Abstract
Basic electrophysiology is a rapidly evolving field, rich in detail. This introductory chapter provides a succinct and essential overview of key concepts in basic electrophysiology covering: The stages of the cardiac action potential and their generation; Excitation-contraction coupling; Cardiac automaticity; The cardiac conduction system and Arrhythmogenesis, including abnormal automaticity, afterdepolarizations, triggered activity and re-entry.
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References
Grant A, Carboni M, Antzelevitch C, Burashnikov A. Cardiac arrhythmia: mechanisms, diagnosis, and management. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2001.
MacLeod K. An essential introduction to cardiac electrophysiology. 1st ed. London: Imperial College Press; 2014.
Grant AO. Cardiac ion channels. Circ Arrhythm Electrophysiol. 2009;2(2):185–94.
Zipes D, Jalife J. Cardiac electrophysiology: from cell to bedside. 6th ed. Philadelphia: Elsevier; 2014.
Papadatos GA, Wallerstein PM, Head CE, et al. Slowed conduction and ventricular tachycardia after targeted disruption of the cardiac sodium channel gene Scn5a. Proc Natl Acad Sci U S A. 2002;99(9):6210–5.
Antzelevitch C, Yan GX. J-wave syndromes: Brugada and early repolarization syndromes. Heart Rhythm. 2015;12(8):1852–66.
Whalley DW, Wendt DJ, Grant AO. Basic concepts in cellular cardiac electrophysiology: part I: ion channels, membrane currents, and the action potential. Pacing Clin Electrophysiol. 1995;18(8):1556–74.
Huang FD, Chen J, Lin M, Keating MT, Sanguinetti MC. Long-QT syndrome-associated missense mutations in the pore helix of the HERG potassium channel. Circulation. 2001;104(9):1071–5.
Lupoglazoff JM, Denjoy I, Berthet M, et al. Notched T waves on holter recordings enhance detection of patients with LQt2 (HERG) mutations. Circulation. 2001;103(8):1095–101.
Brugada R, Hong K, Dumaine R, et al. Sudden death associated with short-QT syndrome linked to mutations in HERG. Circulation. 2004;109(1):30–5.
Gaita F, Giustetto C, Bianchi F, et al. Short QT syndrome: a familial cause of sudden death. Circulation. 2003;108(8):965–70.
Pfeiffer ER, Tangney JR, Omens JH, McCulloch AD. Biomechanics of cardiac electromechanical coupling and mechanoelectric feedback. J Biomech Eng. 2014;136(2):021007.
Bers DM. Cardiac excitation-contraction coupling. Nature. 2002;415(6868):198–205.
Kobayashi T, Solaro RJ. Calcium, thin filaments, and the integrative biology of cardiac contractility. Annu Rev Physiol. 2005;67:39–67.
Gordon AM, Homsher E, Regnier M. Regulation of contraction in striated muscle. Physiol Rev. 2000;80(2):853–924.
Garcia-Frigola C, Shi Y, Evans SM. Expression of the hyperpolarization-activated cyclic nucleotide-gated cation channel HCN4 during mouse heart development. Gene Expr Patterns. 2003;3(6):777–83.
Weisbrod D, Khun SH, Bueno H, Peretz A, Attali B. Mechanisms underlying the cardiac pacemaker: the role of SK4 calcium-activated potassium channels. Acta Pharmacol Sin. 2016;37(1):82–97.
DiFrancesco D. Funny channels in the control of cardiac rhythm and mode of action of selective blockers. Pharmacol Res. 2006;53(5):399–406.
Hagiwara N, Irisawa H, Kasanuki H, Hosoda S. Background current in sino-atrial node cells of the rabbit heart. J Physiol. 1992;448:53–72.
Krapivinsky G, Gordon EA, Wickman K, Velimirovic B, Krapivinsky L, Clapham DE. The G-protein-gated atrial K+ channel IKACh is a heteromultimer of two inwardly rectifying K(+)-channel proteins. Nature. 1995;374(6518):135–41.
Wickman K, Krapivinsky G, Corey S, et al. Structure, G protein activation, and functional relevance of the cardiac G protein-gated K+ channel, IKACh. Ann N Y Acad Sci. 1999;868:386–98.
DiFrancesco D, Ducouret P, Robinson RB. Muscarinic modulation of cardiac rate at low acetylcholine concentrations. Science. 1989;243(4891):669–71.
Tamargo J, Caballero R, Gomez R, Valenzuela C, Delpon E. Pharmacology of cardiac potassium channels. Cardiovasc Res. 2004;62(1):9–33.
Stern MD, Capogrossi MC, Lakatta EG. Spontaneous calcium release from the sarcoplasmic reticulum in myocardial cells: mechanisms and consequences. Cell Calcium. 1988;9(5–6):247–56.
