Cardiac Arrhythmias8th EditionDavid H. Bennett

Practical Notes on Interpretation and Treatment

Bennetts

Bennett Bennetts Cardiac Arrhythm

ias 8th Edition

Reviews of previous editions:

a well conceived practical guide to the interpretation and treatment of the main cardiac rhythm disturbances Lancet

This book presents a concise and simplified approach to the diagnosis and management of abnormalities in cardiac rhythmOne of the books strengths is the number and quality of electrocardiographic tracings New England Journal of Medicine

this book provides an excellent foundation for all those involved in the care of arrhythmia patients British Journal of Hospital Medicine

would recommend it unreservedly to anaesthetists who wish to improve their knowledge of cardiac arrhythmias British Journal of Anaesthesia

This book about cardiac arrhythmias is of much educational value European Heart Journal

Also of Interest:Bayes de Luna: Clinical Arrhythmology; ISBN: 978-0-470-65636-5Kusumoto: Understanding Intracardiac EGMs and ECGs; ISBN: 978-1-4051-8410-6

Bennetts Cardiac Arrhythmias Practical Notes on Interpretation and Treatment, 8th EditionDavid H. Bennett MD FRCP, Senior Consultant Cardiologist, University Hospital of South Manchester, Manchester, UK

A trusted source for junior doctors, students, nurses and cardiac technicians for over 30 years, the new edition of this classic reference continues the winning formula of previous editions while at the same time incorporating essential new content on todays most important clinical topics, including:

Atrial fibrillation: ablation, drugs, rate control versus rhythm control, risk of systemic embolism, prognosis Indications for and management of implantable defibrillators including complications such as arrhythmia storms Indications for pacemaker implantation Anticoagulant therapy (for atrial fibrillation) Long QT syndromes and other channelopathies Recently-approved anti-arrhythmia drugs

The 8th edition also features the latest guidelines on ECG screening of athletes and clear guidance for anaesthetists and surgeons dealing with patients with arrhythmias and/or implantable devices.

Rich with example ECGs and designed for ease of access to information, Bennetts Cardiac Arrhythmias is the reference you can trust to help you master arrhythmia diagnosis and provide optimal treatment of any patient under your care.

9 780470 674932

ISBN 978-0-4706-7493-2

www.wiley.com/go/cardiology

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Bennetts Cardiac Arrhythmias

Bennetts Cardiac ArrhythmiasPractical Notes on Interpretation and Treatment

8th Edition

David H. Bennett, MD FRCPSenior Consultant CardiologistUniversity Hospital of South ManchesterManchester, UK

A John Wiley & Sons, Ltd., Publication

This edition first published 2013 2013 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Bennett, David H.Bennetts cardiac arrhythmias : practical notes on interpretation and treatment / David H. Bennett. 8th ed. p.; cm. Cardiac arrhythmias Rev. ed. of. Cardiac arrhythmias / David H. Bennett. 7th ed., 2006. Includes bibliographical references and index. ISBN 978-0-470-67493-2 (pbk. : alk. paper)I. Bennett, David H. Cardiac arrhythmias. II. Title. III. Title: Cardiac arrhythmias. [DNLM: 1. Arrhythmias, Cardiacdiagnosis. 2. Arrhythmias, Cardiactherapy. WG 330] 616.128dc23

2012021105

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image courtesy of the authorCover design by Andrew Magee Design Ltd

Set in 9/12pt Palatino by SPi Publishers Services, Pondicherry, India

1 2013

v

Contents

Preface, vii

Notes, viii

1 Sinus Rhythm, 1ECG characteristics, 1Sinus bradycardia, 4Sinus tachycardia, 4Sinus arrhythmia, 5

2 Ectopic Beats, 6Prematurity, 6Atrial ectopic beats, 8Atrioventricular junctional ectopic beats, 9Ventricular ectopic beats, 10

3 Escape Beats, 15Timing, 15Origins, 16

4 Bundle Branch and Fascicular Blocks, 17Right bundle branch block, 17Left bundle branch block, 18Left anterior and posterior fascicular blocks, 19

5 The Supraventricular Tachycardias, 24Main types, 24Atrial origin versus atrioventricular re-entry, 25Effects of supraventricular tachycardias, 26

6 Atrial Fibrillation, 29ECG characteristics, 29Causes, 33Prevalence, 34Prognosis, 34Classification, 34Management, 35Systemic embolism, 35Rhythm management, 38

7 Atrial Flutter, 44Common atrial flutter, 44Causes, 49Prevalence, 49

Treatment, 49Systemic embolism, 51

8 Atrial Tachycardia, 52ECG characteristics, 52Causes, 54Treatment, 55Multifocal atrial tachycardia, 55

9 Atrioventricular Junctional Re-entrant Tachycardias, 56Mechanism, 56ECG characteristics, 57Clinical features, 62Treatment, 63

10 WolffParkinsonWhite Syndrome, 67Pre-excitation, 67ECG characteristics, 68Arrhythmias, 69Treatment, 72

11 Ventricular Tachyarrhythmias, 77Ventricular tachycardia, 77Ventricular fibrillation, 78Supraventricular versus ventricular tachycardia, 78

12 Monomorphic Ventricular Tachycardia, 79ECG characteristics, 79Causes, 81Mechanisms of ventricular tachycardias, 81Investigations, 83Treatment, 85Coronary heart disease, 88Hypertrophic cardiomyopathy, 88Arrhythmogenic right ventricular

cardiomyopathy, 89Dilated cardiomyopathy, 92Ventricular tachycardias not due to structural heart

disease, 92Non-sustained ventricular tachycardia, 97Accelerated idioventricular rhythm, 97

Contents

vi

13 Polymorphic Ventricular Tachycardia and Ventricular Fibrillation, 98Polymorphic ventricular tachycardia, 98Torsade de pointes tachycardia, 99Hereditary long QT syndromes, 102Ventricular fibrillation, 106

14 Tachycardias with Broad Ventricular Complexes, 115Causes of a broad complex tachycardia, 115Useless guidelines, 116Useful guidelines, 116

15 Atrioventricular Block, 123Classification, 123Causes of atrioventricular block, 127Atrioventricular