AER 7.2

Page 1

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


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