Skip to main content

Cardiac Arrhythmias

  • Chapter
  • First Online:
Critical Care Study Guide

Abstract

After studying this chapter, you should be able to: Understand the fundamental properties of excitability and refractoriness. Know basic conduction system anatomy. Develop a basic understanding of arrhythmia mechanisms, with particular attention to reentry, which is responsible for most clinically relevant arrhythmias. Develop a systematic approach to the diagnosis and treatment of common bradycardic and tachycardic rhythms. Understand the impact, evaluation, and treatment options of arrhythmias occurring during several common clinical syndromes (long QT syndrome and acute myocardial infarction).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alpert J. Conduction disturbances: Temporary and permanent pacing in patients with acute myocardial infarction. In: Gersh B, Rahimtoola S, eds. Acute Myocardial Infarction: Current Topics in Cardiology. New York, NY: Elsevier; 1991:249-258.

    Google Scholar 

  2. Josephson M, Wellens H. Differential diagnosis of supraventricular tachycardia. Cardiol Clinic. 1990;8(3):411-442.

    CAS  Google Scholar 

  3. Wijffels M, Kirchhof C, Dorland R, Allessie M. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954-1968.

    Article  PubMed  CAS  Google Scholar 

  4. Wijffels M, Kirchhof C, Dorland R, Power J, Allessie M. Electrical remodeling due to atrial fibrillation in chronically instrumented conscious goats: roles of neurohumoral changes, ischemia, atrial stretch, and high rate of electrical activation. Circulation. 1997;96:3710-3720.

    Article  PubMed  CAS  Google Scholar 

  5. Asirvatham S. Correlative anatomy and electrophysiology for the interventional electrophysiologist: Right atrial flutter. J Cardiovas Electrophysiol. 2009 Jan;20(1):113–122.

    Google Scholar 

  6. Bar F, Brugada P, Dassem R, Wellens H. Differential diagnosis of tachycardia with narrow QRS complex (shorter than 0.12 second). Am J Cardiol. 1984;54:555-560.

    Article  PubMed  CAS  Google Scholar 

  7. Guarnieri T, German L, Gallagher J. The long R-P tachycardias. Pacing Clin Electrophysiol. 1987;10(1):103-117.

    Article  PubMed  CAS  Google Scholar 

  8. Lo R, Hsia H. Ventricular arrhythmias in heart failure patients. Cardiol Clinic. 2008;26:381-403.

    Article  Google Scholar 

  9. Akhtar M, Damato A, Batsford W, Ruskin J, Ogunkelu B, Vargas G. Demonstration of re-entry within the His-Purkinje system in man. Circulation. 1974;50:1150-1162.

    Article  PubMed  CAS  Google Scholar 

  10. Blanck Z, Deshpande S, Jazayeri MR, Akhtar M. Catheter ablation of the left bundle branch for the treatment of sustained bundle branch reentrant ventricular tachycardia. J Cardiovasc Electrophysiol. 1995;6(1):40-43.

    Article  PubMed  CAS  Google Scholar 

  11. Lopera G, Stevenson WG, Soejima K, et al. Identification and ablation of three types of ventricular tachycardia involving the his-purkinje system in patients with heart disease. J Cardiovasc Electrophysiol. 2004;15(1):52-58.

    Article  PubMed  Google Scholar 

  12. Caceres J, Jazayeri M, McKinnie J, et al. Sustained bundle branch reentry as a mechanism of clinical tachycardia. Circulation. 1989;79(2):256-270.

    Article  PubMed  CAS  Google Scholar 

  13. Badhwar N, Scheinman MM. Idiopathic ventricular tachycardia: diagnosis and management. Curr Probl Cardiol. 2007;32(1):7-43.

    Article  PubMed  Google Scholar 

  14. Ito S, Tada H, Naito S, et al. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol. 2003;14(12):1280-1286.

    Article  PubMed  Google Scholar 

  15. Belhassen B, Shapira I, Pelleg A, Copperman I, Kauli N, Laniado S. Idiopathic recurrent sustained ventricular tachycardia responsive to verapamil: an ECG-electrophysiologic entity. Am Heart J. 1984;108:1034-1037.

    Article  PubMed  CAS  Google Scholar 

  16. Okumura K, Matsuyama K, Miyagi H, Tsuchiya T, Yasue H. Entrainment of idiopathic ventricular tachycardia of left ventricular origin with evidence of reentry with and area of slow conduction and effect of verapamil. Am J Cardiol. 1988;62:727-732.

    Article  PubMed  CAS  Google Scholar 

  17. Gallagher J, Pritchett E, Sealy W, Kasell J, Wallace A. The preexcitation syndromes. Prog Cardiovasc Dis. 1978;20(4):285-327.

    Article  PubMed  CAS  Google Scholar 

  18. Bardy G, Fedor J, German L, Packer D, Gallagher J. Surface electrocardiographic clues suggesting presence of a nodofascicular Mahaim fiber. J Am Coll Cardiol. 1984;3(5):1161-1168.

    Article  PubMed  CAS  Google Scholar 

  19. McClelland J, Wang X, Beckman K, et al. Radiofrequency catheter ablation of right atriofascicular (Mahaim) accessory pathways guided by accessory pathway activation potentials. Circulation. 1994;89(6):2655-2666.

