CARDIAC ARRHYTHMIA

Charn Sriratanasathavorn, MD,FACC

Her Majesty Cardiac Center
Siriraj Hospital, Mahidol University
SIMPLIFIED CARDIAC SYSTEM
 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

Automaticity Triggered Reentry

EnhancedAbnormal EADs DADs AnisotropyAnatomic

Functiona
Mechanism of triggered arrhythmias
Mechanism of triggered arrhythmias
Reentry arrhythmias
Reentry circuits
Re-entry circui
 CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
– Normal cardiac conduction system
– Cardiac arrhythmia mechanism
– Cardiac arrhythmia evaluation in clinical
practice
RELATIONSHIP OF INTRACELLULAR
POTENTIAL TO SURFACE EKG
 ่
การตรวจคลืนไฟฟ้ าหัวใจ (EKG,
ECG)
 ่
การตรวจคลืนไฟฟ้ าหัวใจ
(12 Lead Electrocardiogram, 12 Lead ECG)
SIMPLIFIED CARDIAC SYSTEM

ECG
 ่
คลืนไฟฟ้ าหัวใจขณะเกิด
อาการ
 CAROTID SINUS
HYPERSENSITIVITY
Holter Monitoring

?
?
 Cardiac Arrhythmia monitoring system

• Holter monitoring system

• Event recording system
• Loop recording system
– Non implantable
– Implantable
การตรวจสมรรถภาพหัวใจด ้วยการออก
กาลัง
(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

Treatment
 Cardiac Bradyarrhythmia-Rx
• Treatment strategy • Factors
• Short term Rx • Type of bradyarrhythmia
• Treat reversible /
underlying causes • Severity of symptoms
• Medication to increase
heart rate • Severity of underlying
• Temporary pacemaker cardiac pathology
• Long term Rx
• Permanent pacemaker • 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 Considering factors
RF ablation Type of tachyarrhythmia
Medication Mechanism of tachyarrhythmia
Anticoagulation Underlying Cardiovascular
Devices (pacemaker, AICD) pathology
Surgery 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