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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
AVRT and AVNRT can usually be distinguished on the ECG, especially when the tachycardia of AVRT is conducted through the concealed pathway and retrogradely through the AV node (antidromic AVRT) where the QRS complexes are broad. If the tachycardia is in AF, then a characteristic broad complex tachycardia that is irregularly irregular develops (pre-excited AF). Both AVRT and AVNRT can be provoked by specific stimuli such as exertion, caffeinated drinks and alcohol. Treatment involves a cardiac electrophysiology study and ablation of the accessory pathway (in AVRT) or one arm of the dual AV node pathways (in AVNRT).
Restraint and control techniques
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
There is some evidence that inspiratory activity may be severely compromised. TASER® devices are used in physically and emotionally charged settings. These factors in isolation have the potential to precipitate adverse cardiac or cerebrovascular events in individuals suffering from clinically diagnosed or subclinical cardiovascular disease. Frequently alcohol, illicit drugs or prescribed drug intoxication may be present in association with acute mental health crises. All have the potential to increase the risk of cardiopulmonary arrest, even in the absence of TASER® use. The UK government's independent advisory committee on the medical implications of less-lethal weapons took the view that it would be prudent to assume that there is a possibility that, in some situations, it would be possible for rapid ventricular capture to be induced. This may be less of an issue for a young, healthy individual, but could be significant in those with diseased hearts or who have taken illicit or prescription drugs which have intrinsic effects on cardiac electrophysiology or coronary perfusion. Such devices can assist in the safe and proper enforcement of law. However, it is important that any current and new technologies being introduced as less-lethal options are appropriately and robustly tested and scrutinised in a scientifically credible manner to reassure a sometimes appropriately cynical and sceptical general public. Unfortunately, some devices are deployed without appropriate review.
Catheter ablation therapy
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Preparation for a CAT procedure often begins well in advance of the procedure itself. As much confirmatory information about the arrhythmia requiring ablation, in the form of an electrocardiogram (ECG), Holter monitor or other cardiac monitor data, should be gathered before the procedure to confirm the type of arrhythmia requiring ablation, to confirm that it is amenable to ablation and to understand the location from which the arrhythmia originates so as to determine the ablation site. Despite this exhaustive preparatory work, often further invasive intra-cardiac electrophysiology studies with provocative testing to try to induce the arrhythmia in question are required to gather sufficient information prior to the ablation.
Computational modelling of mechano-electric feedback and its arrhythmogenic effects in human ventricular models
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Yongjae Lee, Barış Cansız, Michael Kaliske
Computational heart modelling has drawn attention as a valuable instrument as it overcomes the difficulties of classical in-vivo research on cardiology. Firstly, there are no constraints in terms of ethics thanks to non-invasive experiments with virtual hearts. Secondly, the measurement errors could be reduced in computer simulations. For example, dynamically changing nature of a beating heart leads experimental studies to be prone to electrical, mechanical and chemical measurement errors. Thirdly, computational heart simulations can probe the important mechanisms and their relationships, so that they help cardiologists and engineers to comprehend the mechanisms in detail. In other words, each mechanism behind cardiac electrophysiology can be integrated into or excluded from the heart simulations, which is not able to be implemented through existing medical monitoring tools, thereby the influence of mechanisms on the overall function of the heart and on its treatment can be clearly elucidated. Thus, computational heart modelling is an essential supplementary tool for modern cardiology in order to help understanding how the heart functions in a quantitative way.
Comparison of ventricular repolarization parameters of Covid-19 patients diagnosed with chest CT and RT-PCR
Published in Acta Cardiologica, 2021
Ersin Ibisoglu, Bedrettin Boyraz
Regarding the risk of developing arrhythmia, the repolarization phase provides important determination and is an important predictor of arrhythmia in cardiac electrophysiology. In terms of 12-lead ECG, the QT interval is also important and is largely determined by the duration of repolarization, which corresponds to the JT interval. Therefore, the JT interval is more effective than the QT in measuring ventricular repolarization [19]. Furthermore, the prediction of incident cardiovascular events was better with the JT interval than with the QT interval [20,21]; the QT interval, JT interval, and Tp-e measurements, which are the main predictors of ventricular arrhythmia, and the relationship between QT and JT intervals are useful parameters indicating whether patients are susceptible to ventricular arrhythmia [8,22,23].
Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review
Published in Expert Review of Medical Devices, 2020
Miraj Desai, Omar Kahaly, Adil Aslam, Jonnie Saifa-Bonsu, Maham Usmani, Toshimasa Okabe, Muhammad R. Afzal, Mahmoud Houmsse
Cardiac electrophysiology (EP) focuses on the evaluation, treatment, and prevention of abnormal cardiac arrhythmias, sudden cardiac death, and device therapies for brady and tachyarrhythmias. The majority of medical conditions seen by a cardiac electrophysiologist are managed by endovascular access in the EP laboratory, including diagnostic EP studies, catheter-based mapping/ablation, implantation of left atrial appendage occlusion devices, and implantation or extraction of cardiac implantable electronic devices (CIED). To safely navigate diagnostic and ablation catheters within a patient and accurately implant CIEDs, fluoroscopy is typically used for real-time visualization during procedures. Overall, fluoroscopy-guided interventional cardiac EP procedures have been extremely useful for treating patients, and the use of such systems has increased more than tenfold in the last decade [1]. The drastic increase in the number of cardiac EP procedures being conducted has raised the concern of radiation exposure for operating electrophysiologists, patients, and ancillary lab staff. This review summarizes the complications of radiation exposure and comprehensive strategies to minimize radiation exposure.