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Huang’s Catheter Ablation of Cardiac Arrhythmias, 5th Edition

Jason S. Bradfield, Shoei K. Stephen Huang, Kalyanam Shivkumar
ISBN: 9780323931106
ISBN: 9780323931106
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Written and edited by world-renowned experts in the field, including Dr. Shoei K. Stephen Huang, a pioneer of radiofrequency catheter ablation procedures, Huang’s Catheter Ablation of Cardiac Arrhythmias, 5th Edition, provides authoritative, comprehensive information on these increasingly used electrophysiology procedures. This outstanding resource is packed with cutting-edge content in every area of this fast-changing field, including anatomy, diagnostic criteria, differential diagnosis, mapping, and ablation. Ideal for practitioners who need a definitive, user-friendly ablation text for the electrophysiology lab or office setting, it offers quick access to practical content, using detailed tables and high-quality images to help you apply what you learn in your practice.
Key Features
  • Reflects all the latest technology, including the new pulse field ablation (PFA) procedure, new balloon technologies (RF, laser, and PFA) for pulmonary vein isolation, and high-resolution 3D mapping systems.
  • Offers expert guidance on atrial tachycardia and flutter, atrial fibrillation, atrioventricular nodal reentrant tachycardia, tachycardias related to accessory atrioventricular connections, ventricular tachycardia, transseptal catheterization techniques, ablation for pediatric patients, and patient safety and complications.
  • Contains new chapters covering Biophysics and Clinical Applications of Laser Ablation, Biophysics and Clinical Applications of Pulse Field Ablation, Multiple Strategic Approach to Ablate Atrial Fibrillation, Ablation of Challenging/Difficult Accessory Pathways, Ablation of Ventricular Tachycardia in Arrhythmogenic Ventricular Cardiomyopathy, and more.
  • Contains 450 figures, including ECGs, intracardiac recordings, 3D mapping, ultrasound, fluoroscope, and ablation images.
  • Includes numerous tables and boxes that provide quick access to key points, arrhythmia mechanisms, diagnostic criteria, target sites for ablation, use of special equipment, complications, and troubleshooting problems and their solutions.
  • Provides access to 20 video clips, including transseptal access to the left atrium, intracardiac ultrasound, and techniques of pericardial access.
  • An eBook version is included with purchase. The eBook allows you to access all of the text, figures, videos, and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. Any additional digital ancillary content may publish up to 6 weeks following the publication date.

Περιεχόμενα

Cover image
Title page
Copyright
Dedication
Contributors
Preface (Shoei K. Stephen Huang)
Preface (Jason S. Bradfield and Kalyanam Shivkumar)
Acknowledgments
Contents
Video Contents
PART 1 Fundamental Concepts of Transcatheter Energy Delivery
1 Biophysics and Pathophysiology of Radiofrequency Lesion Formation
Key Points
Biophysics of Radiofrequency Energy Tissue Heating
Tissue Pathology and Pathophysiologic Response to Radiofrequency Ablation
Cellular Mechanisms of Thermal Injury
Determinants Of Effective Lesion Formation
Improving Radiofrequency Ablation Effectiveness
Biophysics of Pulsed-Field Ablation Compared to Radiofrequency Ablation
Conclusion
References
2 Biophysics and Clinical Applications of Cryoablation
Key Points
Introduction
History of Cryothermal Energy Use in Cardiovascular Medicine
Biophysics and Mechanisms of Cryothermal Energy Tissue Injury
Cryoablation Technical Aspects
Clinical Advantages of Cryothermal Energy for Catheter Ablation
Clinical Applications
New Perspectives
References
3 Biophysics and Clinical Applications of Laser Ablation
Key Points
Biophysics of Laser Ablation
Clinical Applications of Laser Ablation
Surgical Ablation
Transvenous Ablation
Clinical Outcomes
References
4 Biophysics and Clinical Applications of Pulsed-Field Ablation
Key Points
Biophysics of Lesion Formation
Biological Effects of Cardiac Pulsed-Field Ablation
Effects and Safety of Pfa on Specific Tissue
Atrial Pulsed-Field Ablation
Ventricular Pulsed-Field Ablation
“Reversible” Electroporation
Summary
References
5 Contemporary Irrigated Radiofrequency Catheter Ablation
Key Points
Introduction
Biophysics of Irrigated Radiofrequency Ablation
