CARDIAC ARRHYTHMIA Charn Sriratanasathavorn, MD,FACC Her Majesty Cardiac Center Siriraj Hospital, Mahidol University

SIMPLIFIED CARDIAC SYSTEM ELECTRICAL BLOOD SUPPLY MUSCLE & VALVE

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 Abnormal impulse formation Abnormal impulse conduction Reentry Automaticity Triggered Enhanced Abnormal EADs DADs Anisotropy Anatomic Functional

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

การตรวจคลื่นไฟฟ้าหัวใจ (EKG, ECG)

การตรวจคลื่นไฟฟ้าหัวใจ (12 Lead Electrocardiogram, 12 Lead ECG)

SIMPLIFIED CARDIAC SYSTEM ELECTRICAL BLOOD SUPPLY ECG MUSCLE & VALVE

คลื่นไฟฟ้าหัวใจขณะเกิดอาการ

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

การตรวจสมรรถภาพหัวใจด้วยการออกกำลัง (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 BLOOD SUPPLY ELECTRICAL Treatment MUSCLE & VALVE

Cardiac Bradyarrhythmia-Rx 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 Tachyarrhythmia - Rx Strategies Short term treatment Electrical Therapy in unstable patients Cardioversion, Defibrillation Control ventricular rate Ventricular rate control Rhythm control: Medical / Electrical Identify and treat reversible causes Long term treatment RF ablation Medication Anticoagulation Devices (pacemaker, AICD) Surgery Considering factors Type of tachyarrhythmia Mechanism of tachyarrhythmia Underlying Cardiovascular pathology Local expertise Patient 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