Electrophysiology Flashcards
Typical flutter
Counterclockwise. Down in 2,3 and avf.
Cardio version for Afib/flutter
Ok within 48 hours. Otherwise need to wait 3 weeks or negative tee. Need to stay on afterwards.
What is optimal rate control
Less than 100 or less than 120 with exercises
No need to intervene in pauses unless symptoms.
Af Chf trial
No difference in rate versus rhythm control in any outcomes with pharmacologic therapy.
Andromeda
More deaths in HF patients on dronederone
Av junctional ablation in HF patient
Do crrt
Guidelines for stable vt
Procainamide or amiodarone.
Nexterone no hypotension
Most common cause of polymorphic vt
Bradycardia and ischemic
Secondary prevention trials
Avid, cids and cash
Rrr of 30%
Differences between madit 2 and scd heft
Madit prior mi ef < 30
Both showed a rrr of around 30%
Cabg patch
No benefit post cabg
Guideline: no icd for primary prevention within 90 days of revascularization
Indications for icd primary prevention
Madit ef < 30, prior mi Nyha class 2,3 ef <35 3 months minimum after dx
Trials to establish CRT
Companion: optimal med therapy vs CRT pacing, CRT d.
Resynch decreased heart failure
care HF: just pacing still improved outcomes. Including sudden death.
How does scar impact CRT
Less scar the better. Non ischemics better than ischemics
Indications for CRT
Qrs >130 Ischemic class I or non ischemic class II
How to optimize CRT
- Fix anything you can
2. Are they lv pacing?
Lv pacing on EKG
R/s > 1 n v1
R/s in 1 < 1
When not to do icd
Cabg or pic within 3 months
Acute mi within 40 days
Candidate for revascularization.
Madit CRT
Enrollment
Primary outcome
Class I HF
Ef 130
Either death or HF events
Avid cash and cids
What wre they
Which ones in HF patients
Rrr?
Avid was in low Ef
AICD versus antiarrhythmics
Arr around 7%
Madit 1
Groups
Arr
Hx of Icshemic with Ef <35
Asymptomartic Nsvt with inducible vt
Arr 19%
Scd heft
Inclusion
Results:
Ischemic or non ischemic
Ef < 35%
Class 2-3
Arr 7 Nnt 14
Companion
CRT d vs CRT p vs control in EF 120
Both improved outcomes. No mortality benefit
Which icd CRT trial improved mortality
Care hf
