This document describes equipment and settings used in electrophysiology (EP) studies. It lists various pieces of equipment including fluoroscopy units, recording systems, cardiac stimulators, ablation generators, 3D mapping systems, and intracardiac ultrasound units. It provides details on catheter types, positions, and settings for standard EP studies including studies of arrhythmias like supraventricular tachycardia. It also explains pacing protocols and techniques used in EP studies to evaluate conduction properties and induce arrhythmias.
植入性心臟電子儀器地基本原理與設定
This document discusses the basic principles and settings of implantable cardiac electronic devices. It covers topics such as voltage, current, impedance, pacing modes, detection zones, cardioversion, defibrillation, anti-tachycardia pacing, and challenges in reducing inappropriate therapies. Key points include an overview of Ohm's Law and its application to pacemakers, examples of different pacing modes like VVI and DDD, considerations for programming detection zones and therapy levels in ICDs, and the use of ATP to terminate VT episodes.
How to perform and interpret entrainment pacing BasicsBenjamin Jacob
This document provides information on entrainment pacing, including:
1) Entrainment pacing involves accelerating the rate of a tachycardia to a faster pacing rate and resuming the intrinsic tachycardia rate when pacing stops. It allows study of arrhythmia origins and pathways.
2) For entrainment to occur, there must be a gap in excitability during the tachycardia for a pacing stimulus to be delivered without terminating the arrhythmia.
3) Entrainment can be identified by constant fusion of paced and tachycardia complexes except the last paced beat, or progressive fusion at different pacing rates showing changing morphology from tachycardia to
This document describes equipment and settings used in electrophysiology (EP) studies. It lists various pieces of equipment including fluoroscopy units, recording systems, cardiac stimulators, ablation generators, 3D mapping systems, and intracardiac ultrasound units. It provides details on catheter types, positions, and settings for standard EP studies including studies of arrhythmias like supraventricular tachycardia. It also explains pacing protocols and techniques used in EP studies to evaluate conduction properties and induce arrhythmias.
植入性心臟電子儀器地基本原理與設定
This document discusses the basic principles and settings of implantable cardiac electronic devices. It covers topics such as voltage, current, impedance, pacing modes, detection zones, cardioversion, defibrillation, anti-tachycardia pacing, and challenges in reducing inappropriate therapies. Key points include an overview of Ohm's Law and its application to pacemakers, examples of different pacing modes like VVI and DDD, considerations for programming detection zones and therapy levels in ICDs, and the use of ATP to terminate VT episodes.
How to perform and interpret entrainment pacing BasicsBenjamin Jacob
This document provides information on entrainment pacing, including:
1) Entrainment pacing involves accelerating the rate of a tachycardia to a faster pacing rate and resuming the intrinsic tachycardia rate when pacing stops. It allows study of arrhythmia origins and pathways.
2) For entrainment to occur, there must be a gap in excitability during the tachycardia for a pacing stimulus to be delivered without terminating the arrhythmia.
3) Entrainment can be identified by constant fusion of paced and tachycardia complexes except the last paced beat, or progressive fusion at different pacing rates showing changing morphology from tachycardia to
1. The document discusses the basic principles and settings of cardiovascular implantable electronic devices (CIEDs), including pacemakers.
2. It covers topics such as pacing and sensing functions, parameters like lower and upper rates, pacing modes, and refractory and blanking periods.
3. The optimal settings aim to ensure cardiac pacing meets patients' needs while avoiding unnecessary pacing and maximizing battery longevity.
ECG localization of accessory pathways slideshareCardiology
This presentation is simplified view of accessory pathways in heart and their localization with help of algorithms and ECG examples. Try to read this PPT in power point to see full effects and animations.
The document provides an overview of pacemaker components, physiology, and programming. It discusses the basic hardware components of pacemakers including the pulse generator, leads, and electrodes. It then covers pacing and sensing principles such as capture, impedance, and sensing thresholds. The remainder summarizes various pacing modes and algorithms for managing arrhythmias, rate response, and minimizing ventricular pacing.
The document discusses intracardiac electrograms (IEGMs) and catheter positions used in electrophysiology studies. It provides information on unipolar and bipolar recordings, including how bipolar signals are constructed and how they approximate the rate of change of the cardiac wavefront. The document also discusses how the direction of cardiac activation influences the electrocardiogram and how unipolar and bipolar recordings compare. Key factors that influence electrogram morphology such as conduction speed, myocardial mass, and tissue characteristics are also reviewed.
