Introduction to Clinical Electrophysiology

  • Donald G. Rubenstein
  • Carol Zaher

Abstract

Electrophysiology studies (EPS) began in the late 1960s in the dog laboratory where recording of the His bundle electrogram was accomplished.1 The first recordings in the human heart occurred in a patient with atrial septal defect2; whereas in 1969, Scherlag et al3 were the first investigators to percutaneously, by right heart cardiac catheterization, record a His bundle in humans by safely placing an electrode catheter across the tricuspid valve.

Keywords

Catheter Torque Heparin Luminal Catecholamine 

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References

  1. 1.
    Alanis J, Gonzalez H, Lopez E: Electrical activity of the bundle of His. J Physiol 1958; 142:127.PubMedGoogle Scholar
  2. 2.
    Giraud G, Peuch P, Latour H: L’activité élec-trique physiologique du noeud de Tawara et du Faisceveau de His chez rhomme. Acad Nat Med 1960; May:363.Google Scholar
  3. 3.
    Sherlag BJ, Lau SH, Heifant RH, et al: Catheter technique for recording His bundle activity in man. Circulation 1969; 39:13.Google Scholar
  4. 4.
    Wellens HJJ: Electrical stimulation of the heart in the study and treatment of tachycardias. Leiden, Stenfert Kroese, 1971.Google Scholar
  5. 5.
    Wellens HJJ, Lie KI, Durrer D: Further observation on ventricular tachycardia as studied by electrical stimulation of the heart: Chronic recurrent ventricular tachycardia and ventricular tachycardia during acute myocardial infarction. Circulation 1971; 43:15.Google Scholar
  6. 6.
    Health and Public Policy Committee, American College of Physicians: Diagnostic endocardial electrical recording and stimulation. Ann Intern Med 1984; 100:452.Google Scholar
  7. 7.
    State of the AA Consensus Conference on Electrophysiologic Testing in the diagnosis and treatment of patients with cardiac arrhythmias. Circulation 1987; 75(suppl):4.Google Scholar
  8. 8.
    Kastor JA, Horowitz LN, Hanken AH, et al: Clinical electrophysiology of ventricular tachycardia. N Engl J Med 1981; 304:1004.PubMedCrossRefGoogle Scholar
  9. 9.
    Rae AP, Greenspan AM, Spielman SR, et al: Antiarrhythmic drug efficacy for ventricular tachyarrhythmias associated with coronary artery disease as assessed by electrophysiologic studies. Am J Cardiol 1985; 55:1494.PubMedCrossRefGoogle Scholar
  10. 10.
    Mason JW, Winkle RA: Accuracy of ventricular tachycardic induction study for predicting long-term efficacy and inefficacy of antiarrhythmic drugs. N Engl J Med 1980; 303:1073.PubMedCrossRefGoogle Scholar
  11. 11.
    Ruskin JN, Dimarco JP, Garan H: Out-of-hospital cardiac arrest. Electrophysiologic observations and selection of long-term antiarrhythmic therapy. N Engl J Med 1980; 303:607.PubMedCrossRefGoogle Scholar
  12. 12.
    Horowitz LN, Josephson ME, Farshidi A, et al: Recurrent sustained VT. 3. Role of the electrophysiological study in selection of antiarrhythmic regimens. Circulation 1978; 58:986.PubMedGoogle Scholar
  13. 13.
    Horowitz LN, Spielman SR, Greenspan AM, et al: Role of programmed stimulation in assessing vulnerability to ventricular arrhythmias. Am Heart J 1982; 103:604.PubMedCrossRefGoogle Scholar
  14. 14.
    Liberthson RR, Nagel EL, Hirshman JC, et al: Prehospital ventricular defibrillation: Prognosis and follow-up course. N Engl J Med 1974; 291:317.PubMedCrossRefGoogle Scholar
  15. 15.
    Baum RS, Alvarez H, Cobb LA: Survival after rescitation from out-of-hospital ventricular fibrillation. Circulation 1974; 50:1231.PubMedGoogle Scholar
  16. 16.
