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

2. SIMPLIFIED CARDIAC SYSTEM
ELECTRICAL
BLOOD SUPPLY
MUSCLE & VALVE

3. CARDIAC ARRHYTHMIA Cardiac Arrhythmia Cardiac Bradyarrhythmia
Cardiac Tachyarrhythmia

4. CARDIAC ARRHYTHMIA
Cardiac Arrhythmia
Normal cardiac conduction system

5. NORMAL CARDIAC CONDUCTION SYSTEM
Impulse formation
Impulse conduction

6. NORMAL CARDIAC CONDUCTION SYSTEM

13. THE AUTOMACITY OF SINUS NODE

14. ANS and Sinus Node Function

15. NORMAL CARDIAC CONDUCTION SYSTEM
Impulse formation
Impulse conduction

17. CARDIAC ARRHYTHMIA Cardiac Arrhythmia Normal cardiac conduction system
Cardiac arrhythmia mechanism

18. Mechanism of Bradyarrhythmias
Abnormal impulse formation
decrease impulse formation
Abnormal impulse conduction
conduction block

20. Mechanism of Tachyarrhythmia
Abnormal impulse formation
Abnormal impulse conduction
Reentry
Automaticity
Triggered
Enhanced
Abnormal
EADs
DADs
Anisotropy
Anatomic
Functional

22. Mechanism of triggered arrhythmias

23. Mechanism of triggered arrhythmias

24. Reentry arrhythmias

25. Reentry circuits

26. Re-entry circuit

27. CARDIAC ARRHYTHMIA Cardiac Arrhythmia Normal cardiac conduction system
Cardiac arrhythmia mechanism
Cardiac arrhythmia evaluation in clinical practice

28. RELATIONSHIP OF INTRACELLULAR POTENTIAL TO SURFACE EKG

33. การตรวจคลื่นไฟฟ้าหัวใจ (EKG, ECG)

34. การตรวจคลื่นไฟฟ้าหัวใจ (12 Lead Electrocardiogram, 12 Lead ECG)

35. SIMPLIFIED CARDIAC SYSTEM
ELECTRICAL
BLOOD SUPPLY
ECG
MUSCLE & VALVE

36. คลื่นไฟฟ้าหัวใจขณะเกิดอาการ

38. CAROTID SINUS HYPERSENSITIVITY

39. Holter Monitoring ?

40. ?

41. Cardiac Arrhythmia monitoring system
Holter monitoring system
Event recording system
Loop recording system
Non implantable
Implantable

42. การตรวจสมรรถภาพหัวใจด้วยการออกกำลัง (Exercise Stress Test)

43. ABNORMAL HEART RATE RESPONSE

44. Electrophysiologic study

45. Prolonged Sinus node recovery time

49. Atrioventricular Reciprocating Tachycardia (AVRT)

50. Typical Atrioventricular Nodal Reentry tachycardia ( AVNRT)

51. CARDIAC ARRHYTHMIA Cardiac Arrhythmia Normal cardiac conduction system
Cardiac arrhythmia mechanism
Cardiac arrhythmia evaluation in clinical practice
Cardiac arrhythmia treatment concept

52. SIMPLIFIED CARDIAC SYSTEM
BLOOD SUPPLY
ELECTRICAL
Treatment
MUSCLE & VALVE

53. 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

54. 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

55. CARDIAC ARRHYTHMIA Cardiac Arrhythmia in general
Normal cardiac conduction system
Cardiac arrhythmia mechanism
Cardiac arrhythmia evaluation in clinical practice
Cardiac arrhythmia treatment concept

56. Thank you for your attention