This document discusses the history and evidence for cardiac resynchronization therapy (CRT). It notes that approximately 25% of heart failure patients have intraventricular conduction delays that cause dyssynchronous contraction. CRT aims to resynchronize contraction by pacing both ventricles simultaneously. Randomized controlled trials found CRT improves symptoms, exercise capacity, and survival in patients with low ejection fraction and wide QRS. Guidelines recommend CRT for class III/IV heart failure patients with LBBB morphology and QRS >120ms. Some evidence also supports benefit in milder heart failure. Response can vary and not all patients respond equally.
The document discusses cardiac pacing, including defining a pacemaker, describing pacemaker design and functions, types of pacing including single chamber and dual chamber, nursing considerations for patients with pacemakers such as monitoring for complications and providing education on activity restrictions and precautions regarding electromagnetic interference.
This document provides guidance on managing patients who do not respond to cardiac resynchronization therapy (CRT). It discusses that while CRT has been shown to reduce heart failure hospitalizations and mortality, 30-35% of patients do not adequately respond. The document then reviews factors that determine CRT response, including electrical and mechanical dyssynchrony. It also discusses different criteria used to define response and notes lack of agreement. Potential reasons for non-response are explored, including lead placement and individual patient factors. The document concludes by recommending approaches for evaluating and managing CRT non-responders.
This document discusses indications for cardiac implantable electronic devices (CIEDs) such as pacemakers, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) according to guidelines. It covers classifications of bradyarrhythmias and indications for pacing in various conditions such as persistent bradycardia. Indications for CRT and ICDs are also outlined based on left ventricular ejection fraction, heart failure class, and other factors. Current health insurance reimbursement policies in Taiwan for these devices are also summarized.
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
- Catheter ablation is an effective treatment for ventricular tachycardia (VT) in both structurally normal hearts and those with structural heart disease.
- For normal hearts, activation mapping and pace mapping are used to identify the origin of VT, with typical sites including the right ventricular outflow tract. Success rates are high with few complications.
- In structural heart disease, substrate mapping is used to identify scar tissue which hosts reentrant VT circuits. Entrainment mapping during VT can confirm circuits. Ablation targets abnormal potentials in scar or the scar border zone. Integration of cardiac imaging helps define substrate. Long-term outcomes after ablation are improved compared to antiarrhythmic drugs alone.
- The document discusses the history and evolution of implantable cardioverter defibrillators (ICDs). Key points include:
- ICDs were first conceived in 1966 and the first human implant was in 1980.
- ICDs function by sensing cardiac rhythms, detecting arrhythmias like ventricular tachycardia or fibrillation, and delivering electrical therapies like anti-tachycardia pacing or shocks to treat them.
- Important aspects of ICD function include sensing, detection algorithms, therapy delivery, and troubleshooting problems. Studies show programming ICDs more conservatively with longer detection intervals and fewer unnecessary therapies can reduce inappropriate shocks and mortality.
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
This document discusses cardiac resynchronization therapy (CRT) for heart failure patients. Some key points:
- CRT improves symptoms, exercise tolerance, quality of life and reduces mortality for selected heart failure patients.
- Non-response to CRT remains a problem, occurring in 30-45% of patients.
- Patient selection factors like QRS duration, bundle branch block pattern and degree of ventricular dyssynchrony impact response.
- Optimal lead placement and device programming are important for response. Follow-up optimization of atrioventricular and interventricular delays can improve outcomes.
1) Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia. It involves a reentrant circuit utilizing the fast and slow pathways within the AV node.
2) There are typical and atypical forms of AVNRT depending on the direction of conduction through the fast and slow pathways. In typical AVNRT, antegrade conduction is down the slow pathway and retrograde up the fast pathway. In atypical AVNRT the directions are reversed.
3) Ablation of the slow pathway is an effective treatment for AVNRT and can be performed without damaging the AV node since only a portion of the circuit
This document provides an overview of pacemaker basics and timing cycles. It discusses the components of a pacemaker circuit including the implantable pulse generator containing a battery and circuitry. It describes pacemaker leads which deliver electrical impulses from the pulse generator to the heart. The document outlines characteristics of pacemaker leads including fixation mechanisms, insulation materials, and polarity. It also discusses concepts such as stimulation threshold, polarization, impedance, and how these factors interact based on Ohm's law relationships.
The document discusses various electrocardiogram (ECG) criteria for differentiating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy presenting with a wide QRS complex tachycardia. It outlines criteria from Sandler and Marriott (1965), Wellens (1978), Kindwall (1988), Brugada (1991), Vereckei (2008) and Pava (2010). Key criteria that favor VT include QRS duration >140ms, extreme left axis, AV dissociation, monophasic R wave in V1, R/S ratio <1 in V6, and notching of the S wave in V1.
Cardiac resynchronization therapy (CRT) uses electrical pacing of both ventricles to coordinate their contractions and improve heart function in patients with heart failure. It is recommended for patients with left ventricular ejection fraction below 35%, prolonged QRS duration over 150ms, and evidence of electrical or mechanical dyssynchrony. CRT works by pacing both ventricles simultaneously to resynchronize their contractions, improving heart pumping ability and reducing symptoms. About 30% of patients do not respond adequately, often due to factors like lack of sufficient dyssynchrony, lead placement issues, or scar tissue in the ventricles.
The document provides an overview of basic ICD treatment and concepts, including the evolution of ICDs, device components, automated functions for sensing, detecting arrhythmias, and discriminating supraventricular tachycardias. Key aspects of sensing, detection zones, therapy types, and programming options are discussed at a high level.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
This document discusses the implications of 3D mapping in electrophysiology procedures. It provides an overview of common arrhythmias treated with catheter ablation such as WPW syndrome, AVNRT, atrial flutter, and atrial fibrillation. It describes the typical sequence of an EP study and ablation procedure. It also discusses classification of tachycardias as focal or macroreentrant, and different reentry patterns. The document highlights the development of 3D mapping technologies including contact and non-contact mapping systems, and their ability to create 3D geometry and electroanatomic maps with integration of CT/MRI images. It reviews studies validating the reduction of fluoroscopy time with 3D mapping approaches.
1. The document discusses the basic principles and settings of cardiovascular implantable electronic devices (CIEDs), including pacemakers.
2. It covers topics such as pacing and sensing functions, parameters like lower and upper rates, pacing modes, and refractory and blanking periods.
3. The optimal settings aim to ensure cardiac pacing meets patients' needs while avoiding unnecessary pacing and maximizing battery longevity.
ECG localization of accessory pathways slideshareCardiology
This presentation is simplified view of accessory pathways in heart and their localization with help of algorithms and ECG examples. Try to read this PPT in power point to see full effects and animations.
The document provides an overview of pacemaker components, physiology, and programming. It discusses the basic hardware components of pacemakers including the pulse generator, leads, and electrodes. It then covers pacing and sensing principles such as capture, impedance, and sensing thresholds. The remainder summarizes various pacing modes and algorithms for managing arrhythmias, rate response, and minimizing ventricular pacing.
The document discusses intracardiac electrograms (IEGMs) and catheter positions used in electrophysiology studies. It provides information on unipolar and bipolar recordings, including how bipolar signals are constructed and how they approximate the rate of change of the cardiac wavefront. The document also discusses how the direction of cardiac activation influences the electrocardiogram and how unipolar and bipolar recordings compare. Key factors that influence electrogram morphology such as conduction speed, myocardial mass, and tissue characteristics are also reviewed.
This document discusses the history and evidence for cardiac resynchronization therapy (CRT). It notes that approximately 25% of heart failure patients have intraventricular conduction delays that cause dyssynchronous contraction. CRT aims to resynchronize contraction by pacing both ventricles simultaneously. Randomized controlled trials found CRT improves symptoms, exercise capacity, and survival in patients with low ejection fraction and wide QRS. Guidelines recommend CRT for class III/IV heart failure patients with LBBB morphology and QRS >120ms. Some evidence also supports benefit in milder heart failure. Response can vary and not all patients respond equally.
The document discusses cardiac pacing, including defining a pacemaker, describing pacemaker design and functions, types of pacing including single chamber and dual chamber, nursing considerations for patients with pacemakers such as monitoring for complications and providing education on activity restrictions and precautions regarding electromagnetic interference.
This document provides guidance on managing patients who do not respond to cardiac resynchronization therapy (CRT). It discusses that while CRT has been shown to reduce heart failure hospitalizations and mortality, 30-35% of patients do not adequately respond. The document then reviews factors that determine CRT response, including electrical and mechanical dyssynchrony. It also discusses different criteria used to define response and notes lack of agreement. Potential reasons for non-response are explored, including lead placement and individual patient factors. The document concludes by recommending approaches for evaluating and managing CRT non-responders.
This document discusses indications for cardiac implantable electronic devices (CIEDs) such as pacemakers, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) according to guidelines. It covers classifications of bradyarrhythmias and indications for pacing in various conditions such as persistent bradycardia. Indications for CRT and ICDs are also outlined based on left ventricular ejection fraction, heart failure class, and other factors. Current health insurance reimbursement policies in Taiwan for these devices are also summarized.
