Cardiac Anatomy and Electrophysiology
Cardiac electrophysiology has rapidly moved from the mapping and ablation of accessory atrioventricular connections and ectopic foci to more extensive mapping and substrate modification. Training in cardiac electrophysiology requires a detailed knowledge
- PDF / 3,393,182 Bytes
- 37 Pages / 439.37 x 666.14 pts Page_size
- 27 Downloads / 227 Views
Cardiac Anatomy and Electrophysiology Benedict M. Glover, Orla Buckley, Siew Yen Ho, Damian Sanchez-Quintana, and Pedro Brugada
Abstract Cardiac electrophysiology has rapidly moved from the mapping and ablation of accessory atrioventricular connections and ectopic foci to more extensive mapping and substrate modification. Training in cardiac electrophysiology requires a detailed knowledge of the anatomy and physiology of the heart. In order to understand the basis of cardiac electrophysiology it is important to discuss the different phases of the cardiac action potential, variability in morphology and duration throughout the heart and the most important ion channels and electrolyte shifts responsible for depolarization and repolarization of the cardiac cells. Electrophysiology continues to rely heavily on an understanding of these basic principles as well as the relevant anatomy of all cardiac chambers and surrounding structures. It is therefore fundamental to have a thorough understanding of cardiac anatomy as visualized on fluoroscopy, echocardiography, CT, MRI and 3 dimensional cardiac mapping systems.
B.M. Glover (*) Department of Cardiac Electrophysiology, Queens University, Kingston, ON, Canada e-mail: [email protected] O. Buckley Department of Radiology, Adelaide and Meath Hospital, Dublin, Ireland S.Y. Ho National Heart and Lung Institute, Imperial College, and Royal Brompton and Harefield Hospitals, London, UK D. Sanchez-Quintana Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain P. Brugada, MD, PhD Chairman, Cardiovascular Division, Free University of Brussels, UZ Brussel-VUB, Brussels, Belgium GVM Group, Cotignola, Italy CEO Medisch Centrum Prof. Dr. P. Brugada, Aalst, Belgium Clinical Electrophysiology program, Hospiten Estepona, Marbella, Spain
© Springer International Publishing Switzerland 2016 B.M. Glover, P. Brugada (eds.), Clinical Handbook of Cardiac Electrophysiology, DOI 10.1007/978-3-319-40818-7_1
1
B.M. Glover et al.
2
The Cardiac Action Potential Spontaneous depolarization of cells within the sinus node (SN) results in propagation of excitation throughout adjacent cells within the right atrium (RA) and left atrium (LA). The electrical impulse spreads through the atrioventricular (AV) junction into the His bundle, through the Purkinje network and then into the ventricular muscle where activation occurs from the septum spreading through the endocardium, mid-myocardium and finally the epicardium. Each cardiac cell undergoes a process of depolarization and repolarization, which is recorded across the cell membrane as an action potential and occurs as a result of the relative concentration of ions (predominantly potassium, sodium and calcium) and electrostatic forces across the membrane. As shown in Fig. 1.1 this is composed of 5 components in atrial and ventricular myocytes and 3 components in the SN and AV node. The QTc on the surface ECG is an approximation of the mean duration of the ventricular action potential. 20
SN
40
10
Data Loading...
