Textbook of Interventional Cardiology, 7th Edition

Ideal for cardiologists, surgeons, and referring physicians who need a clinical guide to interventional procedures, Textbook of Interventional Cardiology focuses on the latest treatment protocols for managing heart disorders at every level of complexity. In this updated edition, Dr. Topol continues to bring together experts in the field who present the current state of knowledge and clinical practice in interventional cardiology, including cutting-edge theories, trends, and applications of diagnostic and interventional cardiology, as well as peripheral vascular techniques and practices.

• Offers an in-depth understanding of cardiology, making it well suited for cardiology and interventional cardiology exam preparation.
• Expert guidance from leading authorities ensures a fresh and balanced perspective on every aspect of interventional cardiology.
• Presents the most recent genetic information and clinical trials related to interventional cardiology.

• Highlights the latest treatment advances, procedures, devices, and techniques, including transcatheter aortic valve implantation (TAVI).
• Brand-new chapters include Radiation Safety, Renal Denervation for Resistant Hypertension, Post PCI Hospitalization, Length of Stay and Discharge Planning, and Interventional Heart Failure.
• Offers balanced coverage of the entire scope of technologies available, without favoring one particular device over another.
• Integrates the latest trial data into discussions on clinical practice and recommendations.
• Multiple images of devices and intra-procedural imaging enhance your visual understanding of the material.
• Key Points boxes at the beginning of each chapter summarize the most important facts.
• Features 45 videos easily accessible via Expert Consult.
• Expert Consult eBook version included with purchase. This enhanced eBook experience offers access to all of the text, figures, videos, and references from the book on a variety of devices.

To Link :

https://www.amazon.com/Textbook-Interventional-Cardiology-Eric-Topol/dp/0323340385

Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty 6th Edition, Kindle Edition

Specifically designed to prepare medical students for their initial encounters with patients with heart disease, this award-winning text bridges basic cardiac physiology with clinical care. Written by internationally recognized Harvard Medical School faculty and select medical students, Pathophysiology of Heart Disease, Sixth Edition provides a solid foundation of knowledge regarding diseases of the heart and circulation. Under the experienced editorial guidance of Dr. Leonard S. Lilly, this best-selling monograph has an outstanding reputation among medical students and faculty worldwide.

To Link :
https://www.amazon.com/Pathophysiology-Heart-Disease-Collaborative-Students-ebook/dp/B010TREQ7Q

Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Single Volume, 11th Edition

Trusted by generations of cardiologists for the latest, most reliable guidance in the field, Braunwald’s Heart Disease, 11th Edition, remains your #1 source of information on rapidly changing clinical science, clinical and translational research, and evidence-based medicine. This award-winning text has been completely updated, providing a superior multimedia reference for every aspect of this fast-changing field, including new material about almost every topic in cardiology.

By Douglas P. Zipes, MD, Peter Libby, MD, PhD, Robert O. Bonow, MD, MS, Douglas L. Mann, MD and Gordon F. Tomaselli, MD

2040 pages
Trim Size 8 3/4 X 11 1/16 in
Copyright 2019
$386.99, Hardcover, Reference

to Link:

https://www.elsevier.ca/ca/product.jsp?isbn=9780323462990

Rapid Interpretation of EKG's, Sixth Edition - Dale Dubin,MD

The reader's rapid assimilation of medical concepts is the key to the continuing success of this best-selling book. A caption explains the concept illustrated on each page, and a few simple sentences reinforce the concept with interactive (programmed) learning, which links to the following page. Dr Dubin's light and entertaining style, known world-wide, makes learning enjoyable. Practice twelve-lead tracings at the end establish self-confidence, and summarised reference sheets with examples (designed to be copied) provide an excellent review.


To Link :
https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065 

Cardiac electrophysiology

Cardiac electrophysiology is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to describe studies of such phenomena by invasive (intracardiac) catheter recording of spontaneous activity as well as of cardiac responses to programmed electrical stimulation (PES). These studies are performed to assess complex arrhythmias, elucidate symptoms, evaluate abnormal electrocardiograms, assess risk of developing arrhythmias in the future, and design treatment. These procedures increasingly include therapeutic methods (typically radiofrequency ablation, or cryoablation) in addition to diagnostic and prognostic procedures. Other therapeutic modalities employed in this field include antiarrhythmic drug therapy and implantation of pacemakers and automatic implantable cardioverter-defibrillators (AICD).^[1][2]

