Basic Electrophysiology
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1 Basic Electrophysiology Michael Eldar, M.D. Heart Institute Sheba Medical Center Caesaria 2010
2 Transmembrane Ion-Transfer Modes Ion Channel Pump Exchanger Opie LH, The Heart 1998:75
3 Voltage-Gated Sodium channel Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:64
4 Channel Pore Model Opie LH, The Heart 1998:76
5 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:43
6 The Sodium Channel Whalley DW et al, PACE 1995;18:1561
7 The Action Potetial Berne & Levy,Physiology 1998:30
8 Electro-Mechanical Relation Opie LH, The Heart 1998:74
9 Berne & Levy,Physiology 1998:335
10 Berne & Levy,Physiology 1998:330
11 Ik,ur Whalley DW et al, PACE 1995;18:1565
12 Normal Automaticity I k decay I I f f Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:55
13 Normal Automaticity Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:199
14 ACh and Automaticity Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:202
15 Catecholamines & Normal Automaticity MDP Slope Phase 4 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:201
16 Abnormal automaticity - Depolarized myocytes ( mv) - ph - [O 2 ] - [K+] o
17 Depolarization-induced induced Automaticity Low High Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:206
18 Abnormal automaticity Clinical Arrhythmias - Myocardial infarction minutes hours - AIVR - [K+] o - Ischemia - Injury currents
19 Triggered Activity - activity arising from membrane potential oscillations during or immediately following an AP - Should occur following a previous AP (spontaneous or driven)
20 Triggered Activity Zipes & Jaliffe, Cardiac Electrophysiology1995:208
21 Digoxin induced DAD Rate-Dependence of DAD s Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:211
22 DAD Clinical Arrhythmias - Dig. Intoxication - atrial tach - VT - Accelerated VT during AMI - Reperfusion induced arrhythmias - CPVT - Exercise (catecholamine, camp dependent) induced RVOT VT
23 Early Afterdepolarization Pathophysiology (EAD) Outward current and/or Inward current
24 Quinidine-induced induced EAD s Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:215
25 EAD Clinical arrhythmias - TDP - acquired LQTS - congenital LQTS
26 LQTS- net outward current I,II,V,VI III Viskin, Lancet 99;354:1625
27 Acquired EAD - hypokalemia ( K K conductance) - Acidosis - Bradycardia - Ikr blockers - AAD - Phenothiazine - Antihistamines - Antibiotics - antidepressants
28 Circus Movement Reentry 1. Intact anatomic circuit 2. Unidirectional block (onset) 3. Area of slow conduction 4. Wavelength of tach. < length of circuit
29 Wavelength=Conduction Velocity x Refractory Period
30
31 AVNRT
32 slow fast
33 WPW Syndrome
34 Reentry EPS-Diagnosis 1. Continuous electric activity 2. Inducibility/termination by electrical stimulation 3. Inverse relationship of C.I. of initiating extrastimulus/1 st tachycardia beat 4. Entrainment (resetting) by external stimuli
35 Viskin, Prog Cardiovasc Dis 1998;41:17
36 Phase II Reentry Di Diego, Circulation 1993;88:1177
37 Phase II Reentry
38 Clinical Reentry Tachyarrhythmias Definite SANRT AVNRT AVRT A Flutter Post MI VT BBR VT Probable A Fibrillation PVT VF
39
40 Na Channel
41 OT VT
42 LVOT VT
43 K + channel opener rate Yan Gan-Xin, Circulation 1999;100:1660
44 Berne & Levy,Physiology 1998:330
45 מי מהתעלות הבאות האחר אית העיקרית 2. לשלב ה ח ד רי? של פו טנצ יאל הפ עולה II I ca,l I na I k I k1 I k,ach א- ב- ג- ד- ה- א' התשובה
46 Inward Rectifier Ik 1 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:69
47 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:40
48 מהבאים יוצא דופן? 1.מי I ca I k Ryanodin receptor Na/K ATPase pump Ca/Na exchanger א- ב- ג- ד- ה- התשובה ג' THE HEART INSTITUTE
49 4. המשפטים הבאים מתייחסים ל Activity-.Triggered אחד אינו נכון, מהו? א- ב- ג- ד- ה- DAD גדלים עקב טכיקרדיה LQT3 נגרם בשל מוטציה בתעלת אשלגן TdP מתרופות נגרם מחסימת תעלת אשלגן מחויב להיגרם ע"י פוטנציאל פעולה קודם עודף יונים חיוביים בתא גורם להארכת QT התשובה הנכונ ה ב'
50 3. אחת מהפרע ות הקצב להלן נגרמת עק ב..Abnormal automaticity איזו הי א? א- PAT עקב הרעלת דיגוקסין ב- TdP מקינידין ג- RVOT VT במאמץ ד- AVNRT ה- AIVR התשובה הנכונ ה ה'
51 5. המשפטים הבאי ם מתיי ח סים ל.REENTRY אח ד אי נו נכ ון, מהו? א- המנגנ ו ן השכ י ח בי ותר ב- א ח ר אי ג- לא ר יתמיות באדם ל א רי תמיה בתסמונת ברו ג דה א ח ר אי ע י ק ר י ל VT לא ח ר אוט ם ישן ד- חסם ח ד כי ו ונ י א ינ ו תנאי ה כ ר ח י לה תחל תו ה- בטכי ק ר ד יה, או ר ך ה ג ל קצ ר מ או ר ך המסל ול התשובה הנכונ ה ד'
52 EAD Pathophysiology -AP prolongation Ik,, Ik1, Ito I NA, Ica, electrogenic Na Ca exchanger AP Plateau - Currents sensitivity - Net depolarizing current - Ica, L (window) -
53 Genotype and ECG
54 Reentry Unidirectional block 1. Increase in sinus rate 2. Rapid or premature atrial pacing 3. Retrograde activation from VPC 4. Autonomic influence 5. AAD 6. Ischemia
55 Resetting
56 Leading Circus Reentry 1. Cannot be interrupted by disrupting the circuit 2. No fully excitable gap - unstable - insensitive to electrical stimulation 3. Short cycle length
57 Leading Circle Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:237
58 APC in WPW
59 Atrial flutter circuit SVC CT FO His TV IVC CS
60 Reentry circuit
61 Tetrodotoxin effect on Action Potential 100 mv Berne & Levy,Physiology 1998:339
62 Channels Open in Bursts Opie LH, The Heart 1998:81
63 Berne & Levy,Physiology 1998:285
64 Characteristics DAD - Induction - fast train -1 ES - CI / CL of initiating stimulus/li CI of triggered response - Termination - 1 ES - ODP
65 Berne & Levy,Physiology 1998:330
66 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:70
Basic Electrophysiology
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