Electrophysiological Disorders of the Heart: Expert Consult - Online and Print, 2e

The new edition of Electrophysiological Disorders of the Heart helps you diagnose and treat a full range of heart rhythm disorders using today’s latest technologies and therapies. It provides practical, hands-on coverage of hot topics such as pediatric EP, imaging, echocardiography-guided EP procedures, regenerative therapies, cardiac pacing, and more. Now available in a new full-color format, the title also includes easy online access at www.expertconsult.com. • Discover new ways to treat and manage the full range of heart rhythm disorders with content focused on common clinical features, diagnosis, and management. • Review expert management strategies to help you handle complex patient problems. • Stay current with the latest molecular and technical advances as well as new treatment options implemented over the last few years. • Use the latest technologies and devices to accurately diagnose and manage heart rhythm disorders. • Consult new and expanded coverage of regenerative therapies, echo-guided procedures, cardiac pacing, and CRT, as well as a new section on pediatric electrophysiology and imaging. • Enjoy improved visual guidance with many new full-color images. • Log on to www.expertconsult.com to easily search the complete contents online and access a downloadable image library. Learn about and apply the latest technologies and clinical & device therapies to treat electrophysiological disorders. Cover......Page 1 4-u1.0-B978-1-4377-0285-9..00102-2..DOCPDF......Page 2 Front Matter......Page 3 Electrophysiological Disorders of the Heart......Page 4 Copyright......Page 5 Dedication......Page 6 Contributors......Page 7 Foreword......Page 20 Foreword......Page 21 Preface......Page 22 v_0......Page 24 Intact Animal......Page 25 Wedge Preparations......Page 27 Extracellular Recordings......Page 28 Intracellular Recordings......Page 30 Optical Techniques......Page 31 Methods of Gene Delivery......Page 33 Genetically Modified Mice......Page 34 References......Page 37 Form Fits Function: The Ventricular Cardiomyocyte and Excitation- Contraction Coupling......Page 39 Cell Membrane Architecture Defines Myocyte Local Electrical Activity......Page 40 The Cardiac Dyad......Page 43 Biogenesis and Maintenance of Local Signaling Domains......Page 44 References......Page 46 Membrane Potential and Conduction......Page 48 Passive Membrane Properties and Cable Theory......Page 49 Ion Channels and Transporters: Molecular Building Blocks of the Action Potential......Page 51 Sodium Channels......Page 52 Calcium Channels: L-type......Page 54 Potassium Channels......Page 56 Na+-Ca2+ Exchanger......Page 59 Molecular Basis of Activation and Recovery of the Heart......Page 62 Repolarization and Refractory Periods......Page 64 Alterations in Impulse Initiation: Automaticity......Page 65 After-Depolarizations and Triggered Automaticity......Page 67 Abnormal Impulse Conduction: Re-entry......Page 68 References......Page 69 Circus Movement Re-entry......Page 71 Figure-of-8 Re-entry......Page 73 Modes of Initiation of Spiral Wave Re-entry......Page 74 Spontaneous Formation of Rotors......Page 76 Rotors and Ventricular Fibrillation......Page 78 Fibrillatory Conduction......Page 79 References......Page 80 Atrioventricular Node and Cardiac Conduction System......Page 81 Sinus Node Dysfunction......Page 83 Atrioventricular Conduction Disturbance......Page 84 Ischemic Heart Disease......Page 85 Long QT Syndrome, Brugada Syndrome, and Other Channelopathies......Page 86 Autonomic Responses and Treatment Considerations in Long QT Syndrome......Page 87 Neurally Mediated Reflex Syncope......Page 88 Orthostatic Syncope......Page 89 Summary......Page 90 References......Page 91 Basic Structure of DNA and the Gene......Page 92 Transfer of the Genetic Code: The Central Dogma of Molecular Biology......Page 93 Modes of