EGM assessment of arrhythmias Flashcards
What is Chronic AFL associated with?
Underlying heart disease
What is the acute management of AFL?
Cardioversion
What are the two types of cardioversions?
- Electrical (<50J)
- Chemical (IV ibutilide, amiodarone, sotalol, or Class IV)
What is the treatment of choice for AFL?
ablation of the cavotricuspid isthmus (CTI)
What would we do for a patient when a CTI ablation has failed?
AVN ablation with pacemaker
What other than rate control do we need to be concerned about with AFL?
Stroke prevention therapy with asparin or warfarin
During BBB, most frequently RBBB, how can flutter beats be conducted?
Aberrantly
What are the two segments of RA endocardium?
anterolateral trabeculated posterior smooth-walled
Where is the crista terminalis located?
descends the lateral wall from the anterior septal aspect of the SVC to the inferior lateral aspect of the IVC
Where is the inferior tricuspid annulus located?
a short distance (1 to 4 cm) anterior to the eustachian ridge
Where is the CS ostium located?
medial to the orfice of the IVC at the base of the RA posterior septum
What is the activation sequence of counterclockwise AFL present?
- UP the RA septal wall
- ACROSS the roof of RA
- DOWN the lateral wall of RA
- ACROSS the tricuspid isthmus
What can chronic AFL degenerate into?
A. Fib
What does fib-flutter resemble on an EGM?
variable CL
How can AFL/Afib be induced?
single atrial extra/incremental A. stimulus during RRP
How can you differentiate between intra-atrial tach and AFL?
the rate and termination
- AFL = 220 - 350 ms.
- terminated: rapid pacing
- intra-atrial = 120 - 220 ms.
- termination: single premature impulse
What is the activation sequence of clockwise AFL?
- DOWN the RA septal wall
- ACROSS the tricuspid isthmus
- UP the RA lateral wall
- ACROSS the roof of the RA
Other than typical and atypical flutter, name three other types of AFL?
- Double-wave re-entry
- lower loop re-entry
- intra-isthmus re-entry
What type of AFL is considered Atypical?
clockwise
What type of AFL is considered typical?
counterclockwise
Which type of AFL can be induced with pacing in the CS?
CCW
typical or counterclockwise AFL
Atypical or clockwise AFL
Name the 3 types of scenarios for entrainment pacing for AFL.
- PPI-TCL = <30ms AND no change in atrial activation (concealed entrainment)
- PPI-TCL = <30ms AND change in atrial activation (manifest entrainment)
- PPI - TCL = >30ms AND change in atrial activation (manifest entrainment)
What is manifest entrainment?
PPI-TCL = <30ms
Pacing site is within the flutter circuit, but not in the isthmus
Name the 3 types of AVNRT
- slow-fast
- slow-slow
- fast-slow
What are the characteristics of a jump beat?
>50 ms in the AH interval
How does AVNRT present of an EGM?
Stacked V waves when in the tachycardia
What is the pattern of activation for AVNRT?
H-VA
When burst pacing in the ventricle, what is the VA interval for AVNRT?
<85ms
When burst pacing in the ventricle, what is the VA interval for AVRT?
<85 ms
When burst pacing in the ventricle you see the response: A-A-V, what is the arrhythmia?
AT
What’s the difference between WPW pattern and syndrome?
WPW syndrome is associated with symptoms
What is a major difference between manifest BTs and concealed BTs?
concealed BTs are only capable of retrograde conduction
When V1 is positive with a delta wave, where would we look for an accesory pathway?
left sided
