Bennetts Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment

A trusted source for junior doctors, students, nurses and cardiac technicians for over 30 years, the new edition of this classic reference continues the winning formula of previous editions while at the same time incorporating essential new content on today’s most important clinical topics, including: • Atrial fibrillation: ablation, drugs, rate control versus rhythm control, risk of systemic embolism, prognosis • Indications for and management of implantable defibrillators including complications such as arrhythmia storms • Indications for pacemaker implantation • Anticoagulant therapy (for atrial fibrillation) • Long QT syndromes and other channelopathies • Recently–approved anti–arrhythmia drugs The 8th edition also features the latest guidelines on ECG screening of athletes and clear guidance for anaesthetists and surgeons dealing with patients with arrhythmias and/or implantable devices. Rich with example ECGs and designed for ease of access to information, Bennett’s Cardiac Arrhythmias is the reference you can trust to help you master arrhythmia diagnosis and provide optimal treatment of any patient under your care Reviews of previous editions: ‘ …a well conceived practical guide to the interpretation and treatment of the main cardiac rhythm disturbances’ Lancet ‘ This book presents a concise and simplified approach to the diagnosis and management of abnormalities in cardiac rhythm…One of the book’s strengths is the number and quality of electrocardiographic tracings’ New England Journal of Medicine ‘ …this book provides an excellent foundation for all those involved in the care of arrhythmia patients’ British Journal of Hospital Medicine ‘ …would recommend it unreservedly to anaesthetists who wish to improve their knowledge of cardiac arrhythmias’ British Journal of Anaesthesia ‘ This book about cardiac arrhythmias is of much educational value’ European Heart Journal

