Arrhythmia & Electrophysiology Review Volume 7 • Issue 2 • Summer 2018
Volume 7 • Issue 2 • Summer 2018
www.AERjournal.com
Risk Factor Management in Atrial Fibrillation Axel Brandes, Marcelle D Smit, Bao Oanh Nguyen, Michiel Rienstra and Isabelle C Van Gelder
Treatment of Atrial Fibrillation in Patients with Co-existing Heart Failure and Reduced Ejection Fraction: Time to Revisit the Management Guidelines? Alex Baher and Nassir Marrouche
Sudden Cardiac Death and Arrhythmias Neil T Srinivasan and Richard J Schilling
Pharmacological Therapy in Brugada Syndrome
A Illustration of normal conduction
Oholi Tovia Brodie, Yoav Michowitz and Bernard Belhassen
AV node Fibres predestined for left bundle branch
His bundle
Myocardium Bundle branches
CENTRAL TRIGGERS
Fibres predestined for right bundle branch
Visceral afferents Sympathetic efferents
Vagus efferents
SOMATIC AND VISCERAL TRIGGERS
Vagus afferents
Response to hypotension
Pace maker
A
CPP Syncope
Blood Pressure
Proximal left bundle branch block bypassed by pacing lead positioned distal to site of block
A SUDDEN BRADYCARDIA/ ASYSTOLE Example of RDR functioning as a simple rate hysteresis device
B
RATE DROP RESPONSE
CLOSED LOOP STIMULATION • RV impedence measurement reflective of RV contractility
• ↓ in HR detected Pacing for Vasovagal Physiology, Technology AV • Abruptly ↑ HR by pacing (AV sequential) at a Syncope and Potentialnode of His higher rate • CLS algorithm ↑pacing rate Bundle Pacing Distal site of
HR ↓ Vasodepression (VD)
Syncope
C
Proximal site of left bundle branch block VASODILATATION
BRADYCARDIA/ ASYSTOLE
Vasodepression (VD)
Blood Pressure
CPP
Blood vessels
Mechanoreceptors
BRADYCARDIA/ ASYSTOLE RESPONSE TO VVS TRIGGER
Blood Pressure
AV node
Lower extremity
SPLANCHNIC VASODILATATION
B
AV Node node
Vasodepression (VD)
SLOWER ONSET BRADYCARDIA + PROMINENT VD Example of RDR introducing pacing late and possibly inefficiently
C EARLY ONSET OF VD Detected by CLS algorithm
CPP Syncope
Stratifying Risk AV in Patients nodeSyndrome with Brugada Distal left bundle branch block overcome by electrical remote activation. Consider: higher outputs, source-sink or virtual electrode theories
left bundle Abort syncope branch block
HR ↓
ISSN – 2050-3369
D Reversal due to close proximity to high septal branch
Radcliffe Cardiology
AV node
AV node
bundle branch block Lifelong Learning for CardiovascularLeft Professionals
Left bundle branch block AER 7.2 FC + Spine.indd All Pages
Septal branch of bundle
overcome by pacing lead in close proximity to high septal branch, with initial retrograde activation back up branch before 11/06/2018 23:28 facilitating antegrade conduction beyond block