While there are many outstanding resources providing in-depth review of electrophysiology topics, this extensively updated book is one of the few case-based books that comprehensively cover clinical electrophysiology, devices and ablation. Case review offers a simple, yet effective way in teaching important concepts, offering insight into both the basic pathophysiology of a problem as well as the clinical reasoning that leads to a solution. As the field of cardiac electrophysiology evolves, the challenge remains to educate new generations of cardiac electrophysiologists with the basics as well as the latest advances in the field.  
Cardiac Electrophysiology: Clinical Case Review collates the most comprehensive case-based reviews of electrophysiology designed to appeal to all students of the field whether they are fellows, allied professionals or practicing electrophysiologists. The Editors have recruited some of the true experts in the field to contribute cases that they have encountered and summarizing the important learning objectives in a succinct way. Covering clinical electrophysiology, device troubleshooting and analysis as well as intracardiac electrogram analysis and ablation, readers will find the cases useful as a review of electrophysiology or in their day to day interactions with patients.   

Dedication

Preface
Contributors
Section 1: Clinical Cases: Ventricular Arrhythmias
Case 1: Ablation of Ventricular Tachycardia Using a Non-Ventricular Site
Case 2 When ICD Lead Failure Complicates Ventricular Arrhythmias Treatment
Case 3: Ventricular Tachycardia in a Patient with Mitral Valve Prolaps
Case 4:  Where is the Narrow Passage?
Case 5: Interfascicular Reentrant Ventricular Tachycardia
Case 6: Premature Ventricular Complexes from Pulmonary Artery
Case 7:  Narrow QRS Complex Ventricular Tachycardia
Case 8:  Limitations of Wide Complex Tachycardia Algorithms in a Patient with Ischemic Cardiomyopathy
Case 9: Right Ventricular Dysfunction and Ventricular Arrhythmias:  Challenges in Diagnosis
Case 10: The Management of Electrical Storm in a Patient with Non-Ischemic Cardiomyopathy
Section 2: Clinical Cases: Syncope
Case 11:  QT Prolongation as a Substrate for Syncope
Case 12: His Bundle Pacing
Case 13: Taking a Pause to Consider Arrhythmic Etiologies of Syncope
Case 14:  Right Ventricular Outflow Tract Ventricular Tachycardia and Syncope
Case 15: An 84-Year-Old Woman with Syncope and Orthostatic Dizziness
Case 16:  A 78-Year-Old Woman with Chest Pain and Syncope
Case 17: A 63-Year-Old Man with Atrial Fibrillation and Syncope
Case 18:  Tetralogy of Fallot Going Too Fast
Case 19:  Swallow (Deglutition) Syncope and Carotid Sinus Hypersensitivity
Case 20:  Syncope and Bundle Branch Block
Section 3: Clinical Cases: Hypertrophic Cardiomyopathy
Case 21:  Sudden Cardiac Death in Apical Hypertrophic Cardiomyopathy
Case 22:  Is Permanent Pacing Indicated for this ECG Finding Following Alcohol Septal Ablation?
Case 23:  Recurrent ICD Discharges in a Patient with Obstructive Hypertrophic Cardiomyopathy and High Gradients
Case 24:  Genetic Tailoring of Electrophysiological Management in Hypertrophic Cardiomyopathy
Case 25:  Apical Aneurysm:  An Important Consideration in Hypertrophic Cardiomyopathy Patients
Case 26:  Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy
Case 27:  Management Implications of Hypertrophic Cardiomyopathy Patients with Massive Hypertrophy
Section 4: Clinical Cases: Athletes and Arrhythmias
Case 28:  An Athlete with Atrial Fibrillation
Case 29: Interpretation of the 12-Lead Electrocardiogram in a Young Athlete
Case 30:  An Athlete with Arrhythmic Mitral Valve Prolapse
Case 31: Sudden Cardiac Death with Fibrosis of the Conduction System:  Should Genetic Testing of the Family Be Performed?
