The Essential Visual Guide to Basic Cardiac Electrophysiology

Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows fulfills the need of allied health personnel and new fellows for a practical, hands-on pictorial guide that clearly illustrates the essential concepts of clinical cardiac electrophysiology. More than 70 high-quality tracings, diagrams, fluoroscopic images, and electroanatomic maps accompanied by detailed discussions of each image offer a fundamental understanding of cardiac electrophysiology equipment, principles, and procedures:

• Catheter placement, hardware connections, and intracardiac signals
• Normal electrogram sequences associated with sinus rhythm
• Methodologies used to uncover the mechanisms of common clinical tachycardias

In addition, commentaries provided throughout the book introduce more advanced principles for readers who want to delve further into the EP study.

Authored by a team of experts, Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows is an invaluable resource for a complex technology, providing superb guidance in acclimating new trainees and personnel to the EP laboratory and empowering them with the knowledge and skills needed to practice clinical electrophysiology.

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From the Foreword: “Paul Purves is a unique EP technologist who has coupled his technical expertise and knowledge of EP with a passion for understanding the underpinnings of the study, and teaches what he knows to other technologists, nurses, and indeed physicians. He is a gifted teacher who has coordinated and assembled the “collective wisdom” of our team into this reader-friendly and unique visual guide to performing and understanding the arrhythmia study. It surpasses the needs of a simple introduction and will be useful to all levels of trainee who want to understand what is really “going on” and move to the next level.”

-George J. Klein, MD, FRCP(C)

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From the Preface: Cardiac Electrophysiology: A Visual Guide for Nurses, Techs, and Fellows is just that—a visual guide to electrophysiology. Written for allied health personnel, including nurses, technologists, industry personnel, and new EP fellows, this book presents the most important aspects of the EP study using pertinent images accompanied by detailed discussions of the principles involved. Topics covered include hardware connections (“connectology”), catheter placement, intracardiac signals, normal electrogram sequences associated with sinus rhythm, and—given an initial diagnosis of paroxysmal supraventricular tachycardia—the methodology we employ to uncover the mechanism of the tachycardia.

- Paul D. Purves BSc, RCVT, CEPS

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Cardiac Electrophysiology : A Visual Guide for Nurses, Techs, and Fellows is also available as a hardcover (ISBN: 978-1-935395-49-2, $99.00)

About the Authors
Foreword
Preface
Acknowledgments
Abbreviations
Glossary
Before We Begin an SVT Study

Unit 1: The Basics

1. Catheter Placement

2. The Computer System

3. Signal Processing

4. Signal Sequence in Sinus Rhythm

5. Basic Conduction Intervals

6. Tissue Conduction

7. Supraventricular Tachycardia Diagnostic Study
- Incremental Ventricular Pacing
- Retrograde Wenckebach
- Ventricular Extra-stimulus Pacing
- Retrograde V-A Block
- Ventricular Effective Refractory Period
- Atrial Extra-stimulus Pacing
- Atrioventricular Block
- Atrial Effective Refractory Period
- Incremental Atrial Pacing

Unit 2: Common Clinical Tachycardias

8. AV Nodal Reentrant Tachycardia
- Typical AVNRT Pathways
- Jump
- AV Nodal Echo
- Onset of Tachycardia

9. Atrioventricular Reentrant Tachycardia
- Wolff-Parkinson-White
- Accessory Pathway Locations
- Accessory Pathway Echo
- AVRT Initiation
- Effective Refractory Period of an Accessory Pathway
- Ablation of Accessory Pathways

10. Focal Atrial Tachycardia

11. Atrial Flutter
- Typical Catheter Placement
- Cavo-tricuspid Isthmus Ablation
- Split A’s

12. Atrial Fibrillation
- Basic Diagnosis
- Near-Field Versus Far-Field Electrograms
- Entrance Block
- Exit Block
- Pulmonary Vein Fibrillation
- Independent Pulmonary Vein Activity

13. Ventricular Tachycardia
- Basic Diagnosis
- Activation Mapping
- Pace Mapping
- Entrainment Mapping
- Scar-dependent Ventricular Tachycardia
- Voltage Mapping
- Substrate Modification

Unit 3: Advanced Concepts

14. Mechanisms of Tachycardia

15. Bipolar Versus Unipolar Electrograms

16. Latency

17. Gap Phenomenon

18. PVCs into AVNRT

19. PVCs into AVRT

20. Entrainment Pacing

21. Para-Hisian Pacing

Unit 4: Advanced Tracings

22. An Irregular Rhythm

23. Why Does the A-H Interval Vary?

24.Distinguishing A from V

25. An Unexpected QRS

26. Unusual Onset of Tachycardia

27. Diagnostic Dilemma

28. A Dangling Potential

29. After Pulmonary Vein Ablation

Paul D. Purves, BSc, RCVT, CEPS; Senior Electrophysiology Technologist , Cardiac Investigation Unit, London Health Sciences Centre, London, Ontario, Canada

George J. Klein, MD, FRCP(C); Professor of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada

Peter Leong-Sit, MD, FRCP(C); Assistant Professor of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada

Raymond Yee, MD, FRCP(C); Professor of Medicine, Director, Arrhythmia Service, Division of Cardiology, University of Western Ontario, London, Ontario, Canada

Allan C. Skanes, MD, FRCP(C); Associate Professor of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada

Lorne J. Gula, MD, FRCP(C); Associate Professor of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada

Andrew D. Krahn, MD, FRCP(C); Professor of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada