Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Invasive cardiac electrophysiology studies: Bradyarrhythmias

INTRODUCTION

Studies of cardiac impulse formation and conduction using intracardiac catheters have helped define the mechanisms of bradyarrhythmias [1-4]. These invasive electrophysiology studies (EPS) have become a valuable clinical tool in the evaluation and management of cardiac dysrhythmias.

Significant bradyarrhythmias can be divided into two major categories, depending on the anatomic site of origin:

  • Sinus node (SN) dysfunction
  • Atrioventricular (AV) conduction disorders

This topic will review the role of invasive EPS in the diagnosis and treatment of patients with bradyarrhythmias, particularly its role in determining the need for a permanent pacemaker. An overview of cardiac electrophysiology and its role in the management of tachyarrhythmias are discussed separately. (See "Overview of invasive cardiac electrophysiology studies" and "Invasive cardiac electrophysiology studies: Tachyarrhythmias".)

GENERAL APPROACH

EPS should be used as an adjunct to clinical history, physical examination, electrocardiography, and other noninvasive methods in the evaluation of bradyarrhythmias. (See "Diagnosis and evaluation of the sick sinus syndrome".)

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: Nov 28, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Damato AN, Lau SH, Helfant R, et al. A study of heart block in man using His bundle recordings. Circulation 1969; 39:297.
  2. Mandel W, Hayakawa H, Danzig R, Marcus HS. Evaluation of sino-atrial node function in man by overdrive suppression. Circulation 1971; 44:59.
  3. Narula OS, Scherlag BJ, Samet P, Javier RP. Atrioventricular block. Localization and classification by His bundle recordings. Am J Med 1971; 50:146.
  4. Scherlag BJ, Lau SH, Helfant RH, et al. Catheter technique for recording His bundle activity in man. Circulation 1969; 39:13.
  5. Zipes DP, DiMarco JP, Gillette PC, et al. Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Intracardiac Electrophysiologic and Catheter Ablation Procedures), developed in collaboration with the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 1995; 26:555.
  6. Tracy CM, Akhtar M, DiMarco JP, et al. American College of Cardiology/American Heart Association 2006 update of the clinical competence statement on invasive electrophysiologystudies,catheterablation,andcardioversion: a report of the American College of Cardiology/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training developed in collaboration with the Heart Rhythm Society. J Am Coll Cardiol 2006; 48:1503.
  7. Dimarco JP, Garan H, Ruskin JN. Complications in patients undergoing cardiac electrophysiologic procedures. Ann Intern Med 1982; 97:490.
  8. Horowitz LN, Kay HR, Kutalek SP, et al. Risks and complications of clinical cardiac electrophysiologic studies: a prospective analysis of 1,000 consecutive patients. J Am Coll Cardiol 1987; 9:1261.
  9. Strauss HC, Bigger JT, Saroff AL, Giardina EG. Electrophysiologic evaluation of sinus node function in patients with sinus node dysfunction. Circulation 1976; 53:763.
  10. Narula OS, Shantha N, Vasquez M, et al. A new method for measurement of sinoatrial conduction time. Circulation 1978; 58:706.
  11. Josephson ME. Sinus Node Dysfunction. In: Clinical Cardiac Electrophysiology. Techniques and Interpretations, 3rd ed, Josephson ME (Ed), Lippincott, Philadelphia 2002. p.68.
  12. Dhingra RC, Wyndham C, Denes P, et al. Sinus nodal responses to atrial extrastimuli in patients without apparent sinus node disease. Am J Cardiol 1975; 36:445.
  13. Strauss HC, Saroff AL, Bigger JT Jr, Giardina EG. Premature atrial stimulation as a key to the understanding of sinoatrial conduction in man. Presentation of data and critical review of the literature. Circulation 1973; 47:86.
  14. Cramer M, Hariman RJ, Boxer R, Hoffman BF. Electrograms from the canine sinoatrial pacemaker recorded in vitro and in situ. Am J Cardiol 1978; 42:939.
  15. Cramer M, Siegal M, Bigger JT Jr, Hoffman BF. Characteristics of extracellular potentials recorded from the sinoatrial pacemaker of the rabbit. Circ Res 1977; 41:292.
