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Editors
PHILIP J. PODRID, M.D.
Professor of Medicine
Associate Professor, Pharmacology and Experimental
Therapeutics
Boston University School of Medicine
Boston, Massachusetts
PETER R. KOWEY, M.D.
Professor of Medicine
Jefferson Medical College
Philadelphia, Pennsylvania;
Chief, Division of Cardiovascular Diseases
Lankenau Hospital and Main Line Health System;
President, Main Line Health Heart Center
Wynnewood, Pennsylvania
CONTENTS
Contributors ix
Foreword xiii
Preface xv
Acknowledgments xvii
SECTION 1: BASIC SCIENCE
1. Anatomy and Physiology of the Conduction
System 3
Michael R. Lauer and Ruey J Sung
2. Basic Electrophysiology: Generation of the
Cardiac Action Potential 37
Augustus O. Grant and Michael Carboni
3. Mechanisms of Arrhythmogenesis 51
Charles Antzelevitch and Alexander Burashnikov
4.1. Genetics of Arrhythmogenic Disorders 81
Silvia G. Priori, and Carlo Napolitano
4.2. Influence of Autonomic Factors and Behavioral
State on Vulnerability to Cardiac Arrhythmias 109
Richard L. Verrier, Julie A. Kovach, and
Murray A. Mittleman
SECTION II: DIAGNOSTIC MODALITIES
5. The Use of the Electrocardiogram in the
Diagnosis of Arrhythmia 127
David B. Bharucha and Philip J Podrid
6.1. Role of Hotter Monitoring and Exercise Testing
for Arrhythmia Assessment and Management 165
Harold L. Kennedy and Philip J Podrid
6.2. Heart Rate Variability, Signal-Averaged
Electrocardiography QT Dispersion and
T Wave Alternans 195
Daniel Bloomfield, Anthony R. Magnano, and
J Thomas Bigger
7. Electrophysiologic Testing and Cardiac
Mapping 231
Hasan Garan and Brian McGovern
SECTION III: THERAPEUTIC MODALITIES
8. Antiarrhythmic Drugs 265
Gerald V. Naccarelli, Philip T. Sager, and
Bramah N. Singh
9. Cardioversion and Defibrillation 303,
Javier E. Sanchez, Andrew E. Epstein, and
Raymond E. Ideker
10. Cardiac Pacemakers 323
Amit Shanker and Sanjeev Saksena
11. Implantable Cardioverter-Defibrillators 357
N. A. Mark Estes III and David S. Cannom
12. Catheter and Surgical Ablation for Cardiac
Arrhythmias 383
Ronald Berger, Michael D. Lesh, and Hugh Calkins
SECTION IV: SPECIFIC ARRHYTHMIAS
Tachyarrhythmia
13. Sinoatrial/Atrial Tachyarrhythmias 411
Jeffrey J. Goldberger and Alan H. Kadish
14. Atrioventricular Nodal Reentry 433
Richard I. Fogel and Eric N. Prystowsky
15. Atrial Fibrillation 457
Arshad Jahangir, Thomas M. Munger,
Douglas L. Packer, and Harry J GM. Crijns
16. Atrial Flutter 501
Albert L. Waldo
17. Tachycardias in Wolff-Parkinson-White
Syndrome 517
Roger A. Marinchak and Seth J Rials
18. Ventricular Premature Depolarizations and
Nonsustained Ventricular Tachycardia 549
Alfred E. Buxton and James Duc
19. Sustained Monomorphic Ventricular
Tachycardia 573
David Martin and J. Marcus Wharton
20. Polymorphaus Ventricular Tachycardia,
Including Torsade de Pointes 603
Stefan H. Hohnloser
21. Sudden Cardiac Death 621
Philip J. Podrid and Peter R. Kowey
Bradyarrhythmias
22. Sinus Node Function and Dysfunction 653
James A. Reiffel
23. Atrioventricular Nodal Conduction
Abnormalities 671
Morton F. Arnsdorf and Ralph Verdino
24. His-Purkinje Disease 693
Pablo Denes
SECTION V: SPECIFIC SYNDROMES
25. Arrhythmias in Hypertrophic, Dilated, and Right
Ventricular Cardiomyopathies 721 William J.
