1. Pr inciples of E P (His bundle, Mapping techniques) Dr. Meenu

2. PA – 4 wire

4. Prep Routine EP study 2 kinds of pacing: –ES < –Incremental <

6. SNRT

8. AES Protocol Uses

9. AV node antegrade conduction

10. AVN – decremental conduction

11. VES Uses : –1 –2 –3

16. Incremental A pacing – AV WCL

17. Incremental V pacing – VA WCL

18. Minimum protocol for diagnostic EP Measurement of basic intervals SNRT at BCLs of 800, 600, 500, 400, 350 ms V ES testing down to v refractoriness at BCLs of 600 and 400 ms Incremental V pacing from ~ > SR down to VA Wenkebach point or a min CL of 300 ms A ES testing down to refractoriness at BCLs of 600 and 400 ms Incremental A pacing from ~ > SR down to AV Wenkebach point or a min CL of 300 ms

20. AT- site of origin

21. AT - Mech Microreentry Focal: –Triggered activity –Abnormal automaticity

22. Typical A Fl – Macroreentrant RA circuit

23. Typical A Fl

25. AF

27. AVNRT – Dual AV N Pathways Fast Slow

29. A-H Jump Definition

30. AV N Reentry Typical AV N echo Initiation of AVNRT

33. V pre excitation – EP diagn overview Maneuvers to increase pre excitation Normalizn of abnormal QRS Change in pattern of A activn during V pacing (retrograde A activn sequence) – AP localisn Initiation of AVRT by APC To :manifest ( identify presence of) pre excitn + : aid localizn AP –Differential A pacing –Differential V pacing –Para Hisian pacing

34. Degree of pre excitn –Rel time for atr impulse to reach : AV N / AP –Time taken to conduct over : AV N / AP SR -- absent Delta –Concealed –Latent To incr pre excitn –Delay AV N –Differential A pacing

36. V pre excitation – EP diagn overview Maneuvers to increase pre excitation Normalizn of abnormal QRS Change in pattern of A activn during V pacing (retrograde A activn sequence) – AP localisn Initiation of AVRT by APC To :manifest ( identify presence of) pre excitn + : aid localizn AP –Differential A pacing –Differential V pacing –Para Hisian pacing

37. Normalizn with His ES

38. V pre excitation – EP diagn overview Maneuvers to increase pre excitation Normalizn of abnormal QRS Change in pattern of A activn during V pacing (retrograde A activn sequence) – AP localisn Initiation of AVRT by APC To :manifest ( identify presence of) pre excitn + : aid localizn AP –Differential A pacing –Differential V pacing –Para Hisian pacing

39. Retrograde atr activn – Concentric Eccentric

40. Ecc atr activn clearer (Other than VPCs) Adenosine block AV N Differential V pacing ( at site close to AP ) Observe orthodromic AVRT (retrogr exclusive over AP)

43. V pre excitation – EP diagn overview Maneuvers to increase pre excitation Normalizn of abnormal QRS Change in pattern of A activn during V pacing (retrograde A activn sequence) – AP localisn Initiation of orthodromic AVRT by APC To :manifest ( identify presence of) pre excitn + : aid localizn AP ( Shortest s -∆ interval ) –Differential A pacing – V – P His

45. Differential pacing

46. Unusual AP Rate dependent –Concealed –Anterograde Mahaim

47. VT PVS

48. Pace mapping

49. Activation mapping

52. 1 st AVB

55. 2 nd AVB

58. HVB

62. CHB

64. T hank you.