Case 32:  Hypertrophic Cardiomyopathy in a Young Athlete at Risk for Sudden Cardiac Death
Case 33:  An Athlete with Cardiac Arrest
Case 34:  Supraventricular Tachyarrhythmia Management in Elite Athletes
Case 35:  Broad-Complex Tachycardia in a Young Athlete
Case 36: Sudden Cardiac Arrest in a Young Competitive Athlete
Section5: Clinical Cases: Atrial Fibrillation
Case 37:  Entrainment and Its Value in Arrhythmia Diagnosis
Case 38:  Unexplained Atrial Myopathy and Sick Sinus Syndrome in a Young Patient with Atrial Fibrillation
Case 39: Post-Arterial Flutter Ablation Atrial Flutter:  What Is the Mechanism?
Case 40:  Confirmation of Pulmonary Vein Isolation after Cryoablation of Atrial Fibrillation
Case 41:  Electrogram Signatures in Atypical Arial Flutters Using High Density Multipolar Catheter Mapping in a Post-Heart Transplant Patient
Case 42:  Atypical Atrial Flutter
Case 43:  Understanding the Anatomy of the Cavo-Tricuspid Isthmus to Troubleshoot a Challenging Atrial Flutter Ablation
Case 44:  Left Atrial Microrentrant Flutter
Case 45:  Left Atrial Posterior Wall Isolation
Case 46:  Left Atrial Flutter after Surgical MAZE
Section 6: Clinical Cases: Arrhythmias-Genetic Abnormalities
Case 47:  Listen to your Patient and Act onthe Triggers
Case 48:  Progressive Conduction System Disease in an Apparently Healthy Man
Case 49:  Ventricular Tachycardia in a Patient with Neuromuscular Disease
Case 50:  Atrial Tachycardia in a Patient with Congenital Heart Disease
Case 51:  Comprehensive and Systematic Evaluation following Unexplained Cardiac Arrest
Case 52:  Long QT Syndrome
Care 53:  Can Right Ventricular Outlow Tract Monomorphic Ventricular Tachycardia Be Associated with Brugada Syndrome?
Section 7: Ablation Cases: Supraventricular Tachycardia
Case 54:   Typical Atrioventricular Nodal Reentry Tachycardia
Case 55:  Atrioventricular Nodal Reentrant Tachycardia
Case 56:  Atrioventricular Nodal Reentrant Tachycardia
Case 57:  Typical Atrioventricular Nodal Reentrant Tachycardia
Case 58:  Atrioventricular Nodal Reentrant Tachycardia
Case 59:  Supraventricular Tachycardia or Ventricular Tachycardia
Case 60:  Difficult Ablation for Atrioventricular Nodal Reentrant Tachycardia
Case 61:  Atrioventricular Reentrant Tachycardia
Case 62:  Atrioventricular Reentrant Tachycardia
Case 63:  Atrioventricular Reentrant Tachycardia
Case 64:  Epicardial Wolff-Parkinson-White Syndrome
Case 65:  Wolff-Parkinson-White Syndrome
Case 66:  An Unusual Accessory Pathway
Case 67:  Slowly Conducting Accessory Pathway
Case 68:   Atrial Tachycardia
Case 69:  Focal Atrial Tachycardia from the Non-Coronary Cusp
Case 70:  Atrial Tachycardia
Case 71:  Atrial Tachycardia
Section 8: Ablation Cases: Atrial Fibrillation and Flutter
Case 72:  Clockwise Atrial Flutter
Case 73:  Atypical Atrial Flutter
Case 74:  Microreentry Atrial Tachycardia Post MAZE
Case 75:  Atrial Flutter
Case 76:  Atypical Flutter:  Peri-Mitral Flutter
Case 77:  Atypical Micro-Reentrant Flutter Focus in Post PVAI Ablation for Persistent AF
Case 78:  Post-MAZE Atrial Tachycardia
Case 79:  Atypical Flutter from LAA Post PVAI Ablation for Persistent AF
Case 80:  Atrial Flutter Post Atrial Septal Defect Repair
Case 81:  Atypical Flutter:  Left Atrial Roof Dependent Flutter
Case 82:  Persistent Left Superior Vena Cava and Atrial Fibrillation
Case 83:  Atrial Tachycardia from Left Atrial Appendage