McKenna, Joseph M. Galvin, and Shoaib Hamid
26. Arrhythmias in Congenital Heart Disease 749
Ronald j Kanter and Arthur Garson
27. Arrhythmias and Conduction Disturbances
Associated with Pregnancy 785
Samer R. Dibs and Leslie A. Saxon
28. Arrhythmia in Athletes 805
Michael A. Brodsky and Cyril Y. Leung
29. Arrhythmias After Cardiac and Noncardiac
Surgery 831
Mina K. Chung, Craig R. Asher, David Yamada,
and Kim A. Eagle
30. Periinfarction Arrhythmias 863
Azad V. Ghuran and A. John Camm
31. Arrhythmias in Mitral Valve Disease 889
Paul Kligfield and Richard B. Devereux
32. Arrhythmias in Cardiac Transplantation 907
Steven A. Rothman, Joyce Wald, and
Howard J. Eisen
33. Syncope: Pathophysiology, Evaluation, and
Treatment 925
David G. Benditt
Index 945
CONTRIBUTORS
Charles Antzelevitch, Ph.D. Executive Director, Masonic
Medical Research Laboratory, Utica, New York
13501
Morton E Arnsdorf, M.D. Professor, Department of
Medicine, University of Chicago, Chicago, Illinois
60637
Craig R Asher, M.D. Department of Cardiology, Section of
Cardiac Electrophysiology, Cleveland Clinic
Foundation, Cleveland, Ohio 44195
Ronald Berger, M.D. Arrhythmia Service and
Electrophysiology Laboratory Johns Hopkins
Hospital, Baltimore, Maryland 21287
David G. Benditt, M.D. Professor of Medicine, Cardiac
Arrhythmia Center, University of Minnesota Medical
School, Minneapolis, Minnesota 55455
David B. Bharucha, M.D., Ph.D. Lankenau Hospital,
Wynnewood, Pennsylvania 19096
J. Thomas Bigger, M.D. Professor, Department of Medicine,
Columbia University, New York, New York 10032
Daniel Bloomfield, M.D. Division of Cardiology, Columbia
University, New York, New York 10032
Michael A. Brodsky, M.D. Professor of Medicine, Division
of Cardiology, University of California, Irvine,
Irvine, California 92697; University of California,
Irvine Medical Center, Orange, California 92868
Alexander Burashnikov, M.D. Masonic Medical Research
Laboratory, Utica, New York 13501
Alfred E. Buxton, M.D. Professor of Medicine, Brown
University School of Medicine, Director, Arrhythmia
Services, Rhode Island Hospital, Providence, Rhode
Island 02905
Hugh Calkins, M.D. Professor, Department of Medicine and
Pediatrics, Johns Hopkins University; Chief,
Arrhythmia Service and Clinical Electrophysiology
Laboratory Johns Hopkins Hospital, Baltimore,
Maryland 21287
A. John Camm, M.D., F.R.C.P Professor, Department of
Cardiological Sciences, St. George's Hospital
Medical School, London, SW17 ORE, United
Kingdom
David S. Cannom, M.D. Clinical Professor of Medicine,
University of California, Los Angeles School of
Medicine, Los Angeles, California 90024; Medical
Director of Cardiology, Good Samaritan Hospital,
Los Angeles, California 90017
Michael Carboni, M.D. Departments of Medicine and
Pediatrics, Duke University Medical Center,
Durham, North Carolina 27710
Mina K. Chung, M.D. Department of Cardiology, Section of
Cardiac Electrophysiology, Cleveland Clinic
Foundation, Cleveland, Ohio 44195
Harry J.G.M. Crijns, M.D. Professor of Cardiology,
University of Maastricht; Chair, Department of
Cardiology, University Hospital Maastricht, 6200
Maastricht, The Netherlands
Pablo Denes, M.D. Professor, Department of Medicine,
Northwestern University Memorial Hospital,
Northwestern University, Chicago, Illinois 60611
Richard B. Devereux, M.D. Professor of Medicine, Division
of Cardiology, Weill Medical College of Cornell
University, The New York Presbyterian Hospital,
New York, New York 10021
Samer R Dibs, M.D. Assistant Professor, Division of
Cardiology/Cardiac Electrophysiology, Northwestern
University, Northwestern Memorial Hospital,
Chicago, Illinois 60611
James Duc, M.D. Division of Cardiology, Brown University
School of Medicine, Providence, Rhode Island
02912
Kim A. Eagle, M.D. Albion Walter Hewlett Professor of
Internal Medicine, Department of Internal Medicine,
University of Michigan; Chief, Clinical Cardiology,
University of Michigan Medical Center, Ann Arbor,
Michigan 48109
Howard J. Eisen, M.D. Professor of Medicine and
Physiology, Department of Medicine, Section of
Cardiology, Temple University School of Medicine;
Medical Director, Advanced Heart Failure and
Transplant Center, Temple University Hospital,
Philadelphia, Pennsylvania 19140
Andrew E. Epstein, M.D. Department of Internal Medicine,
Division of Cardiovascular Diseases, University of
Alabama at Birmingham, Birmingham, Alabama
35294
NA. Mark Estes, III, M.D. Professor of Medicine, Tufts
University School of Medicine; Director, Cardiac
Arrhythmia Service, New England Medical Center,
Boston, Massachusetts 02111
Richard I. Fogel, M.D. Clinical Electrophysiologist,
Department of Cardiology, St. Vincent
Hospital/Indiana Heart Institute, Indianapolis,
Indiana 46260
Joseph M. Galvin, M.D. Department of Cardiac Medicine,
St. George's Hospital Medical School, London,
SW17 ORE, United Kingdom
Hasan Garan, M.D. Professor, Department of Cardiology,
University of Texas, Houston Medical School,
Houston, Texas 77030
Arthur Garson, M.D., M.P.H. Senior Vice President and
Dean for Academic Operations, Baylor College of
Medicine; Vice President, Quality and Outcomes
Management, Texas Children's Hospital, Houston,
Texas 77030
Azad V Ghuran, M.B.Ch.B., M.R.C.P.(UK) Cardiology
Research Fellow, Department of Cardiological
Sciences, St. George's Hospital Medical School,
London, SW17 ORE, United Kingdom
Jeffrey J. Goldberger, M.D. Department of Cardiology,
Northwestern University Medical School, Chicago,
Illinois 60611
Augustus O. Grant, M.B., Ch.B., Ph.D. Professor of
Medicine, Duke University, Duke University
Medical Center, Durham, North Carolina 27710
Shoaib Hamid, M.D. Department of Cardiac Medicine, St.
George's Hospital Medical School, London, SW17
ORE, United Kingdom
Stefan H. Hohnloser, M.D. Professor of Medicine, Division
of Cardiology, J.W. Goethe University, 60590
Frankfurt, Germany
Raymond E. Ideker, M.D., Ph.D. Jeanne V Marks Professor
of Medicine, Department of Medicine, University of
Alabama at Birmingham, Birmingham, Alabama
35294
Arshad Jahangir, M.D. Department of Cardiology, Mayo
Foundation, Rochester, Minnesota 55902
Alan H. Kadish, M.D. Professor of Medicine, Northwestern
University; Director, Cardiac Electrophysiology,
Northwestern Memorial Hospital, Chicago, Illinois
60611
Ronald J. : Kanter, M.D. Associate Professor, Department of
Pediatrics, Duke University; Director, Pediatric
Electrophysiology, Duke University Medical Center,
Durham, North Carolina 27710
Harold L. Kennedy, M.D., M.P.H. Professor, Department of
Medicine, University of Nevada, Veterans
Administration Medical Center, Reno, Nevada
89502
Paul Kligfield, M.D., F.A.C.C. Professor, Department of
Medicine, Weill Medical College of Cornell
University; Director, Cardiac Graphics Laboratory,
New YorkCornell Center of New York-Presbyterian
Hospital, New York, New York 10021
Julie A. Kovach, M.D. Department of Cardiology,
University of Michigan Health System, Ann Arbor,
Michigan 48109
Peter R. Kowey, M.D. Professor of Medicine, Thomas
Jefferson University, Philadelphia, Pennsylvania
19107; Chief, Division of Cardiovascular Diseases,
Lankenau Hospital, Wynnewood, Pennsylvania
19096
Michael R Lauer, M.D. Department of Medicine, Stanford
University School of Medicine, San Jose, California
95119
Michael D. Lesh, M.D. Division of Cardiac
Electrophysiology, University of California, San
Francisco, San Francisco, California 94143
Cyril Y Leung, M.D. Assistant Clinical Professor,
Department of Medicine, Division of Cardiology,
University of CaliforniaIrvine Medical Center,
University of California-Irvine, Orange, California
92868
Anthony R. Magnano, M.D. Division of Cardiology,
Columbia University, New York, New York 10032
Roger A. Marinchak, M.D. Clinical Associate Professor of
Medicine, Thomas Jefferson University School of
Medicine, Philadelphia, Pennsylvania 19107;
Director, Arrhythmia Services, Main Line Health
System, The Lankenau Hospital, Wynnewood,
Pennsylvania 19096
David Martin, M.D. Department of Medicine, Duke
University Medical Center, Durham, North Carolina
27710
