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Pr inciples of E P (His bundle, Mapping techniques). Dr. Meenu. PA – 4 wire. Prep Routine EP study 2 kinds of pacing: ES < Incremental <. SNRT. SNRT. AES. Protocol Uses. AV node antegrade conduction. AVN – decremental conduction. VES. Uses : 1 2 3.
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Pr inciples of EP (His bundle, Mapping techniques) Dr. Meenu
Prep • Routine EP study • 2 kinds of pacing: • ES < • Incremental <
AES • Protocol • Uses
VES • Uses : • 1 • 2 • 3
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
AT - Mech • Microreentry • Focal: • Triggered activity • Abnormal automaticity
AV N ReentryTypical AV N echo Initiation of AVNRT
AV N ReentryTypical AV N echo Initiation of AVNRT
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
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
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
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
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)
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
Unusual AP • Rate dependent • Concealed • Anterograde Mahaim
VT • PVS