Clinical Cardiac Electrophysiology in the Young (Developments in Cardiovascular Medicine)

__This volume focuses on the practical aspects of clinical electrophysiology of cardiac arrhythmias in the young as practiced by current and former faculty and fellows in the Department of Pediatric Cardiology at the University of Michigan. Cardiac arrhythmias in children are often symptomatic as well as frightening to the child patient and parent. This volume is intended as a practical guide for the novice or seasoned physician presented with a child with a cardiac arrhythmia.__ __Macdonald Dick II, M.D. is a Professor of Pediatrics at the University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.__ This text focuses on the practical, and theoretical when applicable, aspects of clinical electrophysiology of cardiac arrhythmias in the young. It represents a compilation of the clinical course, electrocardiograms, electrophysiologic studies, pharmacological management and transcatheter ablation therapy in patients from infancy through young adulthood seen at the clinical sites of the authors of this volume. The book is divided into two parts. The first part, Background (Chapters 1-3) discusses the cardiac conduction system - development, anatomy and physiology. Particular attention is directed to the clinical electrophysiology of the cardiac conduction system and the techniques of electrophysiologic study that are specific to children and that have been developed and practiced at the clinical centers represented in this volume. The second part, Cardiac Electrophysiology in Infants and Children focuses on the clinical science of cardiac arrhythmias in infants and children. Chapters 4-12 discuss the mechanisms, the ECG characteristics, electrophysiologic findings, treatment and prognosis of tachyarrhythmias. Chapters 13-16 focus on bradyarrhythmias. Chapters 17-20 address certain specialized subjects including syncope, cardiac pacemakers, implantable cardiac defibrillators, genetic disorders of the cardiac impulse, fetal arrhythmias and sudden cardiac death as it occurs in the young. Chapters 21-22 center on the pharmacology of antiarrhythmic agents, indications for use, doses, side effects and toxicity, as well as on transcatheter arrhythmia ablation. Finally, what the practitioner can expect to see from the impact of cardiac arrhythmias on the life of the patient and family is discussed from the nursing point of view in Chapter 23. This volume is intended for the young house officer or mature physician to increase their understanding, spark their interest and lead them to a therapeutic solution when faced with a child with a cardiac arrhythmia It takes a certain hubris to come forth with a This book emerges from the clinical book entitled Clinical Cardiac Electrophys- practice and research of the pediatric cardiac iology in the Young. There are a number electrophysiology group in the Division of of excellent texts, monographs, and reviews Pediatric Cardiology at the C. S. Mott Ch- on cardiac arrhythmias in both adults and dren's Hospital, the University of Michigan children—Josephson's and also Zipes and in Ann Arbor, and the former pediatric elec- Jalife's comprehensive texts come to mind, as trophysiology fellows from Michigan, now well as a number of others, including Deal, established electrophysiologists in their own Wolff, and Gelband's, the several volumes right. It represents a compilation of the cli- from Gillette, and the recent text from Walsh, cal course, electrocardiograms, electrophysi- Saul, and Triedman, the latter three texts fo- ologic studies, pharmacological management, cusing on children. and transcatheter ablation therapy in patients Nonetheless the past three decades have from infancy through young adulthood seen in witnessed enormous advances in the under- Ann Arbor and at the current clinical sites of standing and management of human cardiac the former Michigan fellows. Thus, while the arrhythmias. This development represents the product may be idiosyncratic, it is not prov- fruits of both basic and clinical investigations cial. We are interested in “how it is done” but in cardiac impulse formation and propagation not to the exclusion of other approaches. Front Matter....Pages 1-1 Development and Structure of the Cardiac Conduction System....Pages 3-15 Physiology of the Cardiac Conduction System....Pages 17-31 Clinical Electrophysiology of the Cardiac Conduction System....Pages 33-47 Front Matter....Pages 49-49 Atrioventricular Reentry Tachycardia....Pages 51-68 Atrioventricular Nodal Reentrant Tachycardia....Pages 69-81 Persistent Junctional Reciprocating Tachycardia....Pages 83-89 Sinoatrial Reentrant Tachycardia....Pages 91-93 Intra-atrial Reentrant Tachycardia—Atrial Flutter....Pages 95-113 Atrial Fibrillation....Pages 115-118 Atrial Ectopic Tachycardias/Atrial Automatic Tachycardia....Pages 119-134 Multifocal Atrial Tachycardia....Pages 135-138 Ventricular Tachycardia....Pages 139-152 Sick Sinus Syndrome....Pages 153-162 First- and Second-Degree Atrioventricular Block....Pages 163-171 Complete Heart Block—Third-Degree Heart Block....Pages 173-181 Syncope....Pages 183-194 Cardiac Pacemakers and Implantable Cardioverter-Defibrillators....Pages 195-215 Genetic Disorders of the Cardiac Impulse....Pages 217-240 Fetal Arrhythmia....Pages 241-256 Sudden Cardiac Death in the Young....Pages 257-265 Front Matter....Pages 49-49 Pharmacology of Antiarrhythmic Agents....Pages 267-288 Transcatheter Ablation of Cardiac Arrhythmias in the Young....Pages 289-314 Nursing Management of Arrhythmias in the Young....Pages 315-326 Focuses on the practical and theoretical aspects of clinical electrophysiology of cardiac arrhythmias in the young. This text represents a compilation of the clinical course, electrocardiograms, electrophysiologic studies, pharmacological management and transcatheter ablation therapy in patients from infancy through young adulthood