The cardiac electrophysiology study (EPS) typically measures the response of the injured or cardiomyopathic myocardium to PES on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained ventricular tachycardia (VT)or ventricular fibrillation VF (VF) in the future. Sometimes a series of EPS drug trials must be conducted to enable the cardiologist to select the one regimen for long-term treatment that best prevents or slows the development of VT or VF following PES. Such studies may also be conducted in the presence of a newly implanted or newly replaced cardiac pacemaker or AICD.^[1]

A specialist in cardiac electrophysiology is known as a cardiac electrophysiologist, or (more commonly) simply an electrophysiologist. Cardiac electrophysiology is considered a subspecialty of cardiology in most countries and usually requires two or more years of fellowship training beyond a general cardiology fellowship. In early 2011, the Centers for Medicare and Medicaid Services (CMS) promoted cardiac electrophysiology to its own specialty category in the United States. Cardiac electrophysiologists are trained to perform interventional cardiac electrophysiology studies (EPS) as well as surgical device implantations.^[1]

Cardiac electrophysiology is a relatively young subdiscipline of cardiology and internal medicine. It was developed during the mid-1970s by Hein J. J. Wellens, professor of medicine at the University of Maastricht in the Netherlands and attending cardiologist at the Academic Hospital in Maastricht. In 1980 the first microprocessor based stimulator was developed there, which led to the foundation of the Maastricht-based company CardioTek.

Author of the definitive textbook in the field is by the late Mark E. Josephson, former Robinette Professor of Medicine and chief of cardiology at the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania, professor of medicine at Harvard Medical School, and attending cardiologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts.^[3] The most recent published edition of Clinical Cardiac Electrophysiology: Techniques and Interpretations is the 4th edition in 2008.

The Heart Rhythm Society, founded in 1979, promotes education and advocacy for cardiac arrhythmia professionals (including cardiac electrophysiologists) and patients. It is the largest society in the field.

Biosense-Webster, a subsidiary of Johnson & Johnson, produces a cardiac electrophysiology system called CARTO.^[4] The system is designed to visualise the real-time calculated position and orientation of a specialised RF ablation catheter within the patient’s heart in order to minimise radiation exposure during fluoroscopy, increase the accuracy of targeted RF ablation and reacquisition of pacing sites for re-ablation.^[5] Its navigation system calculates the position and orientation of the catheter tip, using three known magnetic sources as references. The system uses static magnetic fields that are calibrated and computer controlled. Due to the nature of magnetic fields, the orientation may also be calculated while the tip is stationary. By calculating the strength and orientation of the magnetic fields at a given location, the x,y,z position may be calculated along with the roll, pitch, yaw orientation.^[4]

Electrophysiology Studies (EPS)

What are electrophysiology studies?

Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias).

Quick facts

• Electrophysiology studies test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from.
• These results can help you and your doctor decide whether you need medicine, a pacemaker, an implantable cardioverter defibrillator (ICD), cardiac ablation or surgery. 
• These studies take place in a special room called an electrophysiology (EP) lab or catheterization (cath) lab while you are mildly sedated.

Why do people have electrophysiology studies?When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias.

During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity.  

Doctors use EPS to see: 

• Where an arrhythmia is coming from.
• How well certain medicines work to treat your arrhythmia.
• If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called catheter ablation.
• If a pacemaker or implantable cardioverter defibrillator (ICD) might help you.
• If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating).

During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity.

What are the risks of EPS?Risks may include:

• Arrhythmia. During EPS you may have abnormal heart rhythms that make you dizzy. If this happens, your doctor may give your heart an electric shock to bring back a regular heartbeat.
• Blood clots sometimes can form at the tip of the catheter, break off and block a blood vessel. Your doctor may give you medicine to prevent blood clots.
• Infection, bleeding and bruising at the site where the catheter went in (groin, arm or neck). Your doctor or nurse will help you avoid these problems.

How do I prepare for EPS?

• Don’t eat or drink anything for 6 to 8 hours before the test.
• Tell your doctor about any medicines you take, including over-the-counter medicines, herbs and vitamins. He or she may ask you not to take them before EPS. Don’t stop taking your medicine until your doctor tells you to.
• Have someone drive you to your appointment and take you home.
• If you usually wear a hearing aid, wear it during your procedure. If you wear glasses, bring them to your appointment.

