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Interventional electrophysiology 

Interventional electrophysiology
Chapter:
Interventional electrophysiology
Author(s):

Dr James Harrison

, Dr Nick Linton

, Dr Matthew Wright

, and Dr Mark O’Neill

DOI:
10.1093/med/9780199594764.003.0010
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date: 25 August 2019

One challenge in compiling a chapter of this nature is to achieve a fair balance between the inclusion and exclusion of studies with equally valid claims to be landmarks in the field. Interventional electrophysiology is rich with important contributions, certainly far more than can be included in a shortlist of ten. The last 30 years have seen a shift from an almost exclusively diagnostic specialty, with electrocardiography and pharmacological management the mainstays of the field, to an interventional subspecialty which has grown exponentially in the last decade, and which offers a curative option for many common cardiac arrhythmias.

The earlier years of the specialty were of necessity dominated by critical contributions to the understanding of arrhythmia mechanisms, including, among very many other great names, Langendorf, Moe, Wellens, Coumel, and Josephson. Through observations gleaned from meticulous examination of the 12 lead electrocardiogram, the development of intracardiac recording techniques opened the door to the first therapies for cardiac arrhythmias. For contemporary trainees, it is difficult to visualize an era where open chest cardiac surgery offered the only chance of cure for the Wolff-Parkinson-White syndrome, when today it can usually be treated percutaneously with minimal risk, often in less than one hour using only local anaesthesia.

A landmark is an event, discovery, or change, marking an important stage or turning point in something. Each of the papers included in this chapter fulfils this definition, all in slightly different ways. In the spirit of cardiac electrophysiology, we have included studies (2–4, 6, and 8) almost entirely devoted to the elucidation of arrhythmia mechanism as, without this understanding, there is no basis for interventional arrhythmia management. Contributions to the understanding and treatment of atrial (4–7), AV node-dependent (1–3), and ventricular arrhythmias (8 and 9) are included. The chapter concludes with a description of transpericardial epicardial mapping, a technique used increasingly frequently, and one which means no part of the heart is now inaccessible to the interventional electrophysiologist.

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