CARDIAC ARRHYTHMIA

Charn Sriratanasathavorn, MD,FACC

Her Majesty Cardiac Center

Siriraj Hospital, Mahidol University

SIMPLIFIED CARDIAC SYSTEM

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia

• Cardiac Bradyarrhythmia

• Cardiac Tachyarrhythmia

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia– Normal cardiac conduction system

NORMAL CARDIAC CONDUCTION SYSTEM

• Impulse formation

• Impulse conduction

NORMAL CARDIAC CONDUCTION SYSTEM

THE AUTOMACITY OF SINUS NODE

ANS and Sinus Node Function

NORMAL CARDIAC CONDUCTION SYSTEM

• Impulse formation

• Impulse conduction

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism

Mechanism of Bradyarrhythmias

• Abnormal impulse formation–decrease impulse formation

• Abnormal impulse conduction

–conduction block

Mechanism of Tachyarrhythmia

Anatomic

Abnormal impulse conduction

Automaticity Triggered Reentry

FunctionalEnhanced

Abnormal impulse formation

AbnormalEADs DADsAnisotropy

Mechanism of triggered arrhythmias

Mechanism of triggered arrhythmias

Reentry arrhythmias

Reentry circuits

Re-entry circuit

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical

practice

RELATIONSHIP OF INTRACELLULAR POTENTIAL TO SURFACE EKG

การตรวจคลื่�นไฟฟ�าหั�วใจ (EKG, ECG)

การตรวจคลื่�นไฟฟ�าหั�วใจ (12 Lead Electrocardiogram, 12 Lead ECG)

SIMPLIFIED CARDIAC SYSTEM

ECG

คลื่�นไฟฟ�าหั�วใจขณะเก�ดอาการ

CAROTID SINUS HYPERSENSITIVITY

Holter Monitoring

?

?

Cardiac Arrhythmia monitoring system

• Holter monitoring system

• Event recording system

• Loop recording system– Non implantable– Implantable

การตรวจสมรรถภาพหั�วใจด�วยการออกก!าลื่�งการตรวจสมรรถภาพหั�วใจด�วยการออกก!าลื่�ง(Exercise Stress Test)(Exercise Stress Test)

ABNORMAL HEART RATE RESPONSE

Electrophysiologic study

Prolonged Sinus node recovery time

Atrioventricular Reciprocating Tachycardia (AVRT)

Typical Atrioventricular Nodal Reentry tachycardia ( AVNRT)

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical

practice– Cardiac arrhythmia treatment concept

SIMPLIFIED CARDIAC SYSTEM

Treatment

• Treatment strategy• Short term Rx• Treat reversible /

underlying causes• Medication to increase

heart rate• Temporary pacemaker• Long term Rx• Permanent pacemaker

• Factors• Type of bradyarrhythmia

• Severity of symptoms

• Severity of underlying cardiac pathology

• Severity of co-morbid diseases

Cardiac Bradyarrhythmia-Rx

Cardiac Tachyarrhythmia - Rx Strategies

Long term treatmentRF ablationMedicationAnticoagulationDevices (pacemaker, AICD)Surgery

Short term treatmentElectrical Therapy in unstable patients

Cardioversion, Defibrillation

Control ventricular rateVentricular rate controlRhythm control: Medical / Electrical

Identify and treat reversible causes

Considering factorsType of tachyarrhythmiaMechanism of tachyarrhythmiaUnderlying Cardiovascular pathologyLocal expertisePatient factors

CARDIAC ARRHYTHMIA

• Cardiac Arrhythmia in general– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical

practice– Cardiac arrhythmia treatment concept

Thank you for your attention