Preface, vii Notes, viii 1 Sinus Rhythm, 1 ECG characteristics, 1 Sinus bradycardia, 4 Sinus tachycardia, 4 Sinus arrhythmia, 5 2 Ectopic Beats, 6 Prematurity, 6 Atrial ectopic beats, 8 Atrioventricular junctional ectopic beats, 9 Ventricular ectopic beats, 10 3 Escape Beats, 15 Timing, 15 Origins, 16 4 Bundle Branch and Fascicular Blocks, 17 Right bundle branch block, 17 Left bundle branch block, 18 Left anterior and posterior fascicular blocks, 19 5 The Supraventricular Tachycardias, 24 Main types, 24 Atrial origin versus atrioventricular re–entry, 25 Effects of supraventricular tachycardias, 26 6 Atrial Fibrillation, 29 ECG characteristics, 29 Causes, 33 Prevalence, 34 Prognosis, 34 Classification, 34 Management, 35 Systemic embolism, 35 Rhythm management, 38 7 Atrial Flutter, 44 Common atrial flutter, 44 Causes, 49 Prevalence, 49 Treatment, 49 Systemic embolism, 51 8 Atrial Tachycardia, 52 ECG characteristics, 52 Causes, 54 Treatment, 55 Multifocal atrial tachycardia, 55 9 Atrioventricular Junctional Re–entrant Tachycardias, 56 Mechanism, 56 ECG characteristics, 57 Clinical features, 62 Treatment, 63 10 Wolff–Parkinson–White Syndrome, 67 Pre–excitation, 67 ECG characteristics, 68 Arrhythmias, 69 Treatment, 72 11 Ventricular Tachyarrhythmias, 77 Ventricular tachycardia, 77 Ventricular fibrillation, 78 Supraventricular versus ventricular tachycardia, 78 12 Monomorphic Ventricular Tachycardia, 79 ECG characteristics, 79 Causes, 81 Mechanisms of ventricular tachycardias, 81 Investigations, 83 Treatment, 85 Coronary heart disease, 88 Hypertrophic cardiomyopathy, 88 Arrhythmogenic right ventricular cardiomyopathy, 89 Dilated cardiomyopathy, 92 Ventricular tachycardias not due to structural heart disease, 92 Non–sustained ventricular tachycardia, 97 Accelerated idioventricular rhythm, 97 13 Polymorphic Ventricular Tachycardia and Ventricular Fibrillation, 98 Polymorphic ventricular tachycardia, 98 Torsade de pointes tachycardia, 99 Hereditary long QT syndromes, 102 Ventricular fibrillation, 106 14 Tachycardias with Broad Ventricular Complexes, 115 Causes of a broad complex tachycardia, 115 Useless guidelines, 116 Useful guidelines, 116 15 Atrioventricular Block, 123 Classification, 123 Causes of atrioventricular block, 127 Atrioventricular dissociation, 128 Bilateral bundle branch disease, 128 Clinical aspects of atrioventricular block, 130 Treatment, 131 16 Sick Sinus Syndrome, 132 Causes, 132 ECG characteristics, 133 Clinical features, 135 Diagnosis, 135 Treatment, 136 17 Neurally Mediated Syncope, 137 Malignant vasovagal syndrome, 137 Carotid sinus syndrome, 141 Postural orthostatic tachycardia syndrome, 141 Causes of syncope, 142 18 Arrhythmias due to Myocardial Infarction, 143 Ventricular fibrillation, 144 Ventricular tachycardia, 146 Reperfusion arrhythmias, 146 Arrhythmias subsequent to recent myocardial infarction, 146 Long–term significance of ventricular arrhythmias, 147 Accelerated idioventricular rhythm, 147 Supraventricular tachycardias, 148 Sinus and junctional bradycardias, 148 Atrioventricular block, 149 19 Antiarrhythmic Drugs, 152 Limitations, 152 Choice of treatment, 153 Modes of action, 153 Notes on individual drugs, 154 Antiarrhythmic drugs during pregnancy, 166 20 Sudden Cardiac Death, 167 Definition, 167 Causes of arrhythmic sudden death, 168 Aborted sudden cardiac death, 169 Athletic activities, 169 21 Cardioversion, 171 Transthoracic cardioversion, 171 Transvenous cardioversion, 174 22 Ambulatory ECG Monitoring, 176 Continuous ECG recording, 176 Intermittent ECG recording, 183 23 Cardiac Pacing, 187 Long–term cardiac pacing, 187 Common indications for long–term pacing, 187 Pacing modes, 190 Pacemaker hardware, 200 Pacemaker implantation, 202 Pacemaker clinic, 215 Electromagnetic interference, 215 Other precautions, 217 Temporary cardiac pacing, 218 24 Implantable Cardioverter Defibrillators, 221 Defibrillator implantation, 223 Indications for ICD implanation, 224 Defibrillator function, 226 Precautions, 233 25 Catheter Ablation, 234 Procedure, 234 Wolff–Parkinson–White syndrome, 237 Typical atrioventricular nodal re–entrant tachycardia, 241 Atrial tachycardia, 243 Atrial flutter, 244 Atrial fibrillation, 244 Atrioventricular nodal ablation, 245 Right ventricular outflow tract tachycardia, 247 Fascicular ventricular tachycardia, 248 Ventricular tachycardia due to structural heart disease, 249 Catheter ablation: what should the patient expect? 250 26 Arrhythmias for Interpretation, 252 Questions, 252 Interpretations and answers, 307 Index, 317

David H. Bennett , Senior Consultant Cardiologist, Regional Cardiac Centre, University Hospital of South Manchester & Honorary Clinical Lecturer in Cardiology, University of Manchester

“All in all, I found this book a pleasure to read.  It is very practical, it is very clear, and best of all, it is extremely well illustrated.”  ( British Journal of Anaesthesia , 1 March 2014) “This all makes this book a reference for a large variety of health care professionals and a good foundation for those needing a broad and thorough approach to the diagnosis and the most appropriate management of cardiac arrhythmias.”  ( British Journal of Cardiology , 1 March 2014) “This is an excellent book for clinicians at various levels of comfort with electrocardiograms and telemetry, given that it starts with basic overviews of broad categories followed by detailed descriptions of individual arrhythmiasence.”  ( Doody’s , 16 September 2013)