Inheritance: Genetics of Disease......Page 95 Mutation Types in Human Genetic Disease......Page 96 General Techniques Used in Genetic Testing at the Single Gene Level......Page 97 Genetic Testing: Benefits, Limitations, and Family Matters......Page 99 Micro-RNAs as Pathogenic Contributors to Electrical Diseases of the Heart......Page 100 Induced Pluripotent Stem Cell–Derived Cardiomyocytes......Page 101 References......Page 102 BrS3 and BrS4, CACNA1c and CACNB2b......Page 104 BrS5 and BrS7, SCN1B and SCN3B......Page 105 Mechanism of Arrhythmia in Brugada Syndrome......Page 106 LQT8, CACNA1c......Page 108 Short QT Syndrome......Page 110 Mechanism of Arrhythmia in Short QT Syndrome......Page 111 Catecholaminergic Polymorphic Ventricular Tachycardia......Page 112 References......Page 113 Genetic Disorders of Trafficking......Page 117 Calcium Channels......Page 118 Abnormalities in Intercellular Communication Causing Cardiac Arrhythmias......Page 120 Changes in Gap Junction Conductance Without Changes in Connexin Amount or Location......Page 121 Ventricular Remodeling......Page 122 Changes in Location of Connexin Protein: Lateralization......Page 124 Re-entry Caused by Gap Junction Remodeling Characterized by Changes in Connexin Quantity......Page 125 Automaticity......Page 127 Triggered Activity......Page 128 References......Page 129 Stem Cell–Based Therapy......Page 131 Overexpression of If......Page 132 Human Mesenchymal Stem Cells Overexpressing HCN2......Page 133 Overexpression of SkM1......Page 135 Fibroblasts Expressing Kv1.3......Page 136 Arrhythmic Potential of Stem Cell–Based Cardiac Regeneration Strategies......Page 138 References......Page 139 Historical Perspective......Page 141 Cardiac Impulse Formation and Conduction......Page 144 Electrocardiogram Waveforms......Page 147 Determining Left Versus Right Cardiac Electrical Activity......Page 148 Interpretation of the Normal Electrocardiogram......Page 149 R Waves......Page 150 ST-Segment Morphology......Page 151 Q-T Interval......Page 153 Left Ventricular Dilation......Page 154 Unifascicular Blocks......Page 155 Bifascicular Blocks......Page 157 General Electrophysiological Principles......Page 158 Myocardial Ischemia......Page 161 Subendocardial Injury......Page 162 Epicardial Injury......Page 164 Myocardial Infarction......Page 169 Estimating Infarct Size......Page 170 Key References......Page 173 References......Page 0 References......Page 172 Biology and Biophysics of Cardiac Ion Channels......Page 175 Gene-Based Arrhythmias......Page 177 Intracellular Calcium and Targets......Page 178 Potential Therapies for Delayed After-Depolarization–Related Arrhythmias......Page 179 References......Page 180 Basic Concepts in Pharmacokinetics......Page 181 Drugs with a Narrow Therapeutic Index: Antiarrhythmic Agents......Page 182 Pharmacologic Effects Are Mediated by the Parent Compound Alone......Page 184 The Parent Compound and the Metabolite Have Different Pharmacologic Effects......Page 185 References......Page 186 Key References......Page 187 Intracellular Stimulation......Page 188 Extracellular Stimulation......Page 190 Electrical Stimulus......Page 191 Effect of Stimulus Timing (Strength/Interval Curve)......Page 192 Effect of Electrode Size......Page 194 Tissue Fibrosis......Page 195 Goals of Cardiac Stimulation in Implantable Devices......Page 196 Relationship Between Intracellular Stimulation and Extracellular Stimulation......Page 197 Key References......Page 199 Physiological Responses of the Myocardium to Stimuli......Page 201 Regions of Immediate Postshock Activation......Page 202 Why Do Shocks Fail to Defibrillate?......Page 204 The Critical Point Hypothesis: Classic Interpretation......Page 205 The Critical Point Hypothesis: New Interpretation......Page 206 Upper Limit of Vulnerability and Defibrillation Mechanism......Page 207 Near-Threshold Shocks and Mechanism of Defibrillation......Page 209 Small