Skip to main content
SpringerLink
Log in

Basic Principles of Clinical Cardiac Electrophysiology

  • Chapter
Fundamental Approaches to the Management of Cardiac Arrhythmias

  • 176 Accesses

Abstract

A thorough understanding of basic electrophysiological principles is essential to the proper diagnosis and management of patients with cardiac arrhythmias. Included in this introductory chapter is a discussion of the indications for electrophysiology testing, the equipment and techniques used in a diagnostic electrophysiology study, and the electrophysiological properties of the cardiac conduction system

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Zipes DP, DiMarco JP, Gillette PC, et al.: Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures? J Am Coll Cardiol 26:555–573, 1995.

    Article  PubMed  CAS  Google Scholar 

  2. Horowitz LN: Safety of electrophysiologic studies. Circulation 73:11–28, 1986.

    Article  Google Scholar 

  3. Dimarco JP, Garan H, Ruskin JN: Complications in patients undergoing cardiac electrophysiologic procedures. Ann Intern Med 97:490–493, 1982.

    PubMed  CAS  Google Scholar 

  4. Bekheit S, Murtagh JG, Morton P, Fletcher E: Measurements of sinus impulse conduction from electrogram of bundle of His. Br Heart J 33:719, 1971.

    Article  PubMed  CAS  Google Scholar 

  5. Castellanos A, Castillo C, Agha A: Contribution of the His bundle recording to the understanding of clinical arrhythmias. Am J Cardiol 28:499, 1971.

    Article  PubMed  Google Scholar 

  6. Castellanos A, Jr., Castillo CA, Agha AS, Tessler M: His bundle electrograms in patients with short P-R intervals, narrow QRS complexes, and paroxysmal tachycardias. Circulation 43:667–678, 1971.

    Article  PubMed  Google Scholar 

  7. Damato AN, Lau SH, et al.: Recording of specialized conducting fibers (A-V nodal, His bundle, and right bundle branch) in man using an electrode catheter technic. Circulation 39:435–447, 1969.

    Article  PubMed  CAS  Google Scholar 

  8. Damato AN, Lau SH, Helfant RH, et al.: Study of atrioventricular conduction in man using electrode catheter recordings of His bundle activity. Circulation 39:287–296, 1969.

    Article  PubMed  CAS  Google Scholar 

  9. Damato AN, Lau SH: Clinical value of the electrogram of the conduction system. Prog Cardiovasc Dis 13:119–140, 1970.

    Article  PubMed  CAS  Google Scholar 

  10. Narula OS, Cohen LS, Samet P, et al.: Localization of A-V conduction defects in man by recording of the His bundle electrogram. Am J Cardiol 25:288, 1970.

    Article  Google Scholar 

  11. Narula OS, Scherlag BJ, Samet P, Javier RP: Atrioventricular block: Localization and classification by His bundle recordings. Am J Med 50:146, 1971.

    Article  PubMed  CAS  Google Scholar 

  12. Rosen KM: Evaluation of cardiac conduction in the cardiac catheterization laboratory. Am J Cardiol 30:701–703, 1972.

    Article  PubMed  CAS  Google Scholar 

  13. Rosen KM, Scherlag BJ, Samet P, Helfant RH: His bundle electrogram. Circulation 46:831–832, 1972.

    Article  PubMed  CAS  Google Scholar 

  14. Bekheit S, Murtagh JG, Morton P, Fletcher E: Studies of heart block with His bundle recordings. Br Heart 34:717, 1972.

    Article  CAS  Google Scholar 

  15. Batsford WP, Akhtar M, Caracta AR, et al.: Effect of atrial stimulation site on the electrophysiological properties of the atrioventricular node in man. Circulation 50:283–292, 1974.

    Article  PubMed  CAS  Google Scholar 

  16. Cagin NA, Kunstadt D, Wolfish P, Levitt B: The influence of heart rate on the refractory period of the atrium and the A-V conducting system. Am Heart J 85:358, 1973.

    Article  Google Scholar 

  17. Denes P, Wu D, Dhingra R, et al.: The effects of cycle length on cardiac refractory periods in man. Circulation 49:32–41, 1974.