Bogdanov KY, Vinogradova TM, Lakatta EG. Sinoatrial nodal cell ryanodine receptor and na(+)-ca(2+) exchanger: Molecular partners in pacemaker regulation. Circ Res. 2001;88(12):1254–8.
van Campenhout MJ, Yaksh A, Kik C, et al. Bachmann’s bundle: a key player in the development of atrial fibrillation? Circ Arrhythm Electrophysiol. 2013;6(5):1041–6.
Dobrzynski H, Anderson RH, Atkinson A, et al. Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues. Pharmacol Ther. 2013;139(2):260–88.
Hancox J, Yuill K, Mitcheson J, Convery M. Progress and gaps in un- derstanding the electrophysiological properties of morphologically normal cells from the cardiac atrioventricular node. Int J Bifurcat Chaos. 2003;13:3675–91.
Greener ID, Tellez JO, Dobrzynski H, et al. Ion channel transcript expression at the rabbit atrioventricular conduction axis. Circ Arrhythm Electrophysiol. 2009;2(3):305–15.
Greener ID, Monfredi O, Inada S, et al. Molecular architecture of the human specialised atrioventricular conduction axis. J Mol Cell Cardiol. 2011;50(4):642–51.
Li J. Alterations in cell adhesion proteins and cardiomyopathy. World J Cardiol. 2014;6(5):304–13.
Meens MJ, Kwak BR, Duffy HS. Role of connexins and pannexins in cardiovascular physiology. Cell Mol Life Sci. 2015;72(15):2779–92.
Desplantez T, McCain ML, Beauchamp P, et al. Connexin43 ablation in foetal atrial myocytes decreases electrical coupling, partner connexins, and sodium current. Cardiovasc Res. 2012;94(1):58–65.
Sato PY, Musa H, Coombs W, et al. Loss of plakophilin-2 expression leads to decreased sodium current and slower conduction velocity in cultured cardiac myocytes. Circ Res. 2009;105(6):523–6.
Shu J, Zhou J, Patel C, Yan GX. Pharmacotherapy of cardiac arrhythmias—basic science for clinicians. Pacing Clin Electrophysiol. 2009;32(11):1454–65.
Hirano Y, Moscucci A, January CT. Direct measurement of L-type Ca2+ window current in heart cells. Circ Res. 1992;70(3):445–55.
January CT, Riddle JM. Early afterdepolarizations: mechanism of induction and block. A role for L-type Ca2+ current. Circ Res. 1989;64(5):977–90.
Nattel S, Maguy A, Le Bouter S, Yeh YH. Arrhythmogenic ion-channel remodeling in the heart: heart failure, myocardial infarction, and atrial fibrillation. Physiol Rev. 2007;87(2):425–56.
Bers DM. Cardiac sarcoplasmic reticulum calcium leak: basis and roles in cardiac dysfunction. Annu Rev Physiol. 2014;76:107–27.
Comtois P, Kneller J, Nattel S. Of circles and spirals: bridging the gap between the leading circle and spiral wave concepts of cardiac reentry. Europace. 2005;7(Suppl 2):10–20.
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. 1977;41(1):9–18.
Rensma PL, Allessie MA, Lammers WJ, Bonke FI, Schalij MJ. Length of excitation wave and susceptibility to reentrant atrial arrhythmias in normal conscious dogs. Circ Res. 1988;62(2):395–410.
Li D, Fareh S, Leung TK, Nattel S. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation. 1999;100(1):87–95.
Aguilar M, Nattel S. The past, present, and potential future of sodium channel block as an atrial fibrillation suppressing strategy. J Cardiovasc Pharmacol. 2015;66(5):432–40.
Kneller J, Kalifa J, Zou R, et al. Mechanisms of atrial fibrillation termination by pure sodium channel blockade in an ionically-realistic mathematical model. Circ Res. 2005;96(5):e35–47.
Kalifa J, Jalife J, Zaitsev AV, et al. Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation. Circulation. 2003;108(6):668–71.
Cuculich PS, Wang Y, Lindsay BD, et al. Noninvasive characterization of epicardial activation in humans with diverse atrial fibrillation patterns. Circulation. 2010;122(14):1364–72.
Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel WJ, Miller JM. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J Am Coll Cardiol. 2012;60(7):628–36.
Haissaguerre M, Hocini M, Denis A, et al. Driver domains in persistent atrial fibrillation. Circulation. 2014;130(7):530–8.
Acknowledgments
The authors would like to thank Dr. Charles Pearman from The University of Manchester for kindly providing the material used to make Fig. 1.4.
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Robinson, V.M., Nattel, S. (2017). Basic Electrophysiology. In: Kowey, P., Piccini, J., Naccarelli, G., Reiffel, J. (eds) Cardiac Arrhythmias, Pacing and Sudden Death. Cardiovascular Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-58000-5_1
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DOI: https://doi.org/10.1007/978-3-319-58000-5_1
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