Arrhythmogenic Region after Near-DFT Shocks......Page 211 Postshock Isoelectric Window: Is It Truly Electrically Silent?......Page 212 Harmful Effects of Strong Shocks......Page 213 References......Page 214 Biophysical Aspects of Radiofrequency Ablation......Page 215 Determinants of Lesion Size......Page 217 Cooled Radiofrequency Ablation......Page 218 Ultrasound Ablation......Page 219 Microwave Ablation......Page 221 References......Page 224 Key References......Page 225 Cooled Radiofrequency Ablation Systems......Page 226 Single-Point Cryoablation......Page 228 Balloon Cryoablation......Page 229 Radiofrequency Electrode Arrays......Page 230 References......Page 231 Computed Tomography Imaging......Page 233 Image Segmentation......Page 235 Imaging of the Atrium and Pulmonary Veins......Page 237 Left Atrial Registration......Page 239 Other Applications in Cardiac Arrhythmias......Page 241 Acknowledgments......Page 242 Current Technology of Image Integration......Page 243 Ventricular Tachycardia......Page 246 Imaging of Ablation Lesions......Page 248 Real-Time Magnetic Resonance Imaging......Page 249 Conclusion......Page 250 Principles of Echocardiography......Page 251 Motion Echocardiography......Page 252 Transthoracic Echocardiography......Page 253 Transesophageal Echocardiography......Page 254 Doppler Echocardiography......Page 255 Three-Dimensional Echocardiography......Page 257 Echocardiography in the Evaluation and Management of Cardiomyopathy......Page 258 Optimization of Pacemaker Parameters......Page 259 Echocardiography in the Evaluation of Fetal Arrhythmias......Page 260 Atrial Mechanics......Page 261 Premature Contraction......Page 262 Loss of Atrial Systole in Normal Hearts......Page 263 Hemodynamic Consequences of Catheter Ablation for Atrial Fibrillation......Page 264 Ventricular Tachycardia......Page 265 Hemodynamics During Catheter Ablation......Page 267 Key References......Page 268 Other Design Parameters......Page 269 Intention to Treat......Page 270 Blinding or Masking Therapy......Page 271 Overreads and Clinical Endpoint Adjudication......Page 272 Interim Analyses and Adaptive Designs......Page 273 Adherence......Page 275 Conclusion......Page 276 Femoral Approach......Page 277 Incremental/Decremental: How Fast Is That?......Page 278 Low and Wide......Page 279 Timing of Electrical Events......Page 280 Tandem Method......Page 281 Functional Refractory Period......Page 283 Conduction Intervals......Page 284 Baseline Intervals......Page 285 Atrium......Page 286 Longitudinal Dissociation and “Normalization” of Left Bundle Branch Block......Page 287 Ventricle......Page 288 Summary......Page 289 Key References......Page 290 Cardiac Stimulator......Page 291 Radiofrequency Generator......Page 292 Image Integration......Page 293 Other Image Integration Technologies......Page 294 Key References......Page 295 References......Page 296 Principles of Intracardiac Echocardiographic Imaging......Page 297 Comparison of Mechanical and Phased-Array Intracardiac Echocardiographic Transducers and Systems......Page 298 Baseline Image Acquisition Using Intracardiac Echocardiography......Page 299 Evaluation of the Left Atrium and Left Atrial Appendage......Page 300 Trans-septal Catheterization......Page 301 Intracardiac Echocardiography Guidance During Catheter Ablation of Atrial Fibrillation......Page 302 Intracardiac Echocardiography Guidance During Catheter Ablation of Ventricular Arrhythmias......Page 304 References......Page 306 Significance of the Local Electrogram......Page 307 Utility of the Unipolar Electrogram......Page 308 Utility of Simultaneous Unipolar and Bipolar Recordings in Focal Tachycardias......Page 309 Sustained Arrhythmia......Page 310 Physiology of Arrhythmias Pertaining to Catheter Mapping......Page 313 Activation Sequence Mapping......Page 314 Mapping Macro–Re-Entrant Circuits......Page 316 Entrainment......Page 317 Pacemapping......Page 321 Key