    Article  PubMed  CAS  Google Scholar 

  18. Jurkiewicz NK, Sanguinetti MC: Rate-dependent prolongation of cardiac action potentials by a methanesulfonalide class III antiarrhythmic agent: specific block of rapidly activating delayed rectifier K+ current by dofetilide. Circ Res 72:75–83, 1993.

    Article  PubMed  CAS  Google Scholar 

  19. Sanguinetti MC, Jurkiewicz NK: Two components of cardiac delayed rectifier K+ current: Differential sensitivity to block by class III antiarrhythmic agents. J Gen Physiol 96:194, 1990.

    Article  Google Scholar 

  20. Sanguinetti MC, Jurkiewicz NK: Delayed rectifier outward K+ current is composed of two currents in guinea pig atrial cells. Am J Physiol 260:H393, 1991.

    Google Scholar 

  21. Hoffman BF, Paes de Carvalho A, De Mello WC: Transmembrane potentials of single fibres of the atrio-ventricular node. Nature 181:66–67, 1958.

    Article  PubMed  CAS  Google Scholar 

  22. Hoffman BF, Paes de Carvalho A, De Mello WC, et al.: Electrical activity of single fibers of the atrioventricular node. Circ Res 7:11–18, 1959.

    Article  PubMed  CAS  Google Scholar 

  23. Jalife J: The sucrose gap preparation as a model of AV nodal transmission: Are dual pathways necessary for reciprocation or AV nodal echoes. PACE 6:1106, 1983.

    Article  PubMed  CAS  Google Scholar 

  24. Simson MB, Spear JF, Moore EN: Electrophysiologic studies on atrioventricular nodal Wenckebach cycles. Am J Cardiol 41:244, 1978.

    Article  PubMed  CAS  Google Scholar 

  25. Josephson ME.: Electrophysiologic investigation: General concepts. Clinical Cardiac Electrophysiology: Techniques and Interpretations. Philadelphia: Lea & Febiger, 28–70: 1993.

    Google Scholar 

  26. Sherf L: The atrial conduction system: clinical implications. Am J Cardiol 37:814, 1976.

    Article  PubMed  CAS  Google Scholar 

  27. Schuilenburg RM, Durrer D: Conduction disturbances located within the His bundle. Circulation 45:612, 1972.

    Article  PubMed  CAS  Google Scholar 

  28. Josephson ME. Atrial flutter and fibrillation. Clinical Cardiac Electrophysiology: Techniques and Interpretations. Philadelphia: Lea & Febiger: 1993.

    Google Scholar 

  29. Akhtar M, Caracta AR, Lau SH, et al.: Demonstration of intra-atrial conduction delay, block, gap and reentry: a report of two cases. Circulation 58:947–955, 1978.

    Article  PubMed  CAS  Google Scholar 

  30. Akhtar M, Damato AN, Batsford WP, et al.: A comparative analysis of antegrade and retrograde conduction patterns in man. Circulation 52:766–778, 1975.

    Article  PubMed  CAS  Google Scholar 

  31. Allessie MA, Bonke FI, Schopman FJ: Circus movement in rabbit atrial muscle as a mechanism of trachycardia. Circ Res 33:54–62, 1973.

    Article  PubMed  CAS  Google Scholar 

  32. Allessie MA, Bonke FI, Schopman FJ: Circus movement in rabbit atrial muscle as a mechanism of tachycardia. II. The role of nonuniform recovery of excitability in the occurrence of unidirectional block, as studied with multiple microelectrodes. Circ Res 39:168–177, 1976.

    Article  PubMed  CAS  Google Scholar 

  33. Allessie MA, Bonke FI, Schopman FJ: Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The “leading circle” concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 41:9–18, 1977.

    Article  PubMed  CAS  Google Scholar 

  34. Allessie MA, Lammers WJ, Bonke IM, Hollen J: Intra-atrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog. Circulation 70:123–135, 1984.

    Article  PubMed  CAS  Google Scholar 

  35. Boineau JP, Schuessler RB, Mooney CR, et al.: Natural and evoked atrial flutter due to circus movement in dogs. Am J Cardiol 45:1167, 1980.

    Article  PubMed  CAS  Google Scholar 

  36. Bennett MA, Pentecost BL: The pattern of onset and spontaneous cessation of atrial fibrillation in man. Circulation 41:981, 1970.

