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Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University .

Assess the integrity or function of conductive system Sinus node function AVN function .Induce tachycardia & study its mechanism .r  ° xeneral objectives of EP- EP-study: .

    ° Vascular access (Venous ƛ arterial) ° Electrode catheter (contact mapping ƛ pacing) ° Catheter position ° Multichannel recording system + programmable stimulator .

|ipolar intracardiac recording (localized leectrical activity- depolarization of tissue) . Prox.    Connecting port 4 312 1 Dist.

R      § -current applic. .

LVA CS SCV puncture §ecording from all major 4 chambers & His position .˜     ° SVT VT H§A SAN H§A His AV cond His §VA §VA +/- +/.

˜     §AO LAO His CS §V .

° Sequence of activation .ë      ° |ipolar recording of cardiac elecrical activity (localized area) ° High frequency. high amplitude signal (tissue depolar.) in contact with recording electrode ° Nomenclature ƦƦ.

His-upper §V-no AVN P SCL A V V Cycle length = 60. Heart beats .000/ H§ length of time bet.0        His electrogram (3 components) low §A.

2 successive A waves ° AH interval ( 50Ɯ 50Ɯ120 msec) AVN ° HV interval (35 ƛ 55 msec) His- His.    ° SCL= interval bet.purk ° His deflection (cond. Via His bundle) ° IACT (not basic) = interval bet SAN & His .

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R0  ° Pacing (site- (site.type- type.SACT (50- (50-125 msec) assess cond.variable with H§ -cSN§T (SN§T- (SN§T-|SL) up to 525 msec . of impulse from SAN to adjacent atrial tiss .differentiation) ° Tests of SAN function: -SN§T (assess SAN automaticity) (up to 1500 msec) .

§ecovery interval R0  Time = 30 sec 550 A H§A 400 S1 SCL= 450 msec SN§T= 550 msec CSN§T= 150 msec .

|eat to exit SAN = SCL+ 2 SACT . R0  Idea: reset the SAN ƛ Narula method 8 paced beats S1 580 A §ecovery interval= time of paced beat penetrates & resets SAN+SCL+time for spont.

R R 0  ° Pacing: site type (burst ƛramp) Extrastimulation (site ƛ number- number- coupling intervals) Differentiation (atrial- (atrial.ventricular) .

R   Pacing interval S1 AV AV .

  AV VA .

 R 0  ° Antegrade 1:1 AV conduction ° Antegrade WCL ° §etrograde 1:1 VA conduction ° §etrograde WCL ° AVN/E§P .

V VR   AV .

R 0 S1 S2 400/350 .

V V R  §etrograde sequence of activation VA PCL= 300 msec .

R    A A V V V PCL=260 msec .

  S1 S2 S .