References......Page 324 Atrioventricular Re-entrant Tachycardia and Atrioventricular Node Re-entrant Tachycardia......Page 325 Dual Atrioventricular Nodal Pathway......Page 326 Unusual Physiology of Dual Atrioventricular Nodal Pathways......Page 328 Anatomy and Electrophysiology of Accessory Pathways......Page 329 Electrophysiological Findings in Atrioventricular Re-entry Tachycardia......Page 332 Key References......Page 335 Ischemic Heart Disease......Page 337 Idiopathic Dilated Cardiomyopathy......Page 339 Congenital Heart Disease......Page 340 Acknowledgment......Page 341 References......Page 342 Surface Electrocardiogram......Page 343 Additional Preparation......Page 344 Mapping Strategies: Hemodynamically Stable, Re-entrant Ventricular Tachycardia......Page 345 Conducting Channels......Page 347 Noncontact Mapping......Page 348 Ventricular Tachycardia with Nonischemic Left Ventricular Disease......Page 349 Idiopathic Ventricular Tachycardia......Page 350 Key References......Page 352 Importance of Surface Electrocardiogram and P-Wave Morphology......Page 354 Conventional Mapping......Page 355 Ablation......Page 356 Indications for Catheter Ablation......Page 357 Endpoints for Ablation......Page 358 Atypical, or Non-CTI–Dependent Atrial Flutter......Page 360 Left Atrial Macro–Re-entry......Page 361 Atrial Tachycardias After Catheter Ablation of Atrial Fibrillation......Page 363 key references......Page 364 Early Electrophysiological Observations in Atrial Fibrillation......Page 365 Contact Electrode Catheter Techniques......Page 366 Pacing Techniques During Electrophysiological Evaluation......Page 370 Choice of Mapping Techniques......Page 371 Bi-atrial Contact and Noncontact Mapping Techniques......Page 374 Normal Atrial Electrophysiology......Page 376 Pulmonary Vein Electrophysiology......Page 377 Insights into Atrial Fibrillation Mechanisms from Bi-atrial and Three-Dimensional Mapping......Page 379 References......Page 380 Key References......Page 381 Assessment of Sinus Node Function......Page 382 Assessment of Atrioventricular Conduction......Page 383 Carotid Sinus Hypersensitivity......Page 384 Reference......Page 385 Leads......Page 387 Lead Body......Page 388 Fixation Methods......Page 389 Design of Distal Electrodes......Page 391 Special Considerations for Left Ventricular Leads......Page 392 Design......Page 393 Battery Testing......Page 394 Mechanical Design......Page 395 Sensing Subsystem......Page 396 Microprocessor and Memory Subsystem......Page 397 Fault-Tolerant Design and Risk Management in Pacemakers......Page 398 Key References......Page 401 St. Jude/Pacesetter Autocapture......Page 402 Efficacy......Page 403 Automatic Mode Switching......Page 404 Atrial Tachycardia Detection......Page 405 Automatic Mode Switching Sensitivity......Page 406 Automatic Mode Switching Diagnostics......Page 408 Event Counters......Page 409 Stored Atrial Electrocardiogram......Page 410 Clinical Benefits......Page 411 Illustrative Types of Automatic Mode Switching......Page 412 Implantable Sensors......Page 413 Sensor Classification......Page 414 Characteristics of an Ideal Rate-Adaptive Pacing System......Page 415 Clinical Outcome......Page 417 Key References......Page 418 Implantation......Page 419 Pacemaker Upgrades, Revisions, and Generator Replacements......Page 425 Management of Pocket Hematoma, Erosion, Infection, and Pacer Extraction......Page 426 key References......Page 429 Disorders of Sinoatrial Conduction......Page 430 First-Degree Atrioventricular Block......Page 431 High-Grade Atrioventricular Block......Page 432 Chronic Bifascicular Block......Page 433 Carotid Sinus Hypersensitivity......Page 434 Procedures and Surgeries......Page 435 Multiple-Site Atrial Pacing......Page 436 Temporary Pacing Modalities......Page 437 Acute Myocardial Infarction......Page 438 Summary......Page 439 Key References......Page 440 Dual-Chamber (Atrioventricular) Sensing and