PowerPoint Presentation

Pr inciples of EP (His bundle, Mapping techniques)Dr. MeenuPA 4 wire

PrepRoutine EP study2 kinds of pacing:ES SR down to AV Wenkebach point or a min CL of 300 ms

AT- site of origin

AT - MechMicroreentry

Focal:Triggered activityAbnormal automaticityTypical A Fl Macroreentrant RA circuit

Typical A Fl

AF

AVNRT Dual AV N PathwaysFast Slow

A-H JumpDefinition

AV N ReentryTypical AV N echo Initiation of AVNRT

AV N ReentryTypical AV N echo Initiation of AVNRT

V pre excitation EP diagn overviewManeuvers to increase pre excitationNormalizn of abnormal QRSChange in pattern of A activn during V pacing (retrograde A activn sequence) AP localisnInitiation of AVRT by APC

To :manifest ( identify presence of) pre excitn + : aid localizn APDifferential A pacingDifferential V pacingPara Hisian pacingDegree of pre excitnRel time for atr impulse to reach : AV N / APTime taken to conduct over : AV N / AP

SR -- absent DeltaConcealedLatent

To incr pre excitnDelay AV NDifferential A pacing

V pre excitation EP diagn overviewManeuvers to increase pre excitationNormalizn of abnormal QRSChange in pattern of A activn during V pacing (retrograde A activn sequence) AP localisnInitiation of AVRT by APC

To :manifest ( identify presence of) pre excitn + : aid localizn APDifferential A pacingDifferential V pacingPara Hisian pacingNormalizn with His ES

V pre excitation EP diagn overviewManeuvers to increase pre excitationNormalizn of abnormal QRSChange in pattern of A activn during V pacing (retrograde A activn sequence) AP localisnInitiation of AVRT by APC

To :manifest ( identify presence of) pre excitn + : aid localizn APDifferential A pacingDifferential V pacingPara Hisian pacingRetrograde atr activn Concentric Eccentric

Ecc atr activn clearer (Other than VPCs)Adenosine block AV NDifferential V pacing ( at site close to AP )Observe orthodromic AVRT (retrogr exclusive over AP)

V pre excitation EP diagn overviewManeuvers to increase pre excitationNormalizn of abnormal QRSChange in pattern of A activn during V pacing (retrograde A activn sequence) AP localisnInitiation of orthodromic AVRT by APC

To :manifest ( identify presence of) pre excitn + : aid localizn AP ( Shortest s - interval )Differential A pacing V P His

Differential pacingUnusual APRate dependent ConcealedAnterograde MahaimVTPVS

Pace mapping

Activation mapping

1st AVB

2nd AVB

HVB

CHB

T hank you .