    Kehoe RF, Moran JM, Zheutlin T, et al: Electrophysiologic study to direct therapy in survivors of prehospital ventricular fibrillation. Am J Cardiol 1982; 49:928.CrossRefGoogle Scholar
  17. 17.
    Morady F, Scheinman MM, Hess DS, et al: Electrophysiologic testing in the management of survivors of out-of-hospital cardiac arrest. Am J Cardiol 1983; 51:85.PubMedCrossRefGoogle Scholar
  18. 18.
    Roy D, Waxman HL, Kienzle MG, et al: Clinical characteristics and long-term follow-up in 119 survivors of cardiac arrest: Relation to in-ducibility at electrophysiologic testing. Am J Cardiol 1983; 52:969.PubMedCrossRefGoogle Scholar
  19. 19.
    Benditt DG, Benson DW, Klein GJ, et al: Prevention of recurrent sudden cardiac arrest: Role of provocative electropharmacologic testing. J Am Coll Cardiol 1983; 2:418.PubMedCrossRefGoogle Scholar
  20. 20.
    Skale BT, Miles WM, Heger JJ, et al: Survivors of cardiac arrest: Prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrocardiographic monitoring. Am J Cardiol 1986; 57:113.PubMedCrossRefGoogle Scholar
  21. 21.
    Wilber DJ, Garan H, Kelly E, et al: Out-of-hospital arrest: Role of electrophysiologic testing in prediction of long-term outcome. Circulation 1986; 74(suppl II): 11–482.Google Scholar
  22. 22.
    Zheutlin TE, Steinmann R, Summers C, et al: Long-term outcome in survivors of cardiac arrest with noninducible ventricular tachycardia during programmed stimulation. Circulation 1984; 70(suppl II):II-399.Google Scholar
  23. 23.
    Morady F, DiCarlo L, Winston S, et al: Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. J Am Coll Cardiol 1984; 4:39.PubMedCrossRefGoogle Scholar
  24. 24.
    Wellens HJ, Brugada P, Stevensen WG: Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias. Circulation 1985; 72:1.PubMedCrossRefGoogle Scholar
  25. 25.
    Echt DS, Armstrong K, Schmidt P, et al: Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator. Circulation 1985; 71:289.PubMedCrossRefGoogle Scholar
  26. 26.
    Gallagher JJ, Pritchett ELC, Sealy WC, et al: The pre-excitation syndrome. Prog Cardiovasc Dis 1978; 20:285.PubMedCrossRefGoogle Scholar
  27. 27.
    Wellens HJJ, Durrer D: Wolff-Parkinson-White syndrome and atrial fibrillation. Am J Cardiol 1974; 34:777.PubMedCrossRefGoogle Scholar
  28. 28.
    Castellanos A, Myerberg RJ, Craparo K, et al: Factors regulating ventricular rates during atrial flutter and fibrillation in pre-excitation (Wolff-Parkinson-White) syndrome. Br Heart J 1973; 35:811.PubMedCrossRefGoogle Scholar
  29. 29.
    Sledge C, Scheinman M, Morady F, et al: Medical therapy in Wolff-Parkin son-White syndrome and atrial fibrillation. Circulation 1982; 66(suppl II):II-269.Google Scholar
  30. 30.
    Bavernfeind RA, Swiryn SP, Strasberg B, et al: Electrophysiologic drug testing in prophylaxis of sporadic paroxysmal atrial fibrillation: Technique, applications, and efficacy in severely sumptomatic pre-excitation patients. Am Heart J 1982; 103:941.CrossRefGoogle Scholar
  31. 31.
    Wu D, Denes P, Amat-y-Leon F, et al: Clinical, electrocardiographic, and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol 1978; 41:1045.PubMedCrossRefGoogle Scholar
  32. 32.
    Wu D, Amat-y-Leon F, Simpson RJ Jr, et al: Electrophysiological studies with multiple drugs in patients with atrioventriculoreentrant tachycardias utilizing an extranodal pathway. Circulation 1977; 56:727.PubMedGoogle Scholar
  33. 33.
    Wellens HJJ, Bar FWHM, Lie KI: The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med 1978; 64:27.PubMedCrossRefGoogle Scholar
  34. 34.
    Wellens HJJ, Bar FW, Vanagt EJ, et al: The differentiation between ventricular tachycardia and supraventricular tachycardia with aberrant conduction. The value of 12-lead electrocardiogram, in Wellens HJJ, Kulbertus HE (eds): What’s New in Electrocardiography? The Hague, Martinus Nijhoff, 1981, p 184.Google Scholar
  35. 35.
    Coumel P, Leclercq JF, Attuel P, et al: The QRS morphology in postmyocardial infarction ventricular tachycardia. A study of 100 tracings compared with 70 cases of idiopathic ventricular tachycardia. Eur Heart J 1984; 5:792.PubMedGoogle Scholar
  36. 36.
    Josephson ME, Horowitz LN, Waxman HL: Sustained ventricular trachcardia: Role of 12-lead electrocardiogram in localizing site of origin. Circulation 1981; 64:257.PubMedCrossRefGoogle Scholar
  37. 37.
    Josephson ME, Horowitz LN, Farshidi A, et al: Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation 1978; 57:440.PubMedGoogle Scholar
  38. 38.
    Silverstein MD, Singer DE, Mulley AG, et al: Patients with syncope admitted to medical intensive care units. J Am Med Assoc 1982; 248:1185.CrossRefGoogle Scholar
  39. 39.
    Lipsitz LA: Syncope in the elderly. Ann Intern Med 1983; 99:92.PubMedGoogle Scholar
  40. 40.
    DiMarco JP, Garan H, Hawthorne JW, et al: Intracardiac electrophysiologic techniques in recurrent syncope of unknown cause. Ann Intern Med 1981; 95:542.PubMedGoogle Scholar
  41. 41.
    DiMarco JP, Garan H, Ruskin JN: Approach to the patient with recurrent syncope of unknown cause. Mod Concepts Cardiovasc Dis 1983; 52:11.PubMedGoogle Scholar
  42. 42.
    Hess DS, Morady F, Scheinman MM: Electrophysiologic testing in the evaluation of patients with syncope of undetermined origin. Am J Cardiol 1982; 50:1309.PubMedCrossRefGoogle Scholar
  43. 43.
    Morady F, Shen E, Schwartz A, et al: Long-term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing. J Am Coll Cardiol 1983; 2:1053.PubMedCrossRefGoogle Scholar
  44. 44.
    Morady F, Higgins J, Peters RW, et al: Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol 1984; 54:587.PubMedCrossRefGoogle Scholar
  45. 45.
    Akhtar M, Shenasa M, Denker S, et al: Role of cardiac electrophysiologic studies in patients with unexplained recurrent syncope. PACE 1983; 6:192.PubMedGoogle Scholar
  46. 46.
    Gulamhusein S, Naccarelli GV, Ko PT, et al: Value and limitations of clinical electrophysiologic study in assessment of patients with unexplained syncope. Am J Med 1982; 73:700.PubMedCrossRefGoogle Scholar
  47. 47.
    Boudoulas H, Geleris P, Schani SF, et al: Comparison between electrophysiologic studies and ambulatory monitoring in patients with syncope. J Electrocardiol 1983; 16:91.PubMedCrossRefGoogle Scholar
  48. 48.
    Ezri ME, Lerman BB, Marchlinski FE, et al: Electrophysiologic evaluation of syncope in patients with bifasicular block. Am Heart J 1982; 106:693.CrossRefGoogle Scholar
  49. 49.
    Westvecr DC, Stewart J, Vandam D, et al: The role of electrophysiologic studies in the evaluation of recurrent, unexplained syncope. Cardiovasc Rev Rep 1984; 5:770.Google Scholar
  50. 50.
    Olshansky B, Mazuz M, Martins JB: Significance of inducible tachycardia in patients with syncope of unknown origin: A long-term follow-up. J Am Coll Cardiol 1985; 5:216.PubMedCrossRefGoogle Scholar
  51. 51.
    Doherty JV, Pembrook-Rogers D, Grogan EW, et al: Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 1985; 55:703.PubMedCrossRefGoogle Scholar
  52. 52.
    Denes P, Ezri MD: The role of electrophysiologic studies in the management of patients with unexplained syncope. PACE 1985; 8:424.PubMedGoogle Scholar
  53. 53.
    Hammer A, Vohra J, Hunt D, et al: Prediction of sudden death by electrophysiologic studies in high-risk patients surviving acute myocardial infarction. Am J Cardiol 1982; 50:223.CrossRefGoogle Scholar
  54. 54.