  16. Gomes JA, Kang PS, El-Sherif N. The sinus node electrogram in patients with and without sick sinus syndrome: techniques and correlation between directly measured and indirectly estimated sinoatrial conduction time. Circulation 1982; 66:864.
  17. Hariman RJ, Krongrad E, Boxer RA, et al. Method for recording electrical activity of the sinoatrial node and automatic atrial foci during cardiac catheterization in human subjects. Am J Cardiol 1980; 45:775.
  18. Reiffel JA, Bigger JT Jr. Current status of direct recordings of the sinus node electrogram in man. Pacing Clin Electrophysiol 1983; 6:1143.
  19. Reiffel JA, Gang E, Gliklich J, et al. The human sinus node electrogram: a transvenous catheter technique and a comparison of directly measured and indirectly estimated sinoatrial conduction time in adults. Circulation 1980; 62:1324.
  20. Rakovec P, Jakopin J, Rode P, et al. Clinical comparison of indirectly and directly determined sinoatrial conduction time. Am Heart J 1981; 102:292.
  21. Heddle W, Dorveaux LD, Tonkin AM. Use of rapid atrial pacing to assess sinus node function. Clin Prog Electrophysiol Pacing 1985; 3:299.
  22. Kupersmith J, Krongrad E, Waldo AL. Conduction intervals and conduction velocity in the human cardiac conduction system. Studies during open-heart surgery. Circulation 1973; 47:776.
  23. Narula OS, Cohen LS, Samet P, et al. Localization of A-V conduction defects in man by recording of the His bundle electrogram. Am J Cardiol 1970; 25:228.
  24. Josephson ME, Scharf DL, Kastor JA, Kitchen JG. Atrial endocardial activation in man. Electrode catheter technique of endocardial mapping. Am J Cardiol 1977; 39:972.
  25. Josephson ME. Atrioventricular Conduction. Techniques and Interpretations. In: Clinical Cardiac Electrophysiology, Josephson ME (Ed), Lippincott, Philadelphia 2002. p.92.
  26. Denes P, Levy L, Pick A, Rosen KM. The incidence of typical and atypical A-V Wenckebach periodicity. Am Heart J 1975; 89:26.
  27. Rosen KM, Rahimtoola SH, Gunnar RM. Pseudo A-V block secondary to premature nonpropagated His bundle depolarizations: documentation by His bundle electrocardiography. Circulation 1970; 42:367.
  28. Dhingra RC, Palileo E, Strasberg B, et al. Significance of the HV interval in 517 patients with chronic bifascicular block. Circulation 1981; 64:1265.
  29. Dhingra RC, Wyndham C, Amat-y-Leon F, et al. Incidence and site of atrioventricular block in patients with chronic bifascicular block. Circulation 1979; 59:238.
  30. Kulbertus HE. Reevaluation of the prognosis of patients with LAD--RBBB. Am Heart J 1976; 92:665.
  31. Lasser RP, Haft JI, Friedberg CK. Relationship of right bundle-branch block and marked left axis deviation (with left parietal or peri-infarction block) to complete heart block and syncope. Circulation 1968; 37:429.
  32. McAnulty JH, Rahimtoola SH, Murphy E, et al. Natural history of "high-risk" bundle-branch block: final report of a prospective study. N Engl J Med 1982; 307:137.
  33. Scheinman MM, Peters RW, Suavé MJ, et al. Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol 1982; 50:1316.
  34. Josephson ME. Intraventricular Conduction Disturbances. In: Clinical Cardiac Electrophysiology. Techniques and Interpretations, 3rd ed, Josephson ME (Ed), Lippincott, Philadelphia 2002. p.110.
  35. Dhingra RC, Wyndham C, Bauernfeind R, et al. Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block. Circulation 1979; 60:1455.
  36. Josephson ME, Caracta AR, Ricciutti MA, et al. Electrophysiologic properties of procainamide in man. Am J Cardiol 1974; 33:596.
  37. Tonkin AM, Heddle WF, Tornos P. Intermittent atrioventricular block: procainamide administration as a provocative test. Aust N Z J Med 1978; 8:594.
  38. Akhtar M, Damato AN, Caracta AR, et al. Electrophysiologic effects of atropine on atrioventricular conduction studied by His bundle electrogram. Am J Cardiol 1974; 33:333.
  39. Denes P, Dhingra RC, Wu D, et al. Sudden death in patients with chronic bifascicular block. Arch Intern Med 1977; 137:1005.
  40. Dhingra RC, Amat-Y-Leon F, Wyndham C, et al. Significance of left axis deviation in patients with chronic left bundle branch block. Am J Cardiol 1978; 42:551.
  41. Morady F, Higgins J, Peters RW, et al. Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol 1984; 54:587.