Case 84:  Septal Atrial Premature Contraction Induced Atrial Fibrillation
Case 85:  Importance of Discrete Anatomical Structures During Paroxysmal Atrial Fibrillation Ablation
Case 86:  Comprehensive Ablation of Persistent AF
Section 9: Ablation Cases: Ventricular Arrhythmias
Case 87:  Premature Ventricular Contractions:  Lessons Learned
Case 88:  Papillary Premature Ventricular Contractions
Case 89:   Right Ventricular Outflow Tract Premature Ventricular Contraction Mapping
Case 90:  Idiopathic Premature Ventricular Contraction Ablation
Case 91:  Premature Ventricular Contraction Arising from the Left Ventricular Summit
Case 92:  Direct Monitoring of the Local Electrograms in the Left Ventricular Summit to Guide Ablation of Ventricular Arrhythmias
Case 93:  Premature Ventricular Contractions:  Left Ventricular Summit
Case 94:  Premature Ventricular Contraction from the Left Ventricular Summit
Case 95:  Summit Premature Ventricular Contractions
Case 96:  Premature Ventricular Contractions:  Papillary Muscles
Case 97:  Premature Ventricular Contraction from Right-Left Coronary Cusp Commissure
Case 98:  Premature Ventricular Contractions:  Left Ventricular Outflow Tract
Case 99:  Upper Septal Fascicular Ventricular Tachycardia
Case 100: Bad Peripartum Fascicular Ventricular Tachycardia
Case 101:  A Case of Tachycardia Transformation between Narrow and Wide QRS Complex
Case 102:  The Use of the N+1 Difference in Entrainment Mapping of Ventricular Tachycardia
Case 103:  Purkinje-Related Arrhythmias in Post-Infarction Cardiomyopathy
Case 104:  Ischemic Ventricular Tachycardia
Case 105:  Ischemic Cardiomyopathy:  Simultaneous Epicardial and Endocardial Mapping and Ablation
Case 106:  Substrate Mapping and Ablation for Ventricular Tachycardia:  The LAVA Approach
Case 107:  Incessant Ventricular Tachycardia Causing Tachycardia-Induced Cardiomyopathy and Left Atrial Appendage Thrombus
Case 108:    Ischemic Ventricular Tachycardia
Case 109:  Identification of the Ventricular Tachycardia Isthmus after Infarction by Pacemapping
Case 110:  Utilization of Isochronal Late Activation Mapping to Minimize Ablation Lesion Set in a Patient with Diffuse Epicardial Scar from Non-Ischemic Cardiomyopathy
Case 111:  Ventricular Tachycardia in Non-Ischemic Cardiomyopathy
Case 112:  Epicardial Ventricular Tachycardia:  Simultaneous Epicardial and Endocardial Mapping and Ablation
Case 113:  Idiopathic Dilated Cardiomyopathy Ventricular Tachycardia
Case 114:  Nonischemic Cardiomyopathy:  Simultaneous Epicardial and Endocardial Mapping and Ablation
Case 115:  Surgical Ventricular Tachycardia Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy after Previous Hemopericardium
Case 116:  Right Ventricular Outflow Tract/Arrhythmogenic Right Ventricular Cardiomyopathy Ventricular Tachycardia
Case 117:  Arrhythmogenic Right Ventricular Cardiomyopathy
Case 118:  Chagas Disease Ventricular Tachycardia Ablated Using Electro-Anatomical Mapping
Case 119:  Chagas Disease Ventricular Tachycardia Ablation without Electro-Anatomical Mapping
Case 120:  Sarcoid Ventricular Tachycardia
Case 121:  Ventricular Tachycardia in a Patient with Right Bundle Branch Block
Case 122:  Ventricular Tachycardia in Sarcoidosis
Case 123:  Sarcoid VentricularTachycardia
Case 124:  Premature Ventricular Contractions in Giant Cell Myocarditis
Case 125:  Brugada Syndrome Ablation