    Article  PubMed  CAS  Google Scholar 

  37. Frame LH, Page RL, Hoffman BF: Atrial reentry around an anatomic barrier with a partially refractory excitable gap: A canine model of atrial flutter. Circ Res 58:495, 1986.

    Article  PubMed  CAS  Google Scholar 

  38. Haft JI, Lau SH, et al.: Atrial fibrillation produced by atrial stimulation. Circulation 37:70–74, 1968.

    Article  PubMed  CAS  Google Scholar 

  39. Killip T, Gault JH: Mode of onset of atrial fibrillation in man. Am Heart J 70:172, 1965.

    Article  PubMed  CAS  Google Scholar 

  40. Buxton AE, Marchlinski FE, Miller JM, et al.: The human atrial strength-interval relationship: Influence of cycle length and procainamide. Circulation 79:271, 1989.

    Article  PubMed  CAS  Google Scholar 

  41. Akhtar M, Gilbert CJ, Wolf FG, Schmidt DH: Retrograde conduction in the His-Purkinje system. Analysis of the routes of impulse propagation using His and right bundle branch recordings. Circulation 59:1252–1265, 1979.

    Article  PubMed  CAS  Google Scholar 

  42. Akhtar M: Retrograde conduction in man. Pacing Clin Electrophysiol 4:548–562, 1981.

    Article  PubMed  CAS  Google Scholar 

  43. Akhtar M, Damato AN, Caracta AR, et al.: The gap phenomena during retrograde conduction in man. Circulation 49:811–817, 1974.

    Article  PubMed  CAS  Google Scholar 

  44. Akhtar M, Damato AN, Caracta AR, et al.: The gap phenomenon during retrograde conduction in man. Circulation 49:811, 1974.

    Article  PubMed  CAS  Google Scholar 

  45. Akhtar M, Damato AN, Ruskin JN, et al.: Characteristics and coexistence of two forms of ventricular echo phenomena. Am Heart J 92:174–182, 1976.

    Article  PubMed  CAS  Google Scholar 

  46. Akhtar M, Denker S, et al.: Macro-reentry within the His-Purkinje system. PACE 6:1010, 1983.

    Article  PubMed  CAS  Google Scholar 

  47. Akhtar M, Damato AN, Batsford WP, et al.: Demonstration of re-entry within the His-Purkinje system in man. Circulation 50:1150–1162, 1974.

    Article  PubMed  CAS  Google Scholar 

  48. Farshidi A, Michelson EL, Greenspan AM, et al.: Repetitive responses to ventricular extrastimuli: incidence, mechanism, and significance. Am Heart J 100:59–68, 1980.

    Article  PubMed  CAS  Google Scholar 

  49. Roy D, Brugada P, Bar FWHM, Wellens HJJ: Repetitive responses to ventricular extrastimuli: Incidence and significance in patients without organic heart disease. Eur Heart J 4:79, 1983.

    PubMed  CAS  Google Scholar 

  50. Sung RJ, Waxman HL, Saksena S, Juma Z: Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways. Circulation 64:1059–1067, 1981.

    Article  PubMed  CAS  Google Scholar 

  51. Josephson ME. Miscellaneous phenomena related to atrioventricular conduction. Clinical Cardiac Elec trophysiology: Techniques and Interpretations. Philadelphia: Lea & Febiger: 1993.

    Google Scholar 

  52. Knoebel SB, Fisch C: Concealed conduction. Cardiovasc Clin 5:21, 1973.

    PubMed  CAS  Google Scholar 

  53. Moore EN, Knoebel SB, Spear JF: Concealed conduction. Am J Cardiol 28:406, 1971.

    Article  PubMed  CAS  Google Scholar 

  54. Zipes DP, Mendez C, Moe GK: Evidence for summation and voltage dependency in rabbit atrioventricular nodal fibers. Circ Res 32:170–177, 1973.

    Article  PubMed  CAS  Google Scholar 

  55. Agha AS, Castellanos A, et al.: Type II & type III gaps in bundle branch conduction. Circ 47:325, 1973.

    Article  CAS  Google Scholar 

  56. Agha AS, Castellanos A, Jr., Wells D, et al.: Type I, type II, and type 3 gaps in bundle-branch conduction. Circulation 47:325–330, 1973.

    Article  PubMed  CAS  Google Scholar 

  57. Akhtar M, Damato AN, Batsford WP, et al.: Unmasking and conversion of gap phenomenon in the human heart. Circulation 49:624–630, 1974.

