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Electrophysiology of Cardiac Arrhythmias

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Essential Cardiology

Abstract

Abnormalities in the initiation and propagation of cardiac impulses result in a variety of arrhythmias. The cardiac action potential consists of five phases that are determined by channels that allow ions to flow passively down their electrochemical gradients, as well as by a series of energy-dependent ion pumps, thereby leading to cardiac contraction.

Sodium, potassium, calcium, and chloride ions are principally responsible for the membrane potential (phase 4). Phase 0 marks the initiation of the action potential. In nodal cells, the pacemaker current, If, initiates each cycle. In “nonpacemaker” tissue, If is absent. In these cells, phase 0 is triggered when the cell membrane is depolarized by adjacent cells. Phase 1 consists of rapid membrane repolarization. This is achieved by inactivation of the inward Na+ current and activation of a transient outward current, Ito. Phase 2, the plateau phase, is characterized by a small change in membrane potential generated by the L-type calcium channel, ICa–L. Rapid repolarization of the cell occurs during phase 3. ICa–L is inactivated in a time-dependent fashion, thus decreasing the flow of cations into the cell, while several outward potassium currents become active. This results in a net outward positive current and a negative transmembrane potential.

The mechanisms of cardiac arrhythmias can be divided into three categories: (1) abnormal or enhanced automaticity, (2) triggered activity, and (3) reentry. This chapter reviews each of these mechanisms, along with the common clinical correlates of each.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Westchester Medical Center, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA

    Sei Iwai MD

  2. Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York Presbyterian Hospital, 525 East 68th Street, Starr 4 Pavillion, New York, NY, 10021, USA

    Steven M. Markowitz MD & Bruce B. Lerman MD

Authors
  1. Sei Iwai MD
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  2. Steven M. Markowitz MD
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  3. Bruce B. Lerman MD
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Corresponding author

Correspondence to Bruce B. Lerman MD .

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Editors and Affiliations

  1. The Mount Sinai School of Medicine, The James J. Peters VA Medical Center, Department of Medicine, West Kingsbridge Rd 130, Bronx, 10468, New York, USA

    Clive Rosendorff

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Iwai, S., Markowitz, S.M., Lerman, B.B. (2013). Electrophysiology of Cardiac Arrhythmias. In: Rosendorff, C. (eds) Essential Cardiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6705-2_15

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  • DOI: https://doi.org/10.1007/978-1-4614-6705-2_15

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