Josephson Clinical Cardiac Electrophysiology

173

Chapter 6: Ectopic Rhythms and Premature Depolarizations ■

1

2

3

V1

A

A

A

A

A

A

A

HRA

V

V

V

Hr

V

H

Hr

A

A

A

A

A

A

A

HBE

400 msec

T

FIGURE 6.26 Premature complexes at multiple sites simultaneously. Leads 1, 2, 3, and V1 are shown with electrograms from the high right atrium (HRA) and His bundle (HBE). An atrial tachycardia is shown along with premature complexes from the right bundle branch (first wide complex), the ventricle (second wide complex), and the anterior division of the left bundle branch. Only the fourth QRS complex is conduct; note the prolonged A-H interval. The multiple levels of enhanced excitability should suggest digitalis intoxication. T, time line.

17. Josephson ME, Scharf DL, Kastor JA, Kitchen JG. Atrial endocardial activation in man. Electrode catheter technique of endocardial mapping. Am J Cardiol . 1977;39:972-981. 18. Waldo AL, Vitikainen KJ, Kaiser GA, Malm JR, Hoffman BF. The P wave and P-R interval. Effects of the site of origin of atrial depolarization. Circulation . 1970;42:653-671. 19. MacLean WA, Karp RB, Kouchoukos NT, James TN, Waldo AL. P waves during ectopic atrial rhythms in man: a study utilizing atrial pacing with fixed electrodes. Circulation . 1975;52:426-434. 20. Puech P. The P wave: correlation of surface and intra-atrial electrograms. Cardiovasc Clin . 1974;6:43-68. 21. Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation . 2000;101:1409-1417. 22. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med . 1998;339:659-666. 23. Akhtar M, Damato AN, Caracta AR, Batsford WP, Lau SH. The gap phenom ena during retrograde conduction in man. Circulation . 1974;49:811-817. 24. Santangeli P, Zado ES, Hutchinson MD, et al. Prevalence and distribution of focal triggers in persistent and long-standing persistent atrial fibrilla tion. Heart Rhythm . 2016;13:374-382. 25. Wit AL, Boyden PA. Triggered activity and atrial fibrillation. Heart Rhythm . 2007;4(3 suppl):S17-S23. 26. Wit AL, Cranefield PF. Triggered and automatic activity in the canine coronary sinus. Circ Res . 1977;41:434-445. 27. Rosen MR. The relationship of delayed afterdepolarizations to arrhyth mias in the intact heart. Pacing Clin Electrophysiol . 1983;6:1151-1156. 28. Johnson N, Danilo P Jr, Wit AL, Rosen MR. Characteristics of initiation and termination of catecholamine-induced triggered activity in atrial fibers of the coronary sinus. Circulation . 1986;74:1168-1179. 29. Batsford WP, Akhtar M, Caracta AR, Josephson ME, Seides SF, Damato AN. Effect of atrial stimulation site on the electrophysiological properties of the atrioventricular node in man. Circulation . 1974;50:283-292. 30. Leon FA Y, Denes P, Wu D, Pietras RJ, Rosen KM. Effects of atrial pacing site on atrial and atrioventricular nodal function. Br Heart J . 1975;37: 576-582. 31. Goldreyer BN. Intracardiac electrocardiography in the analysis and understanding of cardiac arrhythmias. Ann Intern Med . 1972;77:117-136. 32. Scherlag BJ, Lazzara R, Helfant RH. Differentiation of “A-V junctional rhythms”. Circulation . 1973;48:304-312. 33. Wit AL, Cranefield PF. Effect of verapamil on the sinoatrial and atrioven tricular nodes of the rabbit and the mechanism by which it arrests reen trant atrioventricular nodal tachycardia. Circ Res . 1974;35:413-425. 34. Rosen KM, Rahimtoola SH, Gunnar RM. Pseudo A-V block secondary to premature nonpropagated his bundle depolarizations: documentation by his bundle electrocardiography. Circulation . 1970;42:367-373.

REFERENCES 1. Hariman RJ, Gomes JA, El-Sherif N. Recording of diastolic slope with cath eters during junctional rhythm in humans. Circulation . 1984;69:485-491. 2. Hariman RJ, Krongrad E, Boxer RA, Weiss MB, Steeg CN, Hoffman BF. Method for recording electrical activity of the sinoatrial node and auto matic atrial foci during cardiac catheterization in human subjects. Am J Cardiol . 1980;45:775-781. 3. Hariman RJ, Cramer M, Naylor RE, Hoffman BF. Coronary sinus rhythm in dogs: induction, recording and characteristics. Am J Cardiol . 1980;45:492. 4. Hariman RJ, Gough WB, Gomes JAG, El-Sherif N. Recording of diastolic slope in a canine model of automatic and unifocal ventricular tachycar dia. J Am Coll Cardiol . 1983;1:731. 5. Brachmann J, Scherlag BJ, Rosenshtraukh LV, Lazzara R. Bradycardia dependent triggered activity: relevance to drug-induced multiform ven tricular tachycardia. Circulation . 1983;68:846-856. 6. Levine JH, Spear JF, Guarnieri T, et al. Cesium chloride-induced long QT syndrome: demonstration of afterdepolarizations and triggered activity in vivo. Circulation . 1985;72:1092-1103. 7. Gavrilescu S, Luca C. Right ventricular monophasic action potentials in patients with long QT syndrome. Br Heart J . 1978;40:1014-1018. 8. Hariman RJ, Holtzman R, Gough WB, et al. In vivo demonstration of delayed afterdepolarization as a cause of ventricular rhythms in one day old infarction. J Am Coll Cardiol . 1984;3:476. 9. Schechter E, Freeman CC, Lazzara R. Afterdepolarizations as a mecha nism for the long QT syndrome: electrophysiologic studies of a case. J Am Coll Cardiol . 1984;3:1556-1561. 10. Wit AL, Wellens HJ, Josephson ME. Electrophysiologic foundations of cardiac arrhythmias: a bridge between basic and clinical electrophysiol ogy. Cardiotext; 2017. 11. Tang CW, Scheinman MM, Van Hare GF, et al. Use of P wave configura tion during atrial tachycardia to predict site of origin. J Am Coll Cardiol . 1995;26:1315-1324. 12. Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphol ogy in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol . 2006;48:1010-1017. 13. Qian ZY, Hou XF, Xu DJ, et al. An algorithm to predict the site of origin of focal atrial tachycardia. Pacing Clin Electrophysiol . 2011;34:414-421. 14. Zipes DP, Dejoseph RL. Dissimilar atrial rhythms in man and dog. Am J Cardiol . 1973;32:618-628. 15. Wu D, Denes P, Leon FA, Chhablani RC, Rosen KM. Limitation of the surface electrocardiogram in diagnosis of atrial arrhythmias. Further observations on dissimilar atrial rhythms. Am J Cardiol . 1975;36:91-97. 16. Zipes DP, Gaum WE, Genetos BC, Glassman RD, Noble J, Fisch C. Atrial tachycardia without P waves masquerading as an A-V junctional tachy cardia. Circulation . 1977;55:253-260.

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.