    Article  PubMed  CAS  Google Scholar 

  58. Damato AN, Akhtar M, Ruskin J, et al.: Gap phenomena: Antegrade and retrograde. In: Wellens HJJ, Lie KI, Janse MJ, eds. The Conduction System of the Heart: Structure, Function and Clinical Implications. Philadelphia: Lea & Febiger: 1976.

    Google Scholar 

  59. Moe GK, Mendez C, Han J: Aberrant A-V impulse propagation in the dog heart: A study of functional bundle branch block. Circ Res 16:261, 1965.

    Article  PubMed  CAS  Google Scholar 

  60. Wu D, Denes P, Dhingra R, et al.: Nature of the gap phenomenon in man. Circ Res 34:682–692, 1974.

    Article  PubMed  CAS  Google Scholar 

  61. Childers RW: Supernormality. Cardiovasc Clin 5:135, 1973.

    PubMed  CAS  Google Scholar 

  62. Pick A, Langendorf R, Katz LN: The supernormal phase of atrioventricular conduction. Circulation 26:322, 1962.

    Article  Google Scholar 

  63. Gallagher JJ, Damato AN, Caracta AR, et al.: Gap in A-V conduction in man; types I and II. Am Heart J 85:78–82, 1973.

    Article  PubMed  CAS  Google Scholar 

  64. Gallagher JJ, Damato AN, Varghese PJ, et al.: Alternative mechanisms of apparent supernormal atrioventricular conduction. Am J Cardiol 31:362–371, 1973.

    Article  PubMed  CAS  Google Scholar 

  65. Moe GK, Childers RW, et al,: An appraisal of “supernormal” A-V conduction. Circulation 38:5, 1968.

    Article  PubMed  CAS  Google Scholar 

  66. Sung RJ, Juma Z, Saksena S: Electrophysiologic properties and antiarrhythmic mechanisms of intravenous N-acetylprocainamide in patients with ventricular dysrhythmias. Am Heart J 105:811–819, 1983.

    Article  PubMed  CAS  Google Scholar 

  67. Sung RJ, Myerburg RJ, Castellanos A: Electrophysiological demonstration of concealed conduction in the human atrium. Circulation 58:940–946, 1978.

    Article  PubMed  CAS  Google Scholar 

  68. Nguyen NX, Yang PT, et al.: Effects of beta-adrenergic stimulation on atrial latency and atrial vulnerability in patients with paroxysmal supraventricular tachycardia. Am J Cardiol 61:1031–1036, 1988.

    Article  PubMed  CAS  Google Scholar 

  69. Greenspan AM, Camardo JS, Horowitz LN, et al.: Human ventricular refractoriness: effects of increasing current. Am J Cardiol 47:244–250, 1981.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stanford University School of Medicine, Stanford University Medical Center, Stanford, California, USA

    Ruey J. Sung M.D. (Professor of Medicine, Director)

  2. Cardiac Electrophysiology & Arrhythmia Service, Stanford University Medical Center, Stanford, California, USA

    Ruey J. Sung M.D. (Professor of Medicine, Director)

  3. Stanford University School of Medicine, Stanford, California, USA

    Michael R. Lauer M.D., Ph. D. (Clinical Assistant Professor of Medicine, Attending Cardiac Electrophysiologist, Assistant Director)

  4. The Permanente Medical Group, Kaiser-Permanente Medical Center, San Jose, California, USA

    Michael R. Lauer M.D., Ph. D. (Clinical Assistant Professor of Medicine, Attending Cardiac Electrophysiologist, Assistant Director)

  5. Cardiac Electrophysiology Laboratory, Kaiser-Permanente Medical Center, San Jose, California, USA

    Michael R. Lauer M.D., Ph. D. (Clinical Assistant Professor of Medicine, Attending Cardiac Electrophysiologist, Assistant Director)

Authors
  1. Ruey J. Sung M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael R. Lauer M.D., Ph. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Sung, R.J., Lauer, M.R. (2000). Basic Principles of Clinical Cardiac Electrophysiology. In: Fundamental Approaches to the Management of Cardiac Arrhythmias. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4371-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-94-011-4371-4_2

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5879-7

  • Online ISBN: 978-94-011-4371-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation