common cardiac arrhythmias 2 the complex arrhythmias mark earley, st bartholomew’s hospital

11
COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Upload: laurence-russell

Post on 17-Jan-2016

228 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

COMMON CARDIAC ARRHYTHMIAS 2the complex arrhythmias

COMMON CARDIAC ARRHYTHMIAS 2the complex arrhythmias

Mark Earley, St Bartholomew’s Hospital

Page 2: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Atrial Fibrillation (AF)Atrial Fibrillation (AF)

Page 3: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Paroxysmal AFParoxysmal AF

Page 4: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

AF – modern terminologyAF – modern terminology

FIRST EPISODE of AF

RECURRENT EPISODE of AF

PAROXYSMAL AF PERSISTENT AF

PERMANENT AF SINUS RHYTHM

Page 5: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

AF - aetiologyAF - aetiology

Page 6: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

AF – mechanism - chaosAF – mechanism - chaos

Page 7: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Mechanism of AF: focal v re-entryMechanism of AF: focal v re-entry

FOCAL RE-ENTRY (Circus movement)

1959-1964 Moe’s Hypothesis multiple random re-entry wavefronts

Page 8: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Mechanism - focal

Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. NEJM 1998; 339:659-66

Page 9: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Mechanism of AFMechanism of AF

Focal ‘triggers’

Multiple wavefronts

Page 10: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Mechanism of AFMechanism of AF

PAROXYSMAL

PERSISTENT

PERMANENT

Page 11: COMMON CARDIAC ARRHYTHMIAS 2 the complex arrhythmias Mark Earley, St Bartholomew’s Hospital

Preexcited AFPreexcited AF