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.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
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.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
This document discusses cardiac anatomy and positioning of electrophysiology catheters from the perspective of interventional electrophysiologists. It describes the orientation of the heart, components of the cardiac conduction system, relationships between surface ECGs and intracardiac recordings, and catheter placement for electrophysiology studies. Diagrams show views of the heart from different angles and depictions of the positions of the His bundle, coronary sinus, and other catheters.
This document discusses electrical testing of pacemakers and pacemaker complications. It describes the components of a pacemaker including the battery, pacing impedance, pulse generator, and modes and mode switching. It then discusses testing various aspects of the pulse generator including output circuit, sensing circuit, timing circuit, and rate responsive pacing. Finally, it briefly outlines some common pacemaker complications such as pocket complications, lead issues, infections, and device malfunctions.
Pacemaker timing & advanced dual chamber conceptsSunil Reddy D
This document discusses various concepts related to pacemaker timing and dual chamber pacing modes. It covers topics such as single chamber timing parameters like lower rate interval, refractory period and blanking period. It then discusses dual chamber timing concepts including the four main faces of DDD pacing, parameters like AV and VA intervals, and upper tracking rate behavior. Rate responsive pacing in modes like VVIR and AAIR is also summarized. Various pacing artifacts and issues like noise sensing, T-wave oversensing and interference are explained through diagrams of pacemaker timing cycles.
The patient presented with an irregular pulse. An ECG showed evidence of two foci of atrial depolarization, indicating both right and left atrial premature depolarizations (APDs). The ECG pattern is known as atrioventricular bigeminy. The APDs are arising from a single irritable focus in the atria, which can be caused by various stimulants, toxins, or medical conditions. While usually benign, atrial bigeminy can potentially lead to more serious arrhythmias. Management involves correcting any underlying predisposing factors.
Electrophysiologic studies use pacing techniques like programmed electrical stimulation (PES) to evaluate cardiac properties. PES involves pacing the heart with drive trains and extrastimuli to measure refractory periods, conduction dynamics, and induce arrhythmias. Pacing can be unipolar or bipolar, and incremental, decremental, or with extrastimuli. Refractory periods like the effective refractory period and relative refractory period are measured using premature extrastimuli during pacing. These techniques provide important information about normal cardiac function and arrhythmia mechanisms.
Session 3 - Microcatheters, new developmentsEuro CTO Club
This document discusses recent developments in microcatheter technology, including new microcatheters from Asahi such as the Corsair Pro XS. It describes design features of various microcatheters like tapered shafts, braided coils, and tip configurations. New devices aim to improve trackability, torque response, and crossability. While microcatheter technology facilitates endovascular techniques, the document notes that further coordinated evolution is still needed between microcatheters and guidewires.
This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
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 the Fontan procedure for univentricular heart defects. It covers the evolution of the Fontan concept from the original atriopulmonary connection to lateral tunnel and extracardiac conduit techniques. It also discusses indications for Fontan, complications such as arrhythmias and ventricular dysfunction, and strategies to optimize outcomes like fenestration.
This document discusses cardiac anatomy and positioning of electrophysiology catheters from the perspective of interventional electrophysiologists. It describes the orientation of the heart, components of the cardiac conduction system, relationships between surface ECGs and intracardiac recordings, and catheter placement for electrophysiology studies. Diagrams show views of the heart from different angles and depictions of the positions of the His bundle, coronary sinus, and other catheters.
This document discusses electrical testing of pacemakers and pacemaker complications. It describes the components of a pacemaker including the battery, pacing impedance, pulse generator, and modes and mode switching. It then discusses testing various aspects of the pulse generator including output circuit, sensing circuit, timing circuit, and rate responsive pacing. Finally, it briefly outlines some common pacemaker complications such as pocket complications, lead issues, infections, and device malfunctions.
Pacemaker timing & advanced dual chamber conceptsSunil Reddy D
This document discusses various concepts related to pacemaker timing and dual chamber pacing modes. It covers topics such as single chamber timing parameters like lower rate interval, refractory period and blanking period. It then discusses dual chamber timing concepts including the four main faces of DDD pacing, parameters like AV and VA intervals, and upper tracking rate behavior. Rate responsive pacing in modes like VVIR and AAIR is also summarized. Various pacing artifacts and issues like noise sensing, T-wave oversensing and interference are explained through diagrams of pacemaker timing cycles.
The patient presented with an irregular pulse. An ECG showed evidence of two foci of atrial depolarization, indicating both right and left atrial premature depolarizations (APDs). The ECG pattern is known as atrioventricular bigeminy. The APDs are arising from a single irritable focus in the atria, which can be caused by various stimulants, toxins, or medical conditions. While usually benign, atrial bigeminy can potentially lead to more serious arrhythmias. Management involves correcting any underlying predisposing factors.
Electrophysiologic studies use pacing techniques like programmed electrical stimulation (PES) to evaluate cardiac properties. PES involves pacing the heart with drive trains and extrastimuli to measure refractory periods, conduction dynamics, and induce arrhythmias. Pacing can be unipolar or bipolar, and incremental, decremental, or with extrastimuli. Refractory periods like the effective refractory period and relative refractory period are measured using premature extrastimuli during pacing. These techniques provide important information about normal cardiac function and arrhythmia mechanisms.
Session 3 - Microcatheters, new developmentsEuro CTO Club
This document discusses recent developments in microcatheter technology, including new microcatheters from Asahi such as the Corsair Pro XS. It describes design features of various microcatheters like tapered shafts, braided coils, and tip configurations. New devices aim to improve trackability, torque response, and crossability. While microcatheter technology facilitates endovascular techniques, the document notes that further coordinated evolution is still needed between microcatheters and guidewires.
This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
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 the Fontan procedure for univentricular heart defects. It covers the evolution of the Fontan concept from the original atriopulmonary connection to lateral tunnel and extracardiac conduit techniques. It also discusses indications for Fontan, complications such as arrhythmias and ventricular dysfunction, and strategies to optimize outcomes like fenestration.
8. SOL PARASTERNAL UZUN-AKS (PLAX)
Prob sternum solu 3-4. interkostal aralıkta
Daha çok sol kalbi gösterir, sağ ventrikül
görülür sağ atrium gözükmez.
Diyastolde LA çap <4.5cm ,LV çap < 6 cm
dir.
LVSol duvarı >10mm ise LV hipertrofisi
vardır.
RV duvarı > 5mm ise RV hipertrofisidir.
26. M modu kullanarak mitral valv açılımına
bakılır
Epoint septal seperasyon (EPSS):
Normalde < 7mm dir. Eğer > 1cm azalmış
kontraktilite ve düşük ejeksiyonu
gösterir.
Mitral valv anomalisi varsa EPSS sistolik
disfonksiyonu göstermez.
27. SOL PARASTERNAL UZUN AKS- m
mode
Fraksiyonel kısalma:
EDD - ESD / EDD X100
> 30 %-45 % normal EF
33. SOL PARASTERNAL UZUN AX-
TAMPONAD
Sağ kalp kompresyonu olmalı.
Paradoksik sağ ventrikül duvarı içeri
gider
Diastolik kollapsı göstermek için m mode
kullan.
Paralize hastada IVC da diyastolik
kollaps
34.
35.
36.
37. SAĞ VENTRIKÜLER INFLOW
Sağ kalbin bölümlerini ,triküspid kapagı
gösterir.
PLAX pozisyonununda transduceri sağ
kalçaya çevir,index markır aynı yerde
40. SAĞ VENTRİKÜL OUTFLOW
Esasen pulmoner arter ve pulmoner kapağı
gösterir
Transduceri sol omza doğru çevir
Perikardiyal efüzyon, tamponat şüphesinde
kullan
54. APIKAL DÖRT-ODAK(A4C)
lateral dekübit pozisyonunda ,probun index
markırı saat 9’ü gösterecek
Apikal pencere: Kalpteki 4 boşluğun çapını ve
hareketini gösterir.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74. Kalbin sağını görmek için en uygun
penceredir.
IVC görüntüleme:Önce sağ atriumu gör
ve daha aşağı inerek IVC ‘a
ulaş.Aorta;IVC’a göre daha kalın duvarlı
ve pulsatil
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95. Prob:Hastanın sağı =>saat yönü
Midesofagial=apikal aks
Transgastrik=parasternal aks
Üst esofagus:20-30cm büyük damar proba
enyakın (apex)
Mid esofagus:30-40cm sol atrium proba en
yakın (apex)
Transgastrik:40-50cm sol ventrikülproba en
yakın