    Article  PubMed  CAS  Google Scholar 

  20. Xie B, Heald S, Bashir Y, et al. Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm. Am J Cardiol. 1994;74:161-165.

    Article  PubMed  CAS  Google Scholar 

  21. Packer D, Gallagher J, Prystowsky E. Physiological substrate for antidromic reciprocating tachycardia: prerequisite characteristics of the accessory pathway and atrioventricular conduction system. Circulation. 1992;85(2):574-588.

    Article  PubMed  CAS  Google Scholar 

  22. deBakker J, van Rijen H. Mechanisms of ventricular tachycardia: underlying pathological and physiological abnormalities. In: Wang P, Hsia H, Al-Ahmad A, Zei P, eds. Ventricular Arrhythmias and Sudden Cardiac Death. Oxford UK: Blackwell; 2008:18-27.

    Google Scholar 

  23. Brugada P, Brugada J, Mont L, Smeets J, Andries E. A new appraoch to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649-1659.

    Article  PubMed  CAS  Google Scholar 

  24. Wellens H, Bar F, Lie K. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRES complex. Am J Med. 1978;64:27-33.

    Article  PubMed  CAS  Google Scholar 

  25. Kindwall K, Brown J, Josephson M. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol. 1988;61:1279-1283.

    Article  PubMed  CAS  Google Scholar 

  26. El-Sherif N, Turitto G. The long QT syndrome and Torsade de Pointes. Pacing Clin Electrophysiol. 1999;22(Pt I):91-110.

    Google Scholar 

  27. Schwartz P, Priori S, Spazzolini C, et al. Genotype-phenotype correlation in the long-QT syndrome; gene-specific triggers for life-threatening arrhythmias. Circulation. 2001;103:89-95.

    Article  PubMed  CAS  Google Scholar 

  28. Priori S, Schwartz P, Napolitano C, et al. Risk stratification in the long-QT syndrome. N Engl J Med. 2003;348(19):1866-1874.

    Article  PubMed  Google Scholar 

  29. Ackerman M, Tester D, Porter C. Swimming, a gene-specific arrhythmogenic trigger for inherited long QT syndrome. Mayo Clin Proc. 1999;74(11):1088-1094.

    Article  PubMed  CAS  Google Scholar 

  30. Hindman M, Wagner G, JaRo M, et al. The clinical significance of bundle branch block complicating acute myocardial infarction. 1. Clinical characteristics, hospital mortality, and one-year follow-up. Circulation. 1978;58(4):679-688.

    Article  PubMed  CAS  Google Scholar 

  31. Hindman M, Wagner G, JaRo M, et al. The clinical significance of bundle branch block complicating acute myocardial infarction. 2. Indications for temporary and permanent pacemaker insertion. Circulation. 1978;58(4):689-699.

    Article  PubMed  CAS  Google Scholar 

  32. Chiladakis J, Patsouras F, Manolos A. The Bezold-Jarisch reflex in acute inferior myocardial infarction: clinical and sympathovagal spectral correlates. Clin Cardiol. 2003;26:323-328.

    Article  PubMed  Google Scholar 

  33. Ustinova E, Schulz H. Activation of cardiac vagal afferents in ischemia and reperfusion: Prostagladins versus oxygen-derived free radicals. Circ Res. 1994;74(5):904-911.

    Article  PubMed  CAS  Google Scholar 

  34. Hindman M, Wagner G. Arrhythmias during myocardial infarction: mechanisms, significance, and therapy. Cardiovasc Clin. 1980;11(1):81-102.

    PubMed  CAS  Google Scholar 

  35. Woelfel A, Gettes L. Tachyarrhythmias during acute myocardial infarction. In: Gersh B, Rahimtoola S, eds. Acute Myocardial Infarction: Current Topics in Cardiology. New York, NY: Elsevier; 1991:236-248.

    Google Scholar 

  36. Hohnloser S, Kuck K, Dorian P, et al. Prophylactic use of an implantable cardioverter–defibrillator after acute myocardial infarction. N Engl J Med. 2004;351:2481-2488.

    Article  PubMed  CAS  Google Scholar 

  37. DeGuzman M, Rahimtoola SH. What is the role of pacemakers in patients with coronary artery disease and conduction anomalities?. Cardiovasc Clin. 1983;13:191-201.

    Google Scholar 

Additional Reading

  • Josephson ME. Clinical Cardiac Electrophysiology: Techniques and Interpretations. 2nd ed. Philadelphia: Lea & Febiger; 1993.

    Google Scholar 

  • Miller J, ed. Ventricular Arrhythmias. Cardiology Clinics. Vol 18. Philadelphia: W.B. Saunders; 2000.

    Google Scholar 

  • Marriot HJL. Practical Electrocardiography. 8th ed. Philadelphia: Williams & Wilkins; 1988.

    Google Scholar 

  • Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia: W.B. Saunders Company; 2000.

    Google Scholar 

  • Opie L. The Heart, Physiology, Metabolism, Pharmacology, Therapy. London: Grune & Stratton; 1987.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Hsing, J.M., Hsia, H.H. (2010). Cardiac Arrhythmias. In: Criner, G., Barnette, R., D'Alonzo, G. (eds) Critical Care Study Guide. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77452-7_19

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-77452-7_19

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-77327-8

  • Online ISBN: 978-0-387-77452-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics