Electrophysiology Flashcards
Loop monitors are indicated in syncope when a … was negative.
24h Holter monitor testing
Carotid sinus hypersensitivity causing syncope is treated with
AV dual chamber PPM
A long RR interval followed by a short RR initiates …
torsades de pointes
… is associated with a peculiar ECG pattern consisting of a pseudo-RBBB and persistent ST segment elevation in V1 to V3 and a related disorder, the sudden unexpected nocturnal death syndrome (SUNDS).
Brugada syndrome
If Valsalva maneuver stops the arrhythmia, … and … should be considered.
SV tachycardia / AV node tachycardia
… are a better alternative to Holter monitoring, with better yield and when they fail to diagnoses arrhythmias, an implantable event recorder should be placed.
Transtelephone monitors
Patients older than 50 or with heart dz should have an ECG done before starting Rx with lithium because it can cause… .
sick sinus syndrome
The drugs of first choice in orthostatic hypotension are…
fludrocortisone (Florinef) and midodrine (ProAmatine).
In the patient with a WCT and subtle, non-rate-related fluctuations or variations in QRS and ST-T wave configuration suggest …
VT and may reflect variations in the VT reentrant circuit within the myocardium.
Early repolarization, in an athlete … require additional evaluation (European Society of Cardiology - Eur Heart J 2009;Dec 22).
does not
Post catheter based ASD closure, the most common longer term complication is …
device erosion (0.1%, typically with oversized devices).
… is reasonable for treatment of recurrent ventricular tachycardia in patients post-MI with normal or near normal ventricular function who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good function
ICD implantation (Arrhythmias and the Prevention of Sudden Cardiac Death: ACC-AHA-ESC 2006 Guidelines)
An… (morphopathologic change) can be inferred from the presence of deep S in anterior leads and high R in the lateral leads.
enlarged LV diameter
A very low lead impedance (<250ohms) may indicate…
failure of lead insulation.
Lidocaine, a negative inotropic agent, can induce… in patients with total AVB.
asystole
Left posterior hemiblock is typically associated with a QRS axis of about…
+120°.
The antianginal therapy of choice in patients with supraventricular tachycardia is… (2 classes).
beta-blockers and nondihydropyridines (verapamil and diltiazem)
… is the only arrhythmic drug that has a beneficial effect on mortality and reduces the number of arrhythmic deaths in patients with low EF (CASCADE trial).
Amiodarone
After successful resuscitation of a cardiac arrest victim, this intervention is indicated if the patient remains comatose…
hypothermia at 32-34C.
Spontaneous VT without structural heart disease not amendable to drug therapy is class I indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
Patients with congenital long QT syndrome should have… available to take when having excessive sweating and diarrhea.
K+ supplement
Syncope of undetermined origin with EPS inducible VT/VF and ineffective drug therapy is class I indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
An unwitnessed in-hospital arrest with the initial rhythm not VT/VF and CPR for more than 10 minutes has a survival of… %.
0
The standard recommended dose for epinephrine is…
1mg IV q 3-5 minutes.
The standard recommended dose for atropine in ACLS is…
1mg IV q 3-5 minutes with maximum total 3mg.
The results of the ALIVE study show that… should be the drug of choice for shock resistant VF.
IV amiodarone
The immediate therapy in AF caused by pre-excitation with HR>250 or hemodynamic compromise is…
cardioversion.
In…, the anatomic substrate or abnormality is the presence of dual AV node pathways (slow and fast) each with slightly differing conduction and refractory periods.
AVNRT (AV node)
Patients with congenital long QT syndrome should not engage in…
competitive sport activities.
A dramatic improvement in the outcome of patients after CPR was obtained with… (CPR technique).
interposed abdominal compression
The usual dose of amiodarone is a… and infusion 1mg/min for 6 hours then 0.5mg/min to a maximum daily dose of 2 grams.
300mg rapid IV infusion with repeat 150mg doses PRN
… is the most effective drug for cholinergic-mediated bradycardia, hypotension and vagal reactions.
Atropine sulfate
A cardiac arrest due to VT/VF not related to a reversible cause is class I indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
Spontaneous sustained VT in association with structural heart disease is class I indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
In atypical AVNRT, the P wave is generally … in lead I
upright or isoelectric
Erythromycin has been shown to cause this EKG change…
prolong the QT interval
Mutations in the SCN2A gene (the gene that encodes the alpha subunit of the cardiac sodium channel gene, leading to Na channel inactivation) lead to two diseases associated with sudden death: one form of congenital long QT syndrome and the… syndrome.
Brugada
Because of the high success rate with catheter ablation in patients with AVN reentrant tachycardia, a… becomes the most common indication.
drug-free lifestyle
Symptomatic patients with WPW should undergo…
accessory pathway ablation.
A carotid hypersensitivity test is defined as cardioinhibitory when there is a pause greater then… seconds.
3
Antiarrhythmic agents with predominant… (Na channel blockers) are effective at converting and suppressing SVT and ventricular ectopy.
class I action
… is useful in atrial, AV junctional and ventricular tachyarrhythmias.
Quinidine
Class I action antiarrhythmic agents are associated with increased mortality in patients with…
structural heart disease.
… (drug) is particularly useful in AF with rapid conduction over an accessory pathway.
Procainamide
The correct way to check for carotid hypersensitivity is with the patient in upright position and pressing on the carotid bifurcation for… seconds.
5
Ibutilide is only available IV for the acute termination of…
AF/FL.
… (drug) is universally effective in reentrant arrhythmias that use the AVN as a portion of the circuit.
Adenosine
… is the most common form of paroxysmal SVT.
AVN reentrant tachycardia
The best indication for catheter ablation in patients with… is for the relief of symptoms in patients refractory or intolerant to vagal maneuvers and AVN blocking agents.
AVNRT
The cause of type I AV flutter is a… (direction) current around the tricuspid annulus seen from below the valve plane.
counterclockwise
After checking the ECG for LBBB and before checking for ST segment deviation, check for the …
RBBB
Systematic reviews have found that… reduces the risk of sudden death and marginally reduces mortality in people at high risk of arrhythmic death after myocardial infarction (based on low EF, frequent PVCs, or NSVT, but no history of sustained symptomati
amiodarone
One RCT has found good evidence that an… reduces mortality in people with heart failure who have experienced a near fatal ventricular arrhythmia.
implantable cardiac defibrillator
… is useless in the pre-excitation syndrome due to repolarization abnormalities.
Routine ECG stress test
Patients with QRSD>200ms on RV pacing for bradycardia and severely depressed EF and symptomatic CHF should be considered for…
CRT (cardiac resynchronization therapy).
If the diagnosis of pre-excitation syndrome is in doubt, recording an ECG during the administration of… exposes the accessory pathway conduction.
adenosine IV
The best candidates for… in AF are patients with frequent AF episodes and drug-refractory AF.
ablation
Patients in VT not responding to an antiarrhythmic drug should receive…
electrical cardioversion instead of other drug.
… is sustained AF, either resistant or not appropriate for, cardioversion.
Permanent AF
Typical… has a RBBB aspect with pseudo-r’ waves.
AVNRT
… is episodic AF caused by heavy alcohol consumption.
Holliday heart syndrome
In acute lead perforation, the lead should be…
withdrawn and repositioned.
… is the easiest IV drug to use for termination of a tolerated sustained VT.
Procainamide
A… accessory pathway of the pre-excitation syndrome is termed so if only retrograde conduction occurs.
“concealed”
The difference between the accessory pathway of the pre-excitation syndromes and normal AV conduction is that in… increasingly higher heart rate leads to decremental conduction.
AV conduction
The fundamental anatomic abnormality or substrate for… (tachycardia) is the presence of a second connection between the atria and ventricles (normally, the AV node is the only connection between atria and ventricles)
AVRT (Atrioventricular)
Neck pounding, caused by cannon waves is an important diagnostic clue thought to be practically pathognomonic for…
AVNRT.
… is the most common form of SVT associated with the pre-excitation syndrome.
Orthodromic AV re-entry tachycardia (retrograde conduction though the accessory pathway)
The reduction in all-cause mortality was… % in MADIT II in the patients treated with an ICD.
31
… is the most common etiology of sustained monomorphic VT.
CAD
Patients with chronic AF and bradycardia are the only ones in which… pacemaker mode is optimal.
VVI
Before exposure to electrocautery, patients with pacemakers should have the mode changed to… to prevent asystole.
VOO
Junctional tachycardias are SVTs that either originate from or require the… as a critical component of the tachycardia circuit.
AVN
A narrow-complex tachycardia with no p-waves and regular RR interval is…
AVNRT.
A narrow-complex tachycardia with p-waves and pseudo-r’ in lead V1 or pseudo-S wave in lead I is…
AVNRT.
The failure of vagal maneuver to terminate SVT leads to the use of…
adenosine.
The safe approach to… is to administer an antiarrhythmic agent that is effective at both ventricular and supraventricular level: Ia (quinidine and procainamide), Ic (propafenone), and III (amiodarone and sotalol).
wide-complex tachycardia
… syndromes are caused by an activation of part of the ventricle by an anomalous connection before the normal AV conducting system.
The pre-excitation
The therapy in symptomatic patients with pre-excitation syndrome is…
ablation.
After cardioversion, atrial stunning occurs and the likelihood of new thrombus formation is actually transiently enhanced, so anticoagulation is indicated in virtually all patients after cardioversion for …
1 month.
The optimal pacemaker mode for sinus node dysfunction with AVB is…
DDDR.
Asymptomatic cases of 3rd degree AVB need…
pacemaker implantation.
The… has a blood supply from the AVN artery, PDA and LCX.
LBB
The alternative pacemaker mode for sinus node dysfunction (optimal is AAIR) is…
AAI or DDDR.
The term bifascicular block is used in an association of RBBB with hemiblock of either of the two left fascicles, with the… one more common.
anterior
The ECG picture of a… is characterized by a small r wave followed by a deep S wave in leads I and aVL and showing a narrow initial q wave followed by a large R wave in leads II, III and aVF.
left posterior hemiblock
The first step before inserting a temporary pacemaker for poorly tolerated bradycardia is the infusion of IV agent like…
isoproterenol.
All symptomatic cases of AVB need…
pacemaker implantation.
Asymptomatic patients with BBB in whom pharmacologic therapy that could increase conduction delay is contemplated should undergo…
EPS.
The sinoatrial nodal artery is a proximal branch of RCA in 55-60% of patients and of… in the rest.
LCX
The alternative pacemaker mode for sinus node dysfunction with AVB (optimal is DDDR) is…
DDD.
In… sinoatrial exit block, several P waves will be dropped, but the total pause will be a multiple of the sinus cycle length.
high-grade
The optimal pacemaker mode for neurally mediated syndromes is…
DDI.
Asymptomatic cases of 2nd degree AVB, when the block is determined to be intra- or infra-His in origin or to be associated with BBB or bifascicular block need…
pacemaker implantation.
Patients with bifascicular or trifascicular block and syncope, without apparent 2nd or 3rd degree AVB should undergo…
EPS.
To differentiate between sinus tachycardia and reentrant SVT,… has a “warm up” and a “cool down” phase, rather then abrupt onset and termination.
sinus tachycardia
The ECG picture of a… is characterized by a qR wave in leads I and aVL, with leads II, III and aVF showing a small r wave followed by a deep S wave.
left anterior hemiblock
When a type II AVB is associated with a BBB, the disturbance is localized in the His-Purkinje system and is very likely to progress to…
symptomatic third degree AVB.
The alternative pacemaker mode for chronic AF with AVB (optimal is VVIR) is…
VVI.
The optimal pacemaker mode for chronic AF with AVB is…
VVIR.
The optimal pacemaker mode for sinus node dysfunction is…
AAIR.
When a pacemaker lead is placed in the RA,… (technique) is recommended as standard to avoid lead dislodgement.
active fixation
A very high lead impedance (>2000ohms) with high pacing threshold indicates…
lead fracture.
The correct way to check for orthostatic hypotension is checking BP and HR lying flat, immediately after standing and after… minutes of standing.
3
A carotid hypersensitivity test is defined as vasodepressor when there is a decrease in BP greater then… mmHg not associated with bradycardia.
50
The sinus node is located in the… between the SVC and right atrial appendage.
sulcus terminalis
In type… sinoatrial exit block, the PP intervals before the pause progressively lengthen with a Wenckebach-type periodicity.
I
In type… sinoatrial exit block, the PP intervals remain constant before the dropped P waves.
II
The AVN receives most of its blood supply from a dedicated ascending branch of the… in about 90% of people.
RCA
The term trifascicular block is used in an association of RBBB with left anterior or POSTERIOR hemiblock and…
prolonged PR interval.
In the setting of atropine- and dopamine-resistant bradyarrhythmias (when transcutaneous/venous pacing is not available),… (drug) is indicated.
isoproterenol
According to the British Pacing and EP Group (BPEG), elderly patients with chronic Möbitz type I AVB (Wenckebach block), whether symptomatic or asymptomatic, should be treated with…
permanent pacing.
Patients with bifascicular or trifascicular block and syncope, without apparent 2nd or 3rd degree AVB and no cause for syncope detected with EPS should undergo…
permanent pacemaker placement.
… should be instituted when the 2nd or 3rd degree ABV persists for more then 8-10 days after AMI.
Permanent pacing
Adenosine triphosphate (ATP) is an effective agent for terminating AVNRT, mainly by producing antegrade block in the … pathway.
slow
Asymptomatic trifascicular block is an indication for …
no workup or intervention.
AVNRT is most often initiated by… , which results in sudden prolongation of the PR interval in the premature beat since the impulse travels down the slow rather than the fast pathway.
a premature atrial depolarization
Increased vagal tone can cause termination of AVNRT by slowing antegrade conduction in the …
slow pathway
It is possible that a train of impulses at a rate faster than the spontaneous ventricular nodal reentrant tachycardia (AVNRT) can gain control of the reentrant pathway and accelerate the arrhythmia, a phenomenon called …
entrainment.
The prognosis is generally … in idiopathic LV tachycardia.
very good, but if occurrences are frequent, there is risk of developing cardiomyopathy.
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common arrhythmia, accounting for approximately … of cases of paroxysmal supraventricular tachycardia.
two-thirds
One pathway of dual AV nodal electrophysiology conducts rapidly and has a relatively long refractory period is often called the fast or …
beta pathway
The circuit can become repetitive with antegrade conduction down the slow pathway and retrograde conduction up the fast pathway resulting in a sustained tachycardia, the so-called slow-fast pathway type of AVNRT or the …
common form of AVNRT.
The … form of AVNRT is associated with a P wave that appears shortly before the QRS complex.
uncommon
… (class III antiarrhythmic) is usually effective in suppressing idiopathic LV tachycardia.
Amiodarone
One of the dual AV nodal electrophysiology pathway conducts relatively slowly and has a shorter refractory period is often called the slow or …
alpha pathway
The uncommon form of AVNRT, affects … percent of patients.
20
Negative T waves newly acquired after the termination of AVNRT commonly are seen in the … leads and were present in about 40 percent of patients in one study
anterior or inferior
The common form of AVNRT, affects … percent of patients.
80 to 90
Entrainment followed by the cessation of pacing can be used to terminate …
the atrioventricular nodal reentrant tachycardia (AVNRT)
The electrocardiogram in the … form of AVNRT shows a supraventricular tachycardia in which the P wave is buried in the QRS complex or occurs slightly before or slightly after the QRS complex, often in fusion with the QRS complex
common
NSVT with CAD, prior AMI, LVD, EPS inducible VT/VF and ineffective class I antiarrhythmic agent therapy is class I indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
AV junctional reentrant tachycardia, reciprocal or reciprocating AV nodal reentrant tachycardia, and junctional reciprocating tachycardia are other synonyms for …
atrioventricular nodal reentrant tachycardia (AVNRT).
The rate of AVNRT is generally between … beats/minute.
120 to 220
Significant ST segment depression during tachycardia (representing either repolarization changes or a retrograde atrial activation) has been observed in 25 to 50 percent of patients with AVNRT, although it is more commonly seen in those with an AV reentra
an accessory pathway
If there is no hemodynamic compromise, the recommended approach to acute termination of AVNRT should begin with …
vagotonic maneuvers such as the Valsalva maneuver or carotid sinus massage.