Sequential, Non–P-Synchronous Pacing with Inhibition (DDI)......Page 441 Blanking and Refractory Periods......Page 444 Base-Rate Behavior......Page 446 Atrioventricular Interval or Delay......Page 447 Upper Rate Behavior......Page 448 Hysteresis......Page 450 Managed Ventricular Pacing......Page 451 Atrial Flutter Response......Page 453 Noise Reversion Response......Page 454 V–V Timing......Page 455 References......Page 456 Chronotropic Incompetence......Page 457 Optimal Heart Rate......Page 458 Heart Rate and Cardiac Resynchronization Therapy......Page 459 Prevention and Management of Atrial Conduction Delay......Page 460 Atrioventricular Optimization in DDD/DDDR Pacing......Page 462 Atrioventricular Optimization Methods......Page 463 Limitations of Atrioventricular Optimization......Page 464 Pacing Mode and Clinical Outcomes......Page 465 Cardiac Pacing and Obstructive Hypertrophic Cardiomyopathy......Page 466 Right Ventricular Upgrade......Page 467 Single Left Ventricular Stimulation......Page 468 Short-Term Hemodynamic Effects......Page 469 Optimization of Ventricular Timing......Page 470 Conclusion......Page 472 Key References......Page 474 Pacing Stimuli and the Evoked Response......Page 475 Fused and Pseudo-Fused Pacing Complexes......Page 476 Left Ventricular Endocardial and Epicardial Pacing......Page 477 Biventricular Pacing......Page 478 Basic Device Operation and Electrocardiogram Manifestations......Page 479 Apparent and Real Pacemaker Malfunction......Page 480 Issues Specific to Dual-Chamber Devices......Page 483 Key References......Page 486 Equipment......Page 487 Remote Monitoring and Remote Control......Page 488 Remote Follow-up......Page 490 Technical Pacemaker Control......Page 491 More Advanced Control and Troubleshooting......Page 493 Medical Conditions Requiring Adjustment of Pacing......Page 495 References......Page 496 Remote Follow-up of Cardiac Pacing Devices......Page 497 Newer Cardiac Pacing System Algorithms......Page 499 Site Selection......Page 500 Biologic Pacing......Page 501 Key References......Page 502 Anatomy......Page 503 Sinus Node in Congenital Heart Malformations......Page 504 Basic Electrophysiology of the Sinus Node......Page 506 Currents......Page 507 Intrinsic Causes of Sinus Node Dysfunction......Page 508 Clinical Manifestations......Page 509 Noninvasive Testing......Page 512 Pacing Mode Choice......Page 513 Indications for Permanent Pacing......Page 514 Pacing Mode Selection......Page 515 Carotid Sinus Hypersensitivity and Carotid Sinus Syndrome......Page 516 Key References......Page 517 Anatomy and Blood Supply......Page 519 Congenital Complete Atrioventricular Block......Page 520 Idiopathic Bilateral Bundle Branch Fibrosis......Page 521 Miscellaneous......Page 522 The Compact Atrioventricular Node......Page 523 Bundle of His and Bundle Branches......Page 524 Pacing Mode Choice......Page 525 Indications for Permanent Pacing......Page 526 VVI and VVIR Pacing......Page 527 Key References......Page 528 Epidemiology......Page 529 Atrioventricular Node......Page 530 Atrioventricular Node–Bundle Junction......Page 531 Accessory Atrioventricular Node and Its Relationship to Pre-excitation and Atrioventricular Junctional Tachycardias......Page 532 Basic Electrophysiology......Page 533 Atrioventricular Re-entrant Tachycardias......Page 535 Clinical Presentation......Page 536 Onset......Page 537 Position of the P Wave......Page 538 P-Wave Morphology......Page 540 Pre-excited Tachycardias......Page 541 Patterns of Ventricular Pre-excitation......Page 542 Clinical Evaluation......Page 543 Differential Diagnosis of Supraventricular Tachycardia from the Electrocardiogram......Page 544 Tachycardia with Narrow QRS Complexes......Page 545 Tachycardia with Regular Wide QRS Complex......Page 546 Noninvasive Investigations......Page 547 Principles of Management......Page 548 Evidence-Based Therapy......Page 549 Prophylaxis of Recurrent Paroxysmal