Design of Irrigated- and Cool-Tip Radiofrequency Catheters
Titrating Power and Duration During Irrigated Radio frequency Ablation
Irrigated Radiofrequency Ablation of Atrial Fibrillation
Irrigated Radiofrequency Ablation for Atrial Flutter
Irrigated Ablation for Ventricular Tachycardia
Irrigated Ablation from the Coronary Sinus for Accessory Pathways and Ventricular Arrhythmias
Conclusion
References
PART 2 Cardiac Mapping and Imaging
6 Cardiac Anatomy for Catheter Mapping and Ablation of Arrhythmias
Key Points
Introduction
Progressive Real Dissection of the Heart Viewed from the Right Anterior Oblique Direction
Progressive Virtual Dissection of the Heart Viewed from the Left Anterior Oblique Direction
Conclusion
Acknowledgment
References
7 Fundamentals of Intracardiac Mapping
Key Points
Underlying Basis for the Extracellular Electrogram
Electrogram Recording: Amplification, Filtering, and Digitization of Signals
Unipolar and Bipolar Signals
Characteristics of Intracardiac Signals: Normal Heart
Endocardial Mapping Techniques
References
8 Fundamentals of Catheter Three-Dimensional Mapping Systems
Key Points
Introduction
Technology Used in 3D Mapping Systems
Functions (Capabilities) of 3D Mapping Systems
Step-By-Step Guide for Mapping
Additional Functions
Use in Various Arrhythmias
References
9 High-Resolution Three-Dimensional Mapping Systems
Key Points
Introduction
Point-By-Point Versus Multielectrode Mapping
Types of Multielectrode Catheters
Limitations of High-Resolution Mapping
Future Perspectives of High-Resolution Mapping
Conclusion
References
10 Intracardiac Echocardiography, Computed Cardiac Tomography, and Magnetic Resonance Imaging for Guiding Mapping and Ablation
Key Points
Introduction
Intracardiac Echocardiography
Cardiac Magnetic Resonance
Multidetector Computed Tomography
Summary
References
PART 3 Catheter Ablation of Atrial Tachycardias and Flutters
11 Ablation of Focal Atrial Tachycardias
Key Points
Introduction
Anatomy
Pathophysiology
Arrhythmia Diagnosis and Differential Diagnosis
Mapping
Troubleshooting the Difficult Case
Discussion
Conclusion
References
12 Ablation of Cavotricuspid Isthmus–Dependent Atrial Flutters
Key Points
Atrial Flutter Terminology
Anatomy and Pathophysiology
Diagnosis
Ablation
Outcomes and Complications
Troubleshooting the Difficult Case
References
13 Ablation of Non–Isthmus-Dependent Flutters and Atrial Macroreentry
Key Points
Introduction
Anatomy
Pathophysiology
Diagnosis
Ablation
Specific Forms of Atypical Flutter (See Table 13.1)
References
14 Ablation of Atrial Flutter/Tachycardia in Congenital Heart Disease
Key Points
Introduction
General Principles of Catheter Ablation for Congenital Heart Disease
Intra-Atrial Reentrant Tachycardia Circuit Characteristics in Congenital Heart Disease
Approach to Catheter Ablation
Potential Complications and Collateral Damage
Catheter Ablation for Specific Forms of Congenital Heart Disease
Outcomes of Catheter Ablation in Congenital Heart Disease
Conclusion
References
PART 4 Catheter Ablation of Atrial Fibrillation
15 Pulmonary Vein Isolation Using Radiofrequency Energy Ablation Technologies
Key Points
Preprocedural Considerations
Procedural Considerations
Complications of Pulmonary Vein Isolation
Difficult Cases
Postprocedural Considerations
Radiofrequency-Balloon Ablation for Pvi
Conclusion
References
16 Pulmonary Vein Isolation Using the Cryoballoon Catheter
Key Points
Introduction
Randomized Controlled Trial Data
Preprocedural Considerations
Cryoballoon Ablation Procedure
Cryoballoon Dosing
Postprocedure Care
Conclusion
References
17 Pulmonary Vein Isolation Using Pulsed-Field Ablation or Laser Balloon
Key Points
Pulsed-Field Ablation for Pulmonary Vein Isolation
Pulmonary Vein Isolation with Laser Balloon
Summary
References
18 Catheter Ablation of Atrial Fibrillation Initiated by Non–Pulmonary Vein Triggers
Key Points
Introduction
Electrophysiologic Characteristics and Incidence of Npv Triggers
Pathophysiology of Af Triggers from Npv Areas
Provocation Test for Npv Triggers
Mapping and Localization of the Npv Triggers
Npv Triggers From Different Locations
Efficacy and Outcome of Catheter Ablation
Conclusion
References
19 Substrate-Based Ablation of Atrial Fibrillation
Key Points
Introduction
Anatomic Approaches to Substrate Modification
Electrogram-Guided Atrial Ablation
Right Atrial Substrate Ablation
Additional Techniques and Future Considerations
Conclusion
References
