,
primary care physician, nurse practitioner and other general
medical professionals to understand each topic covered. The
coverage is comprehensive but concise and is designed to act as a
primary reference tool for subjects across the eld of medicine.

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, specically
the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microlms 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 specic
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 afliations.
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 difcult,” 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 signicantly, 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. Specically, 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
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