By Antonio Bay?s de Luna MD FESC FACC

The research and administration of irregular middle rhythms is the center of Electrophysiology, however the winning id and administration of arrhythmias is necessary to a much broader variety of physicians, from trainees in cardiology to normal scientific cardiologists to practitioners in different parts of specialization, for instance internists. This booklet is a radical review of medical arrhythmology designed to assist common medical cardiologists and trainees within the fields of scientific cardiology and electrophysiology in attaining the competency they want for medical perform or for additional specialization within the subject matters coated in the book. 

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1992). At the same time, pacemakers do not always offer adequate protection (see later). Non-pharmacological treatment, consisting of lifestyle advice (adequate fluid and salt intake is advised and excessive alcohol intake is discouraged) and physical counter pressure maneuvers (leg-crossing, handgrip and arm tensing, etc) are recommended as the first-line treatment to avoid vasovagal syncope (Van Dijk et al. 2006, Brignole et al. 2004, Moya et al. 2009). Also, autonomic nervous system training, such as a progressively prolonged time in standing position leaning back on the wall, may be useful avoiding neuromediated syncope, and some promising results have been reported (Reybrouck and Ector 2006).

One of the last proposed is the ROSE rule (Reed et al. 2010), that has an excellent sensitivity and negative predictive value (NPV) in the identification of high-risk patients with syncope. ● For the management of syncope, we refer to The Integrated Strategy for Syncope Management by the European Society of Cardiology (Brignole et al. 2004; McCarthy et al. 2009; Moya et al. 2009). From these guidelines, we will comment on some relevant aspects (Morady 2009). Neuromediated and hypotensive syncopes are, the most common.

The internodal bundles, although less numerously. They are also found around the two nodes. 23). 10). 2C). This explains why, although they have a certain automatic activity, their principal function is to rapidly conduct stimuli. A Y-shaped association of three Purkinje cells is frequently observed, which could be the anatomic basis explaining micro-reentry. 3). 4). The sinus node is the structure within the SCS containing the greatest amount of P cells. P cells have the greatest automatism capacity, thus the automaticity of the sinus node is greater than that of the AV junction, where a lower number of P cells is observed, and much greater than that of the ventricular Purkinje fibers, where P cells are rarely present.

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