Endocardial Electrophysiological Study in Clinical Practice in Patients with Bradysystole and Conduction Rhythm Disorders: a review

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The article demonstrates modern diagnostic capabilities of endocardial electrophysiological examination in cardiological patients with bradysystole and conduction disturbances that allow adequate assessment of the clinical situation. We made an attempt to systematize current indications for an electrophysiological study in this category of patients based on the analysis of several current recommendations.

作者简介

Evgeny Zhelyakov

Pirogov National Research University

编辑信件的主要联系方式.
Email: zheleu@rambler.ru
ORCID iD: 0000-0003-1865-8102
SPIN 代码: 8498-4764
Scopus 作者 ID: 210792

associate professor

俄罗斯联邦, Moscow

Andrey Ardashev

Pirogov National Research University

Email: ardashev@yahoo.com
ORCID iD: 0000-0003-1908-9802
SPIN 代码: 9336-4712

MD, PhD, Professor

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Determination of SNRT and cSNRT during endoEPS. The leads I and III of the body-surface ECG and intracardiac recording channel from the upper lateral segments of the right atrium are presented from top to bottom. Against the sinus rhythm, there is the A–A interval of 910 ms (left part). After an asynchronous atrial ECP with a cycle length of 800 ms for 1 min, the SNRT is determined as the interval between the last stimulation artifact (St) and the first EG spike on the HRA channel, which is 1150 ms (right part). To calculate the cSNRT, the difference between the SNRT value (1150 ms) and the spontaneous cycle length before the start of the ECP (910 ms) is determined, which is 240 ms in our example

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3. Fig. 2. Degree 1 AV block (proximal or suprahisian). The leads I, II, III, and V1 of the body-surface ECG, intracardiac endograms from the upper lateral segments of the right atrium (HRA), atrioventricular bundle region (HISp, HISm, and HISd), and right ventricular apex (RVA), recorded against the sinus rhythm, are presented from top to bottom. According to the body-surface ECG, degree 1 AV block is diagnosed (P–Q interval of 235 ms). An analysis of the intervals obtained during the registration of intracardiac EG reveals that AV conduction impairments occur in the proximal parts of the AV connection (A–H interval of 180 ms), whereas no conduction disorders are registered in the distal parts of the AV connection (H–V interval of 40 ms)

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4. Fig. 3. Distal degree 1 (infrahisian) block and complete left bundle branch block. Leads I, II, III and V1 of the body-surface ECG, intracardiac endograms from the upper lateral segments of the right atrium (LRA), proximal parts of the coronary sinus (CSp), mapping electrode positioned in the area of the atrioventricular bundle (MAPp and MAPd), recorded against the sinus rhythm, are presented from top to bottom. According to the body-surface ECG, degree 1 AV block (P–Q interval of 230 ms) and left bundle branch block are diagnosed. An analysis of the intervals obtained during the registration of intracardiac EG indicates that AV conduction disorders occur in the distal parts of the AV connection (V–H interval of 103 ms), whereas no conduction impairment is noted in the proximal parts of the AV connection (A–H interval of 80 ms).

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5. Fig. 4. Distal block with programmed stimulation. Leads I, II, III, and V1 of the body-surface ECG, intracardiac endograms from the upper lateral parts of the right atrium (HRA), area of the atrioventricular bundle (HISp, HISm, and HISd), coronary sinus (from the proximal pair (CS9) to the distal part (CS)), and right ventricular apex (RVA) are presented from top to bottom. Against the sinus rhythm, the P–Q interval is 186 ms, there are signs of right bundle branch block, and signs of infrahisian disorders in AV conduction are detected (H–V interval of 92 ms) (complex in the right part of the figure). During the programmed atrial ECP with a base cycle length of 500 ms and the introduction of S2 with a programmed extra stimulus delay of 410 ms, an atrioventricular conduction block is verified in the distal parts of the conduction system of the heart (after the A2 spike, the H2 spike is verified without the subsequent appearance of the V2 spike characterizing myocardial depolarization of ventricles)

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