20 Ablation of Persistent and Long-Standing Persistent Atrial Fibrillation
Key Points
Introduction
Assessment of the Patient with Persistent and Long-Standing Persistent AF
Ablation Strategies in Patients with Persistent AF
Conclusion
References
21 Epicardial and Endocardial Hybrid Ablation for Atrial Fibrillation
Key Points
Introduction
Catheter Approach
Surgical Approaches
Hybrid Approach
Conclusion
References
22 Ablation Strategies for Persistent and Long-Standing Persistent Atrial Fibrillation
Key Points
Introduction
Anatomy
Pathophysiology
How to Map Patients with Nonparoxysmal AF
Ablation
Ancillary Techniques in Patients with PeAF
Ablation of Other Structures
Future Perspectives
Conclusion
References
PART 5 Catheter Ablation of Atrioventricular Nodal Reentry Tachycardia and the Atrioventricular Junction
23 Ablation of Atrioventricular Nodal Reentry Tachycardia and Focal Junctional Tachycardia
Key Points
Introduction
Anatomy of the Atrioventricular Node and Its Inputs
Pathophysiology
Diagnosis
Differential Diagnosis
Atrioventricular Nodal Reentry and Atypical Presentations
AV Nodal Reentry and Other Arrhythmias
Junctional Tachycardia
Ablation
Radiofrequency Ablation
Cryoablation
End Points of Ablation
Preventing Atrioventricular Block During Catheter Ablation
Outcomes of Slow Pathway Ablation
Ablation of Junctional Tachycardia
Troubleshooting the Difficult Case
Acknowledgments
References
24 Ablation of Challenging/Difficult Atrioventricular Nodal Reentry Tachycardia
Key Points
Introduction
Anatomical Challenges
Diagnostic Challenges
Baseline Electrophysiologic Challenges
When Your Ablation does not Seem To Be Working
Conclusion
References
25 Ablation/Modification of Atrioventricular Junction for Heart Rate Control of Permanent Atrial Fibrillation
Key Points
Introduction
Complete Atrioventricular Junction Ablation
Atrioventricular Junction Ablation in Patients Undergoing Cardiac Resynchronization Therapy Device Implantation
Atrioventricular Junction Ablation Plus Pacing Versus Primary Catheter Ablation in Drug-Refractory Atrial Fibrillation
Outcomes and Complications of AV Junction Ablation
Troubleshooting the Difficult Cases
Atrioventricular Junction Modification
References
PART 6 Catheter Ablation of Accessory Atrioventricular Connections
26 Ablation of Free Wall Accessory Pathways
Key Points
Anatomy
Pathophysiology
Mapping
Clinical Results
Troubleshooting the Difficult Case
Acknowledgments
References
27 Ablation of Posteroseptal Accessory Pathways
Key Points
Anatomy
Pathophysiology
Arrhythmia Diagnosis and Differential Diagnosis
Mapping
Target Sites
Ablation
Outcomes
Complications
Troubleshooting the Difficult Case
References
28 Catheter Ablation of Superoparaseptal (“Anteroseptal”) and Midseptal Accessory Pathways
Key Points
Anatomy and Nomenclature
Diagnosis and Differential Diagnosis
Mapping and Ablation Techniques
Troubleshooting the Difficult Case
Summary
References
29 Ablation of Atriofascicular Accessory Pathways and Variants
Key Points
Atriofascicular Accessory Pathways
Anatomy
Pathophysiology
Diagnosis
Differential Diagnosis
Atrioventricular Nodal Reentry Tachycardia Coexisting with Atriofascicular Accessory Pathways
Mapping
Mapping of Accessory Pathway Along the Tricuspid Annulus
Catheter-Induced Mechanical Conduction Block
Identification of the Atrial Insertion
Identification of the Ventricular Insertion
Ablation
Troubleshooting the Difficult Case
Atriofascicular Pathway Variants
Atrioventricular Pathways with Decremental Conduction
Left-Sided Decremental Accessory Pathways
Nodoventricular and Nodofascicular Accessory Pathways
Mapping and Ablation
Fasciculoventricular Accessory Pathways
References
30 Ablation of Challenging/Difficult Accessory Pathways
Key Points
Introduction
Common Challenges in Accessory Pathway Mapping/Ablation
1. Misdiagnosis of the Tachycardia
2. Localization Error
Oblique Accessory Pathways
3. Unusual Ap Location
Challenging Case Presentation
Conclusion
References
PART 7 Catheter Ablation of Ventricular Tachycardias
31 Ablation of Ventricular Outflow Tract Tachycardias
Key Points
Mechanism
Anatomical Substrate
Anatomy of the Outflow Tracts
Diagnosis
Ablation
Clinical Outcomes and Complications
Troubleshooting the Difficult Case
Basal Inferoseptum: Site of Origin for Idiopathic VAs
Conclusion
References
32 Ablation of Idiopathic Left and Right Ventricular and Fascicular Tachycardias
Key Points
Mitral Annular Ventricular Tachycardia