What happens during EPS?At a hospital or clinic, doctors and nurses do EPS in a room that has special equipment for the tests. You may hear this room called the electrophysiology laboratory, or EP lab. Some call it the catheterization laboratory (cath lab). During the test:

• A nurse will put an IV (intravenous line) in your arm. You’ll get medicine (a sedative) that will help you relax. But you’ll be awake and able to follow instructions during the test.
• Your nurse will clean and shave the part of your body where the doctor will be working. This is usually in the groin but may be the arm or neck.
• You’ll be given a shot – a local anesthetic will be given  — to make the area numb. Your doctor will make a needle puncture through your skin and into your blood vessel. A small straw-sized tube called a sheath will be inserted into your artery or vein. The doctor will gently guide several specialized EP catheters into your blood vessel through the sheath and advance them to your heart. A video screen will show the position of the catheters. You may feel some pressure in the area where the sheath was inserted, but you shouldn’t feel any pain.
• Your doctor will send small electric pulses through the catheters to make your heart beat at different speeds. You may feel your heart beat stronger or faster.
• Electrical signals produced by your heart will be picked up by the special catheters and recorded. This is called cardiac mapping and allows the doctor to locate where arrhythmias are coming from,
• Your doctor will remove the catheters and the IV line. Your nurse will put pressure on the puncture site to stop any bleeding. 
• EPS usually last 1 to 4 hours.

If the type and location of the arrhythmia is identified and an appropriate therapy decided, cardiac ablation or insertion of a pacemaker or ICD may be performed during or immediately after the EPS.

“I could feel my heart speeding up, which was weird. But it didn’t hurt. It was more like hiking up and down hills really fast.” Esmerelda, age 38

What happens after EPS?You’ll be moved to a recovery room where you should rest quietly for 1 to 3 hours. During this time:

• Stay still as long as your nurse tells you to. Be sure to keep the arm or leg used for the test straight. 
• Your nurse will check on you often to see if there is bleeding or swelling at the puncture site. 
• After the sedative wears off, your doctor will talk to you about your test results. 
• Before you leave, you’ll be told what to do at home.

What happens after I get home?Follow the instructions your nurse or doctor gave you, including taking any new medicines that were prescribed. Most people can start eating food and taking their medicines within 4 to 6 hours after the test. Most can do their usual daily activities the day after the test. Don’t drive for at least 24 hours.

The puncture site may be sore for several days. A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or EP lab.

What should I watch for?
Call 9-1-1 if you notice:

• A sudden increase in swelling around the puncture site.
• Bleeding doesn’t slow down when you press hard on the site.

Call your doctor right away if you notice:

• Your arm or leg that was used for the sheath feels numb or tingles.
• Your hand or foot feels very cold or changes color.
• The puncture site looks more and more bruised.
• The puncture site begins to swell or fluids begin to come from it.

How do I learn the results of my EPS?Most of the time, doctors will ask you to make an appointment to discuss the results of your test. You’ll discuss your treatment at that appointment.

How can I learn more about EPS?Talk with your doctor. Here are some good questions to ask:

• Are there medicines that I can use to control my abnormal heartbeats?
• Will I need a pacemaker or implantable cardioverter defibrillator (ICD) now or in the future?
• What caused my irregular heartbeat?
• Am I at risk of serious heart rhythm problems in the future?

http://www.heart.org/HEARTORG/Conditions/Arrhythmia/SymptomsDiagnosisMonitoringofArrhythmia/Electrophysiology-Studies-EPS_UCM_447319_Article.jsp#.WsYnyS7FKig

Transcatheter Ventricular Septal Defect (VSD) Closure by Abd El-Salam Dawood Salman Al-Ethawi

This is a step-by-step transcatheter closure of a ventricular septal defect (VSD) of the perimembranous (subaortic) type in a five-year-old female child.
The procedure has been done in the largest and busiest cardiac center in Baghdad-Iraq, namely 'Ibn Al-Bittar Center for Cardiac Surgery' in January, 2017.
Although surgical closure is the 'gold-standard' for decades in many centers across the globe, many physicians -including us- started to close many VSDs via the transcatheter approach.
Strict selection criteria are needed because it is challenging, time-consuming, and expensive procedure with a lot of risk.

In this video, we used Amplatzer Duct Occluder (ADO-I) device (an off-label) from St. Jude Medical (USA). However, we have an experience with Amplatzer Muscular Device from St. Jude Medical (USA) and Nit-Occlud Le VSD from PFM Medical (Germany).

After three trials in snaring the arterial guidewire, we finally succeeded, and here we are sharing our experience to the already-present, and ever-growing knowledge in this field.

Please, if you like it, then subscribe, share it, and comment if you wish.

Follow us on facebook (https://www.facebook.com/) and LinkedIn (www.linkedin.com/in/abd-el-salam-dawood-al-ethawi-1b67b2106)

Many thanks

Abd El-Salam Dawood Salman Al-Ethawi
Pediatric Interventional cardiologist