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. Contents......Page 11 I. BACKGROUND......Page 13 1 Development and Structure of the Cardiac Conduction System......Page 14 2 Physiology of the Cardiac Conduction System......Page 27 3 Clinical Electrophysiology of the Cardiac Conduction System......Page 42 II. CLINICAL ELECTROPHYSIOLOGY IN INFANTS AND CHILDREN......Page 57 4 Atrioventricular Reentry Tachycardia......Page 58 5 Atrioventricular Nodal Reentrant Tachycardia......Page 76 6 Persistent Junctional Reciprocating Tachycardia......Page 89 7 Sinoatrial Reentrant Tachycardia......Page 96 8 Intra-atrial Reentrant Tachycardia—Atrial Flutter......Page 99 9 Atrial Fibrillation......Page 118 10 Atrial Ectopic Tachycardias/Atrial Automatic Tachycardia......Page 122 11 Multifocal Atrial Tachycardia......Page 138 12 Ventricular Tachycardia......Page 142 13 Sick Sinus Syndrome......Page 156 14 First- and Second-Degree Atrioventricular Block......Page 166 15 Complete Heart Block—Third-Degree Heart Block......Page 175 16 Syncope......Page 184 17 Cardiac Pacemakers and Implantable Cardioverter-Defibrillators......Page 196 18 Genetic Disorders of the Cardiac Impulse......Page 217 19 Fetal Arrhythmia......Page 241 20 Sudden Cardiac Death in the Young......Page 257 21 Pharmacology of Antiarrhythmic Agents......Page 266 22 Transcatheter Ablation of Cardiac Arrhythmias in the Young......Page 288 23 Nursing Management of Arrhythmias in the Young......Page 314 A......Page 326 D......Page 327 J......Page 328 S......Page 329 U......Page 330 X......Page 331 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