Tricuspid Annular Ventricular Tachycardia
Papillary Muscle Ventricular Tachycardia
Ventricular Tachycardia Arising from the Crux of the Heart
Reentrant Left Fascicular Ventricular Tachycardia
Nonreentrant Fascicular Ventricular Tachycartdia
Conclusion
References
33 Ablation of Ventricular Tachycardia in Coronary Artery Disease
Key Points
Introduction
Anatomy
Pathophysiology
Arrhythmia Diagnosis and Differential Diagnosis
Periprocedural Considerations
Mapping Strategies
Ablation Lesion Delivery
Outcomes
Complications
Troubleshooting the Difficult Case
Conclusions
References
34 Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy
Key Points
Disease Spectrum
Etiology and Characterization of the Arrhythmogenic Substrate
Disease-Specific Arrhythmogenic Substrate
Preablation Workup and Procedural Planning
Selection of Target Sites for Ablation
Ablation Technique and Endpoints
Disease-Specific Considerations For Ablation
Troubleshooting the Difficult Case
References
35 Ablation of Unstable Ventricular Tachycardia and Idiopathic Ventricular Fibrillation
Key Points
Introduction
Ablation Strategies Based on Substrate Mapping
Integrating the Mapping and Ablation Strategies for Ablation of Unstable Ventricular Tachycardia
Ablation of Idiopathic Ventricular Fibrillation
Conclusion and Future Directions
References
36 Substrate-Based Ablation for Ventricular Tachycardia
Key Points
Introduction
Anatomy and Pathophysiology
Mapping Ventricular Tachycardia Substrate
Cardiac Imaging to Guide Substrate-Based Ablation
Substrate-Based Ablation for Elimination of Ventricular Tachycardia
Complications
Troubleshooting the Difficult Case
Conclusion
References
37 Epicardial Approach to Catheter Ablationof Ventricular Tachycardia
Key Points
Pericardial Anatomy
Clinical Indications for Epicardial Mapping
Subxiphoid Percutaneous Technique
Surgical Access
Mapping and Ablation Tools
Coronary Arteries
Phrenic Nerve
Epicardial Fat
Intrapericardial Steroid and Repeat Access
Reported Complications
Efficacy
Conclusion
References
38 Ablation of Ventricular Tachycardia in Congenital Heart Disease
Key Points
Introduction
Anatomy
Pathophysiology
Arrhythmia Diagnosis and Differential Diagnosis
Mapping: Approach to Efficient Mapping
Ablation
Success
Risk Stratification Prior to Pulmonary Valve Replacement
Surgical Ablation
Troubleshooting the Difficult Case
Ebstein Anomaly
Conclusion
References
39 Ablation of Ventricular Tachyarrhythmias in Brugada Syndrome
Key Points
Arrhythmogenic Substrates
Catheter Ablation of Brugada Substrates
Mapping
Ablation Protocol and Endpoint
Efficacy and Safety of Catheter Ablation for BRS
Combined Syndrome of Brs and Ers
Conclusion
References
40 Catheter Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy
Key Points
Introduction
Substrate Formation: Arrhythmogenesis and Disease Phenotype
Sympathetic Modulation and Arrhythmogenesis in Early ARVC
Substrate Distribution: Patterns of Scar and Implications on Electroanatomical Mapping
The Role of Endocardial Mapping and Ablation in ARVC
Pericardial Access
Epicardial Electroanatomical Mapping and Ablation Strategies
Complications
Outcomes of Epicardial Ablations in ARVC
Perspectives
References
41 Hybrid Approaches for Catheter Ablation of Ventricular Tachycardia
Key Points
Introduction
Patient Selection
Procedure Planning
Access Site
Mapping and Ablation
Safety and Outcome
Summary
References
PART 8 Miscellaneous Topics
42 Complications Associated with Catheter Ablation of Cardiac Arrhythmias
Key Points
Introduction
Vascular Access–Related Complications
Sheath/Catheter Manipulation–Related Complications
Energy Delivery–Related Complications
Epicardial Catheter Ablation–Related Complications
Acknowledgments
References
43 Atrial Transseptal Catheterization
Key Points
Introduction
Anatomic Considerations for Transseptal Catheterization
Indications and Contraindications for Atrial Transseptal Catheterization
Intraprocedural Patient Management: Sedation and Anticoagulation
Techniques and Tools for Transseptal Catheterization
Approach to the Difficult Transseptal Catheterization
Procedural Complications and Tools to Lower Their Risks
Conclusion
Acknowledgments
References
44 Ablation of Cardiac Arrhythmias in Pediatric Population
Key Points
Introduction
Are children just little adults?
Arrhythmias Unique to the Pediatric Patient
Summary
Acknowledgment
References
Index

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