Case 126:  Early Repolarization Syndrome During Local Heart or Full Body Hypothermia
Section 10: Devices Cases
Case 127:  Repetitive Nonreentrant Ventriculoatrial Synchrony
Case 128:  Leadless Pacing for Superior Vena Cava Occlusion
Case 129:  VVI at Elective Replacement Indicator
Case 130: Implantable Cardioverter Defibrillator Shocks While Walking Around the Shopping Mall
Case 131:  Feeling Poorly after an Upgrade to a Cardiac Resynchronization Therapy Device
Case 132:  A Nine Beat Run of Ventricular Tachycardia that Saved a Life
Case 133:  Failure of LV Lead Placement for Biventricular Pacing-His Bundle Pacing for Cardiac Resynchronization Therapy
Case 134:  Atrial Oversensing and Optimizing His Bundle Lead Position
Case 135:  Resynchronization for Cardiomyopathy with Right Bundle Branch Block Pattern
Case 136:  Shared Decision Making for an MRI Centered Lead Management Case
Case 137:   Management of a Possibly Infected Cardiovascular Implantable Electronic Device System
Case 138:  Lead Addition in a Patient with Bilateral Subclavian Vein Occlusion
Case 139:  Cardiac Resynchronization Therapy Selection in a Patient with Nonischemic Heart Failure
Case 140:  Cardiac Resynchronization Therapy Selection in a Patient with Coronary Artery Disease
Case 141:  Cardiac Resynchronization Therapy Selection in a Patient with Non Left Bundle Branch Block
Case 142:  Post-Operative Atrioventricular Block:  Using Device Algorithms
Case 143:  Unusual Presentation of Pacemaker Syndrome
Case 144:  Electromagnetic Interference and Device Programming
Case 145:  Why Did the Patient Receive Therapy in the Shock Zone?
Case 146:  Subcutaneous Implantable Cardioverter Defibrillator Therapy Two Days Post Implant
Case 147:  Subcutaneous Implantable Cardioverter Defibrillator Therapy with a Left Ventricular Assist Device
Case 148:  Palpitations after Pacemaker Implant
Case 149:  Fatigue after Pacemaker Implant
Case 150:  Telemetry Tracing after Pacemaker Implant
Case 151:  Making Sense of Oversensing
Case 152:  Fatigue and Dyspnea after Pacemaker Implant
Case 153:  VT Clusters on a Single Day
Case 154: Ignoring the Atrial Electrogram
Case 155:  Atrial Pacing above the LRL
Case 156:  Cardiovascular Implantable Electronic Device Detected Atrial Fibrillation
Case 157: Burst Pacing of an Arrhythmia
Case 158: Heart Failure with RV Pacing
Case 159: Single or Dual Tachycardia?
Case 160: Antitachycardia Pacing Termination of Tachycardia
Case 161: Shock After Arrhythmia Termination
Case 162: Noise on RV Lead
Case 163: Railroad Tracking
Case 164:  Multiple Ventricular Tachycardia/Ventricular Fibrillation Episodes.-Case 165: Remote Transmission after a Shock
Case 166:  Shock Termination of Tachycardia
Case 167:  Six Shocks without Premonitory Symptoms
Case 168: A Shocking Handshake
Case 169: Pacing Related Proarrhythmia
Case 170: Postmortem Implantable Cardioverter Defibrillator Interrogation
Case 171: Pacing Failure, Ventricular Tachycardia, and Implantable Cardioverter Defibrillator Shocks
Case 172:  Fluctuations of  High Voltage Impedance
Case 173: Misdiagnosis of Ventricular Tachycardia as Supraventricular Tachycardia
Case 174: Implantable Cardioverter Defibrillator Shock:  What Is the Trigger?Case 175:  Antitachycardia Pacing Termination of Tachycardia: What Is the Mechanism?
Case 176:  Loss of Left Ventricular Pacing After Cardiac Resynchronization Therapy:  What Is the Cause?
Index.