Adult Congenital Heart Disease - UCLAheart.ucla.edu/workfiles/Adult_Congenital/Electrocardiogram...
Transcript of Adult Congenital Heart Disease - UCLAheart.ucla.edu/workfiles/Adult_Congenital/Electrocardiogram...
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The Electrocardiogram in Adult Congenital Heart Disease
I shall focus on five aspects of this topic: 1) History of the electrocardiogram. 2) Vectorcardiography 3) Unusual or unfamiliar forms of common arrhythmias. 4) The Long QT Interval 5) The Signal Averaged Electrocardiogram (SAECG)
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The History of Electrocardiography
Many brilliant minds contributed to the development of electrocardiography as a
clinical science. The early history (1900-1945) was dominated by Professor Willem Einthoven in the Netherlands, Sir Thomas Lewis in England and Frank N. Wilson in the United States. These pioneers laid the foundation for modern electrocardiography.
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Professor Willem Einthoven
The 1924 Nobel Prize in Physiology or Medicine. Awarded to Willem
Einthoven "for his discovery of the mechanism of the electrocardiogram".
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Professor Willem Einthoven
The 1924 Nobel Prize in Physiology or Medicine. Awarded to Willem
Einthoven "for his discovery of the mechanism of the electrocardiogram".
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Sir Thomas Lewis
Cardiologist and Clinical Scientist Established atrial fibrillation as a clinical
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Frank N. Wilson
Introduced the modern era of electrocardiography. He demonstrated negativity of the ventricular cavity
and activation from endocardium to epicardium.
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Vectorcardiography Spatial Vector Electrocardiography: Clinical
Electrocardiographic Interpretation. Robert Purves Grant & E. Harvey Estes
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Unfamiliar or Unusual Forms of Common Arrhythmias
Sinus Arrhythmia (Heart Rate Variability)
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Sinus Arrhythmia Sinus arrhythmia can only occur if the atrial
septum is intact. It is minimal or absent with an atrial septal defect.
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Atrial Septal Defect No Sinus Arrhythmia
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Atrial Septal Defect Closed Sinus Arrhythmia
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Long QT Interval
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Lange-Nielson Syndrome
An autosomal recessive disorder characterized by congenital deafness, QT interval
prolongation, ventricular tachycardia, syncope, and sudden death.
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Dalmatian Coach Hounds
May Look Alike
But some dogs drop dead on the hunt because of canine Long QT Lange-Nielson Syndrome.
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Coupled Babies
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Coupled Rhythms
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The Signal Averaged Electrocardiogram
In the 1970’s, Michael B. Simson, a cardiology fellow at the University of
Pennsylvania, developed the signal averaged electrocardiogram to detect the slow
conduction substrate of reentry.
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Signal Averaged Electrocardiogram The SAECG identifies low-amplitude
potentials(curved arrow below) at the end of the QRS complex. Late potentials represent delayed
ventricular activation and increased risk of reentrant monomorphic ventricular tachycardia.
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The Signal Averaged Electrocardiogram
Perloff JK, Middlekauf HR, Stevenson WG. The Post-ventriculotomy Signal Averaged
Elecrocardiogram in Congenital Heart Diseae. Am J Cardiol 2006;98:1646-1651.
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Ventricular Tachycardia Electrophysiologic mechanisms of
ventricular tachycardia: reentry, automaticity, triggered activity.
Inducible sustained ventricular tachycardia is
typically reentry & monomorphic:
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Substrate Plus Trigger Reentrant substrates remain dormant unless activated (triggered). The overt expression of reentrant MVT requires both a substrate and a trigger . The signal averaged ECG detects the substrate. Severe pulmonary regurgitation serves as a trigger.
Substrate Trigger
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In patients with a positive SAECG, slow conduction reentrant substrates are usually along
ventriculotomy scars.
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Reentrant substrates can be eliminated by radiofrequency
ablation or surgical revision of the ventriculotomy scar.
Ablation Revision
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The Electrocardiogram in Adult Congenital Heart Disease
I have focused on five aspects of this topic: 1) The history of the electrocardiogram. 2) The vectorcardiogram 3) Unusual or unfamiliar forms of common arrhythmias. 4) The Long QT Interval 5) The Signal Averaged Electrocardiogram.
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Thank You