Supraventricular Tachycardias......Page 550 Sinoatrial Tachycardias......Page 553 Surgical Ablation of Atrioventricular Nodal Re-entrant Tachycardia......Page 554 Device Therapy......Page 555 References......Page 556 Associated Disease and Risk Factors......Page 557 Heart Failure......Page 558 Alcohol......Page 560 Genetic Factors......Page 561 Classification......Page 562 Progression of Atrial Fibrillation......Page 563 Stroke......Page 564 Hospitalizations......Page 566 Quality of Life......Page 567 Silent Atrial Fibrillation......Page 568 Mortality......Page 569 Interrelationship......Page 570 Right Atrium......Page 571 Left Atrium......Page 573 Atrial Septum and Inter-atrial Connections......Page 575 Counterclockwise Atrial Flutter......Page 576 Difficulties with Electrocardiogram Interpretation......Page 578 Historical Aspects......Page 579 Significance of Ectopic Activity......Page 581 Determinants of the Ventricular Response......Page 582 Etiology and Pattern......Page 583 12-Lead Electrocardiogram......Page 585 Holter Monitoring......Page 586 Blood Tests......Page 587 Pathogenesis of Stroke in Atrial Fibrillation......Page 589 Stroke......Page 593 Bleeding......Page 594 International Normalized Ratio Monitoring......Page 596 Dabigatran......Page 598 Rhythm Control Versus Rate Control Strategies......Page 600 Electrical Cardioversion......Page 603 Anticoagulation During Cardioversion......Page 604 Pill-in-the-Pocket Approach......Page 605 Ibutilide......Page 606 Vernakalant......Page 607 β-Blockers......Page 610 Sotalol......Page 611 Amiodarone......Page 612 Dronedarone......Page 613 Where to Initiate Antiarrhythmic Drug Therapy......Page 614 Constituents of Rate Control......Page 615 Atrioventricular Node Ablation and Pacing......Page 616 Pulmonary Vein Ablation......Page 617 References......Page 620 Key References......Page 621 Epidemiology......Page 623 Nonsustained Ventricular Tachycardia Associated with a “Normal” Heart......Page 624 Cardiomyopathies and Other Conditions......Page 625 Trans-thoracic Echocardiography......Page 627 Signal-Averaged Electrocardiography......Page 628 Cardiac Magnetic Resonance Imaging......Page 629 Apparently Healthy Individuals......Page 630 Ischemic Heart Disease......Page 631 Cardiomyopathies......Page 632 Nonsustained Ventricular Tachycardia in Inherited Channelopathies......Page 634 Nonsustained Ventricular Tachycardia in Dilated Cardiomyopathy......Page 635 Nonsustained Ventricular Tachycardia in Coronary Artery Disease......Page 636 References......Page 638 Etiology and Pathologic Anatomy......Page 639 Primary Electrical Diseases......Page 640 Idiopathic Ventricular Tachycardia Caused by Congenital Abnormalities of the Conduction System......Page 641 Ischemia and Ventricular Tachyarrhythmias......Page 642 The Substrate for Re-entrant Tachycardia in the Human Heart with a Healed Infarct......Page 643 Role of Cardiac Remodeling in Ventricular Tachycardia......Page 644 Clinical Presentation......Page 645 Electrocardiographic Diagnosis of Ventricular Tachycardia......Page 646 Electrocardiographic Localization of the Origin of Ventricular Tachycardia......Page 648 Confirming the Diagnosis......Page 652 Bundle Branch Re-entry Ventricular Tachycardia......Page 653 Catheter Mapping of Ventricular Tachycardia......Page 655 Acute Treatment of Sustained Ventricular Tachycardia......Page 657 Impact of Clinical Trials......Page 659 Impact of Catheter Ablation Techniques......Page 661 Key References......Page 662 Epidemiology......Page 664 Mechanisms and Clinical Presentation......Page 665 Right Ventricular Outflow Tract......Page 666 Left Ventricular Outflow Tract......Page 667 Clinical Electrophysiology......Page 671 Principles of Practice......Page 673 Evidence-Based Therapy......Page 674 Management of Idiopathic Ventricular Tachycardia and Ventricular Fibrillation......Page 675 References......Page 677 Sudden Cardiac Death in