Negative T waves newly acquired after the termination of AVNRT may be seen immediately upon termination or may develop within the first … hours, and can persist for a variable duration (mean of 34 hours).
six
In hypertrophic cardiomyopathy, the post-extrasystolic potentiation of the resting outflow gradient observation confirms …
severe outflow tract obstruction.
… is usually effective in terminating idiopathic LV tachycardia, although it should be reserved for very specific types of tachycardia in the absence of heart disease.
IV verapamil
The RBBB and left axis deviation, coupled with the absence of heart disease are clues to … (arrhythmia).
idiopathic LV tachycardia.
A recent study indicates that intravenous… followed by direct-current cardioversion results in a 100% success rate in restoring sinus rhythm in atrial fibrillation.
ibutilide (Corvert®)
The therapy for lone atrial fibrillation in a patient without risk factors and younger than 65 years old is…
ASA.
Atrial fibrillation with a rapid ventricular response rate is a risk factor for sudden death in WPW syndrome and warrants early… therapy.
ablation
… pacing is preferred for patients with bradycardia-tachycardia syndrome.
Dual chamber
Patients with syncope or ventricular tachycardia are at risk for… during pregnancy.
sudden death
… (antiarrhythmic) has been associated with serious adverse events such as severe hypotension and torsades de pointes.
Flecainide (Tambocor™, Classs Ic)
Three RCTs in people with atrial fibrillation of up to 7 days’ duration found no significant difference between… and placebo in conversion to sinus rhythm but two of the RCTs found that… reduced ventricular rate after 30 minutes and after 2 hours.
digoxin
The drugs likely to be beneficial for reducing ventricular rate in patients with… were Digoxin, Diltiazem, Timolol, and Verapamil.
atrial fibrillation
The use of antiarrhythmic drugs in the treatment of MAT has generally been disappointing. There is, however, evidence of benefit with… (drug and class).
verapamil and beta blockers
Patients with mild hyperthyroidism (normal T4 and free T4 and suppressed TSH) are at risk for this CV disease… (especially when TSH<0.1).
atrial fibrillation
… (electrolyte imbalance) decreases the threshold for nerve depolarization leading to paresthesias, tetany, and, in severe cases, seizures.
Acute hypocalcemia
More than 80 percent of patients with documented… (condition causing tachycardia) have imaging abnormalities of right ventricular size or function, or Doppler abnormalities of tricuspid regurgitant flow velocity.
PE - accuracy may be even greater in cases of massive PE
… can occur in DM patients with advanced autonomic neuropathy causing a fixed heart rate at 80-90/min and associated with painless AMI and sudden death.
Cardiac denervation
Lyme disease with high degree AVB and PR>0.3 sec need therapy with… (ABx).
IV beta-lactams.
Patients with heart disease and unexplained… (symptom) who have ventricular tachycardia (VT) induced by electrophysiologic testing have a similar rate of VT recurrence (documented by stored electrograms from an implantable cardioverter-defibrillator) as
syncope
… is a common cause of syncope in patients with structural heart disease.
Paroxysmal VT
In a well-designed, Canadian, double-blind, controlled trial (NCT01235130), researchers randomized 337 patients with paroxysmal or persistent AF to 4 g of omega-3 fatty acids daily or to placebo in order to determine if it impacts to atrial fibrillation (AF) burden
Symptomatic or asymptomatic AF occurred in 64% of fish oil recipients and 63% of placebo recipients. No group differences were found in the secondary outcomes of levels of high-sensitivity C-reactive protein and myeloperoxidase, markers of inflammation and oxidative stress.
Data on more than 122,000 patients (mean age, 72) with newly diagnosed AF who were treated in the Veterans Affairs health system between 2004 and 2008; about 23% of patients received digoxin within 90 days of diagnosis for its impact on mortality
During follow-up of roughly 3 years, cumulative all-cause mortality was significantly higher among digoxin recipients than among nonrecipients (95 vs. 67 deaths per 1000 person-years), even after adjustment for important clinical variables
