electrophysiological
study
Dr Mervat Aboulmaaty
Prof. of Cardiology, Ain Shams University
Dr Rehab Hamdy
Lecturer of Cardiology, Alazhar University
2014
The normal conductive system
of the heart
His
SAN
AVN
Objectives
General objectives of EP-study
4 312 1
Dist.
Prox.
CS
catheter
Subclavian
venous sheath
Ablator
Temp:
time:
Impedence:
Ablation catheter
Indifferent electrode
Catheter position
SVT VT
HRA SAN HRA
His AV cond His
RVA RVA +/- LVA
CS SCV/IVC
HRA
HIS
CS
RV
Catheter position
RAO LAO
His
ABL CS
CS
ABL
RV
Catheters projection in RAO and LAO views
Cs catheter (deflectable) inserted through IVC
LAO 20 Pole mapping catheter catheter
(HALO) and long sheaths for stability
Halo
catheter
mapping the
RA
ABL
CS
Long
Sheath His
Ablation Catheters
Measurements
550 A
HRA 400
S1
S1 580
A
Recovery interval= time of paced beat penetrates & resets SAN+SCL+time for spont.
Beat to exit SAN = SCL+ 2 SACT SACT=580-450/2 = 65 msec
Tests of AVN function
AV
Atrial pacing
Weckebach AV block
RA A A A A
HIS
H
HIS
V V V
RV
Basic intracardiac ECG
Atrial pacing, Wenckebach more yellow than purple
Atrial Extrastimulation
To measure AVN/ERP
Atrial Extrastimulation
to measure AVN/ERP
Atrial Extrastimulation
AVN/ERP 500/280 msec
V pacing
To measure retrograde AVN
or detect AP
AV VA
1:1 VA cond. Retrograde sequence of activation
Concentric
VA VA VA
A A A A A
V V V
PCL=260 msec
Ventricular
Extrastimulation S1 S2
V1 V2
A1 A2
Ventricular
Extrastimulation
Decremental conduction
V1
V2
A2
A1
Ventricular Extrastimulation :
ERP of retrograde limb of AVN
V1 S2 No V
A1
Ventricular Tachycardia Study
Induction by Extra stimulus and
termination by Overdrive Pacing
The CARTO XP System
Components
• Patient Interface Unit (PIU)
• PC Windows NT 4
Workstation
• Location Pad
(external, ultra-low magnetic
field emitter.)
47
Location Pad
An External Ultra-Low
Magnetic Field Emitter
48
Catheter Tip Location
The Fields possess
Temporal and spatial The Triangulation Principle
distinguishing
characteristics
D1 D3
D2
49
Two Sensors: REF and
MAP
Mapping Catheter Mapping Catheter
Reference Reference
Patch Patch
50
Carto Concept:
Sequential Contact Mapping of
Endocardium
51
What is new ??!!
Patient with LVOT VT .CARTO 3 Mapping
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