Athletes or the Young and Healthy......Page 678 Ventricular Fibrillation and Population Considerations......Page 679 Dynamics of Re-entrant Ventricular Fibrillation......Page 681 Nature of Fibrillatory Wavefronts......Page 682 Restitution Hypothesis......Page 684 Autonomic Modulation of Ventricular Fibrillation......Page 685 Long QT Syndrome......Page 686 Brugada Syndrome......Page 687 Arrhythmogenic Right Ventricular Cardiomyopathy......Page 688 Evaluation of Transient or Reversible Causes......Page 690 Identification of Structural Heart Disease......Page 691 Documentation of the Mechanism of Ventricular Fibrillation......Page 692 Electrophysiological Characteristics Associated with Induction of Ventricular Fibrillation......Page 693 Prognosis and Clinical Relevance......Page 695 Drug Therapy in Acute Management of Ventricular Fibrillation......Page 696 β-Blockers......Page 697 New Class III Drugs......Page 698 Revascularization......Page 699 Implantable Cardioverter-Defibrillator......Page 700 Primary Prevention of Sudden Cardiac Death......Page 701 Key References......Page 702 References......Page 703 Epidemiology......Page 704 Disease States Leading to Sudden Cardiac Death......Page 705 Hypertrophic Cardiomyopathy......Page 706 Long QT Syndrome......Page 707 Brugada Syndrome......Page 708 Early Repolarization......Page 709 Risk Stratification for Sudden Cardiac Death......Page 710 Interventions Targeting Sudden Cardiac Death......Page 712 Community-Based Resuscitation......Page 713 Key References......Page 714 Convulsions and Syncope......Page 715 Reflex-Mediated Syncope......Page 716 History and Physical Examination......Page 717 Tilt-Table Testing......Page 718 Reflex Neurally Mediated Vasovagal Syncope......Page 719 Fludrocortisone......Page 720 Physical Diagnosis......Page 721 Emergency Department Risk Rules......Page 722 Syncope Management Units......Page 723 References......Page 724 Case 1......Page 725 Repolarization Abnormalities......Page 727 Case 2......Page 728 Case 3......Page 730 Case 4......Page 732 Arrhythmogenic Right Ventricular Dysplasia......Page 733 Case 5......Page 734 Atrioventricular Block......Page 735 Reference......Page 736 Q-T Interval and QT Dispersion......Page 738 Atrial Fibrillation......Page 739 Congenital Long QT Syndrome......Page 741 Sudden Cardiac Death......Page 742 Brugada Syndrome......Page 743 Implantable Cardioverter-Defibrillators: Use and Outcomes......Page 744 Cardiac Resynchronization Therapy: Use and Outcomes......Page 747 Key References......Page 748 Reference......Page 749 Electrical Voltage Criteria for Cardiac Enlargement......Page 750 Ethnicity......Page 752 Sporting Discipline......Page 753 Prolonged Q-T Interval......Page 754 Arrhythmias in the Athlete......Page 755 Bradyarrhythmias......Page 756 Atrial Fibrillation and Atrial Flutter......Page 758 Wolff-Parkinson-White Syndrome......Page 759 Ventricular Fibrillation and Athletes with Implantable Cardioverter Defibrillators......Page 760 Reference......Page 761 Cellular Mechanisms of Torsades De Pointes Ventricular Tachycardia......Page 763 Electrocardiographic Harbingers of Torsades de Pointes Ventricular Tachycardia......Page 767 Cardiac Arrhythmia Suppression Trials......Page 769 Incessant Ventricular Tachycardia Secondary to Sodium Channel–Blocking Drugs......Page 770 Induced Proarrhythmia and Device Therapy......Page 771 Antiarrhythmic Drug Effects on Defibrillation Thresholds......Page 773 Key References......Page 774 Normal Physiological Effects of Exercise......Page 775 Triggered Activity......Page 776 Ischemic Heart disease......Page 777 Left Ventricular Dysfunction......Page 779 Catecholaminergic Polymorphic Ventricular Tachycardia......Page 780 Long QT Syndrome......Page 781 Outflow Tract Ventricular Tachycardia......Page 783 Verapamil-Sensitive Ventricular Tachycardia......Page 784 Exercise-Induced Supraventricular Arrhythmias......Page 785 