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
- Catheter ablation is an effective treatment for ventricular tachycardia (VT) in both structurally normal hearts and those with structural heart disease.
- For normal hearts, activation mapping and pace mapping are used to identify the origin of VT, with typical sites including the right ventricular outflow tract. Success rates are high with few complications.
- In structural heart disease, substrate mapping is used to identify scar tissue which hosts reentrant VT circuits. Entrainment mapping during VT can confirm circuits. Ablation targets abnormal potentials in scar or the scar border zone. Integration of cardiac imaging helps define substrate. Long-term outcomes after ablation are improved compared to antiarrhythmic drugs alone.
- The document discusses the history and evolution of implantable cardioverter defibrillators (ICDs). Key points include:
- ICDs were first conceived in 1966 and the first human implant was in 1980.
- ICDs function by sensing cardiac rhythms, detecting arrhythmias like ventricular tachycardia or fibrillation, and delivering electrical therapies like anti-tachycardia pacing or shocks to treat them.
- Important aspects of ICD function include sensing, detection algorithms, therapy delivery, and troubleshooting problems. Studies show programming ICDs more conservatively with longer detection intervals and fewer unnecessary therapies can reduce inappropriate shocks and mortality.
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
This document discusses cardiac resynchronization therapy (CRT) for heart failure patients. Some key points:
- CRT improves symptoms, exercise tolerance, quality of life and reduces mortality for selected heart failure patients.
- Non-response to CRT remains a problem, occurring in 30-45% of patients.
- Patient selection factors like QRS duration, bundle branch block pattern and degree of ventricular dyssynchrony impact response.
- Optimal lead placement and device programming are important for response. Follow-up optimization of atrioventricular and interventricular delays can improve outcomes.
1) Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia. It involves a reentrant circuit utilizing the fast and slow pathways within the AV node.
2) There are typical and atypical forms of AVNRT depending on the direction of conduction through the fast and slow pathways. In typical AVNRT, antegrade conduction is down the slow pathway and retrograde up the fast pathway. In atypical AVNRT the directions are reversed.
3) Ablation of the slow pathway is an effective treatment for AVNRT and can be performed without damaging the AV node since only a portion of the circuit
This document provides an overview of pacemaker basics and timing cycles. It discusses the components of a pacemaker circuit including the implantable pulse generator containing a battery and circuitry. It describes pacemaker leads which deliver electrical impulses from the pulse generator to the heart. The document outlines characteristics of pacemaker leads including fixation mechanisms, insulation materials, and polarity. It also discusses concepts such as stimulation threshold, polarization, impedance, and how these factors interact based on Ohm's law relationships.
The document discusses various electrocardiogram (ECG) criteria for differentiating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy presenting with a wide QRS complex tachycardia. It outlines criteria from Sandler and Marriott (1965), Wellens (1978), Kindwall (1988), Brugada (1991), Vereckei (2008) and Pava (2010). Key criteria that favor VT include QRS duration >140ms, extreme left axis, AV dissociation, monophasic R wave in V1, R/S ratio <1 in V6, and notching of the S wave in V1.
Cardiac resynchronization therapy (CRT) uses electrical pacing of both ventricles to coordinate their contractions and improve heart function in patients with heart failure. It is recommended for patients with left ventricular ejection fraction below 35%, prolonged QRS duration over 150ms, and evidence of electrical or mechanical dyssynchrony. CRT works by pacing both ventricles simultaneously to resynchronize their contractions, improving heart pumping ability and reducing symptoms. About 30% of patients do not respond adequately, often due to factors like lack of sufficient dyssynchrony, lead placement issues, or scar tissue in the ventricles.
The document provides an overview of basic ICD treatment and concepts, including the evolution of ICDs, device components, automated functions for sensing, detecting arrhythmias, and discriminating supraventricular tachycardias. Key aspects of sensing, detection zones, therapy types, and programming options are discussed at a high level.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
This document discusses the implications of 3D mapping in electrophysiology procedures. It provides an overview of common arrhythmias treated with catheter ablation such as WPW syndrome, AVNRT, atrial flutter, and atrial fibrillation. It describes the typical sequence of an EP study and ablation procedure. It also discusses classification of tachycardias as focal or macroreentrant, and different reentry patterns. The document highlights the development of 3D mapping technologies including contact and non-contact mapping systems, and their ability to create 3D geometry and electroanatomic maps with integration of CT/MRI images. It reviews studies validating the reduction of fluoroscopy time with 3D mapping approaches.
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.