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
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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
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