References......Page 786 KVLQT1 or KCNQ1: The LQT1 Gene......Page 787 SCN5A: The LQT3 Gene......Page 788 minK or KCNE1: The LQT5 Gene......Page 789 MiRP1 or KCNE2: The LQT6 Gene......Page 790 Electrocardiographic and Biophysical Features......Page 791 Clinical Aspects of Brugada Syndrome......Page 792 Risk Stratification in Brugada Syndrome......Page 793 Cardiac Conduction Disease......Page 794 Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy......Page 796 References......Page 798 Key References......Page 799 Conventional Risk Markers......Page 800 Pharmacologic Treatment......Page 801 Implantable Defibrillators......Page 802 Atrial Fibrillation......Page 803 Atrial Fibrillation–Related Mortality and Morbidity......Page 804 Clinical Variability......Page 805 Acute Deterioration......Page 806 Surgical and Catheter-Based Therapies......Page 807 References......Page 809 Atrial Fibrillation......Page 810 Pharmacologic Therapy: Antiarrhythmics......Page 811 Nonpharmacologic Therapy......Page 812 References......Page 813 Mechanisms......Page 814 Reperfusion Arrhythmias......Page 815 Ventricular Tachycardia, Polymorphic Ventricular Tachycardia, and Ventricular Fibrillation......Page 816 Bradyarrhythmias in the Setting of Acute Ischemia......Page 818 Arrhythmias in Chronic Coronary Artery Disease......Page 819 Premature Ventricular Contractions and Nonsustained Ventricular Tachycardia......Page 820 Exercise-Induced Arrhythmias......Page 821 Key References......Page 822 Genetics and Other Causes of Dilated Cardiomyopathy......Page 824 Heart Rate Variability, Baroreflex Sensitivity, and Heart Rate Turbulence......Page 825 Antiadrenergic Therapy......Page 826 Implantable Cardioverter-Defibrillator Therapy......Page 828 Biventricular Pacing......Page 829 Conclusion......Page 830 Key References......Page 831 Left Ventricular Involvement......Page 833 Genetics......Page 834 Nondesmosomal ARVC......Page 835 Clinical Features......Page 836 Electrocardiographic Features of Arrhythmogenic Right Ventricular Cardiomyopathy......Page 837 Electroanatomic Mapping......Page 838 Disease Management......Page 839 Management of Heart Failure......Page 840 Key References......Page 841 Prognosis......Page 842 Prophylactic Therapy with Pharmacologic Agents......Page 843 Prophylactic Therapy with Pacing......Page 844 Rate Control Treatment for Postoperative Atrial Fibrillation......Page 845 Anticoagulation for Postoperative Atrial Fibrillation......Page 846 Incidence and Prognosis......Page 847 Postoperative Risk Stratification and Treatment......Page 848 Risk Stratification and Management Strategies......Page 849 Key References......Page 850 Electrophysiological Effects of Hypokalemia......Page 851 Arrhythmogenic Potential and Clinical Implications of Hypokalemia......Page 852 Electrophysiological Effects of Hyperkalemia......Page 853 Potassium and Myocardial Ischemia......Page 856 Electrocardiographic Manifestations of Hypocalcemia......Page 857 Magnesium......Page 858 Lithium......Page 859 Key References......Page 860 SCN5A (LQT3)......Page 861 Clinical Presentation......Page 862 Echocardiographic Abnormalities......Page 863 Molecular Genetics and Risk Stratification......Page 864 Clinical Diagnosis......Page 865 β-Blockers......Page 866 Gene-Specific Therapy and Management......Page 867 Key References......Page 868 Genetics of Brugada Syndrome......Page 870 Clinical Manifestations of Brugada Syndrome......Page 872 Sex Differences......Page 873 Children......Page 874 Electrocardiogram and Modulating Factors......Page 875 Diagnostic Tools: Drug Challenge......Page 876 Prognosis and Risk Stratification......Page 879 Implantable Cardioverter Defibrillator......Page 881 Approach to Patients with Suspected Brugada Syndrome: Family Screening......Page 883 Key References......Page 886 Molecular Genetics......Page 887 Prognosis......Page 888 Key References......Page 889 Genetic Bases......Page 890 Summary