Brian McGovern, M.D. Massachusetts General Hospital,
Boston, Massachusetts 02114
William J. McKenna, M.D. Professor of Cardiac Medicine,
St. George's Hospital Medical School, London,
SW17 ORE, United Kingdom
Murray A. Mittleman, M.D. Department of Medicine,
Harvard Medical School; Institute for Prevention of
Cardiovascular Disease, Beth Israel Deaconess
Medical Center, Boston, Massachusetts 02215
Thomas M. Munger, M.D. Department of Cardiology, Mayo
Foundation, Rochester, Minnesota 55902
Gerald V Naccarelli, M.D. Professor, Department of
Medicine, Penn State University College of
Medicine; Chief, Division of Cardiology, The Milton
S. Hershey Medical Center, Hershey, Pennsylvania
17033
Carlo Napolitano, M.D. University of Pavia, 27100 Pavia,
Italy
Douglas L. Packer, M.D. Professor of Medicine, Department
of Electrophysiology, Mayo Foundation, St. Mary's
Hospital, Rochester, Minnesota 55905
Philip J. Podrid, M.D. Professor of Medicine, Department of
Medicine/Cardiology; Associate Professor of
Pharmacology and Experimental Therapeutics,
Boston University School of Medicine, Boston,
Massachusetts 02118
Silvia G. Priori, M.D., Ph.D. Associate Professor of
Cardiology, University of Pavia; Director, Molecular
Cardiology Division, Fondazione Salvatore Maugeri,
27100 Pavia, Italy
Eric N. Prystowsky, M.D. Consulting Professor of Medicine,
Duke University Medical Center, Durham, North
Carolina 27710; Director, Clinical Electrophysiology
Laboratory, St. Vincent's Hospital, Indianapolis,
Indiana 46260
James A. Reifel, M.D. Professor of Clinical Medicine,
Division of Cardiology, Columbia University;
Director, ECG Laboratory, The New York
Presbyterian Hospital, New York, New York 10032
Seth J. Rials, M.D., Ph.D. Heart Care, Inc., Columbus, Ohio
43214
Steven A. Rothman, M.D. Department of Medicine,
Division of Clinical Electrophysiology, Temple
University School of Medicine, Philadelphia,
Pennsylvania 19140
Philip T. Sager, M.D. Department of Cardiology, University
of California, Los Angeles School of Medicine;
Veterans Administration Medical Center West Los
Angeles, Los Angeles, California 90073
Sanjeev Saksena, M.D. Cardiovascular Institute of the
Atlantic Health System, Passaic, New Jersey 07055
Javier E. Sanchez, M.D. Department of Internal Medicine,
Division of Cardiovascular Diseases, University of
Alabama at Birmingham, Birmingham, Alabama
35294
Leslie A. Saxon, M.D. Associate Professor of Medicine,
Department of Cardiac Electrophysiology; Director,
Electrophysiology Laboratory and Implantable
Device Service, University of California, San
Francisco, California 94143
Amit Shanker, M.D. Department of Medicine, Robert Wood
Johnson School of Medicine, New Brunswick, New
Jersey 08903
Bramah N. Singh, M.D., Ph.D. Professor of Medicine,
Department of Cardiology, University of California,
Los Angeles School of Medicine; Veterans
Administration Medical Center West Los Angeles,
Los Angeles, California 90073
Ruey J. Sung, M.D. Professor of Medicine, Stanford
University School of Medicine, Stanford University
Medical Center, Stanford, California 94305
Ralph Verdino, M.D. Section of Cardiology, University of
Chicago Hospital, Chicago, Illinois 60637
Richard L. Verrier, Ph.D. Department of Medicine, Harvard
Medical School; Institute for Prevention of
Cardiovascular Disease, Beth Israel Deaconess
Medical Center, Boston, Massachusetts 02215
Joyce Wald, M.D. Department of Medicine, Temple
University School of Medicine, Philadelphia,
Pennsylvania 19140
Albert L. Waldo, M.D. The Walter H. Pritchard Professor of
Cardiology and Professor of Medicine, Case Western
Reserve University; Director, Cardiac
Electrophysiology Program, University Hospital,
Cleveland, Ohio 44106
J. Marcus Wharton, M.D. Associate Professor of Medicine,
Division of Cardiology, Duke University; Director,
Clinical Cardiac Electrophysiology, Duke University
Medical Center, Durham, North Carolina 27710
David Yamada, M.D. Department of Cardiology, Section of
Cardiac Electrophysiology, Cleveland Clinic
Foundation, Cleveland, Ohio 44195
