HRS Board Review Course: Part II (Ventricular Arrhythmias)-HRS Board Review Course: Part II (Ventricular Arrhythmias)

Video Transcription

Video Summary

During the Heart Freedom 2025 board review session, experts gathered to discuss the complexities of ventricular arrhythmias, focusing on PVC localization, using ECG and anatomical mapping. Dr. Knight from Northwestern University started by exploring the different ventricular locations linked to arrhythmias, highlighting the electrocardiography's role in pinpointing common sources like the RVOT, LVOT, and others. He explained the importance of knowing the anatomical origins as it informs treatment planning, especially when evaluating outflow tract PVCs and VT localization.<br /><br />Key considerations include using lead V1, determining if the bundle branch block pattern aligns with either the right or left ventricle, and observing how signal transition across the precordium could indicate the arrhythmia’s point of origin. Distinguishing between epicardial and septal origins is significant, considering intricacies like conduction tissue engagement in narrow QRS patterns.<br /><br />Dr. Knight emphasized the value of modern mapping techniques and paced QRS morphed mapping, integrating both endocardial and epicardial evaluations to precisely assess arrhythmia substrates. The technological advancements present enable more accurate localization and guidance for therapeutic ablation.<br /><br />Following Dr. Knight, Dr. John Miller delved into the nuances of entrainment—a process for diagnosing and treating tachycardias by pacing slightly faster than the tachycardia cycle length. He discussed the hallmarks of entrainment, including fusion and concealed fusion, and the pitfalls in recognizing and interpreting these correctly. The emphasis was on understanding how entrainment could aid in identifying reentrant circuits and distinguishing focal from reentrant arrhythmias.<br /><br />Finally, Dr. Swedlow addressed ICD electrograms and troubleshooting, emphasizing recognizing oversensing through patterns and understanding the distinctions between lead issues and artifacts, crucial for appropriate ICD management and avoiding inappropriate shocks.<br /><br />The session underscored the importance of continuous learning and adapting to new methodologies for accurate diagnosis and successful arrhythmia management.

Keywords

ventricular arrhythmias

PVC localization

ECG

anatomical mapping

RVOT

LVOT

outflow tract PVCs

VT localization

entrainment

paced QRS mapping

ICD electrograms

oversensing

arrhythmia management