    Richards DA, Cody DU, Denniss AR, et al: Ventricular electrical instability: A predictor of death after myocardial infarction. Am J Cardiol 1983; 51:75.PubMedCrossRefGoogle Scholar
  55. 55.
    Marchlinkski FE, Buxton AE, Waxman HL, et al: Identifying patients at a risk of sudden death after myocardial infarction: Value of the response for programmed stimulation, degree of ventricular ectopic activity, and severity of left ventricular dysfunction. Am J Cardiol 1983; 52:1190.CrossRefGoogle Scholar
  56. 56.
    Santarelli P, Bellucci F, Luperfido F, et al: Ventricular arrhythmia induced by programmed ventricular stimulation after acute myocardial infarction. Am J Cardiol 1985; 55:391.PubMedCrossRefGoogle Scholar
  57. 57.
    Roy D, Marchand E, Theroux P, et al: Programmed ventricular stimulation in survivors of an acute myocardial infarction. Circulation 1985; 72:487.PubMedCrossRefGoogle Scholar
  58. 58.
    Gonzales R, Arriagada D, Corbalan R, et al: Programmed electrical stimulation of the heart does not help to identify patients at high-risk postmyocardial infarction. Circulation 1984; 70(suppl II):II-19.Google Scholar
  59. 59.
    Buxton AE: Nonsustained ventricular tachycardia in patients with coronary artery disease: Role of electrophysiologic study. Circulation 1987; 75(6): 1178–1185.PubMedCrossRefGoogle Scholar
  60. 60.
    Wellens HJJ, Farre J, Bar FW: Wolff-Parkinson-White syndrome. Value and limitations of programmed electrical stimulation, in Narula OS (ed): Cardiac Arrhythmias. Baltimore, Williams & Wilkens, 1979, p 589.Google Scholar
  61. 61.
    Horowitz LN: Safety of electrophysiology studies. Learning Center Highlights 1986; 2(2):5.Google Scholar
  62. 62.
    Horowtiz LN, Kay HR, Kutalek SP, et al: Risks and complications of clinical cardiac electrophysiologic studies: A prospective analysis of 1000 consecutive patients. J Am Coll Cardiol 1987; 9:1261.CrossRefGoogle Scholar
  63. 63.
    Gettes LS, Zipes DP, Gillette PC, et al: Personnel and equipment required for electrophysiologic testing. Report of the Committee on Electrocardiography and Cardiac Electro-physiology, Council on Clinical Cardiology, The American Heart Association. AHA files no. 72–023-A.Google Scholar
  64. 64.
    Josephson ME, Seides SF: Clinical Cardiac Electrophysiology. Philadelphia, Lea & Febiger, 1979.Google Scholar
  65. 65.
    Reddy CP, Damato AN, Akhtar M, et al: Time dependent changes in the functional properties of the atrioventricular conduction system in man. Circulation 1975; 52:1012.PubMedGoogle Scholar
  66. 66.
    Mandel WG, Hayakawa H, Danzig R, et al: Evaluation of sinoatrial node function in man by overdrive suppression. Circulation 1971; 44:59.PubMedGoogle Scholar
  67. 67.
    Narula OS, Samet P, Xavier RP: Significance of the sinus node recovery time. Circulation 1972; 45:140.PubMedGoogle Scholar
  68. 68.
    Kerr CR, Grant AO, Wenger TL, et al: Sinus node dysfunction, in Zipes DP (ed): Cardiology Clinics: Arrhythmias II, Vol 1, No. 2. Philadelphia, W.B. Saunders Co., 1983, pp 187–207.Google Scholar
  69. 69.
    Strauss HC, Bigger JT Jr, Saroff AL, et al: Electrophysiologic evaluation of sinus node function in patients with sinus node dysfunction. Circulation 1976; 53:763.PubMedGoogle Scholar
  70. 70.
    Breithardt G, Seipel L, Loogen F: Sinus node recovery time and calculated sinoatrial conduction time in normal subjects and patients with sinus node dysfunction. Circulation 1977; 56:43.PubMedGoogle Scholar
  71. 71.
    Narula OS, Shartha N, Vasquez M, et al: A new method for measurement of sinoatrial conduction time. Circulation 1978; 58:706.PubMedGoogle Scholar
  72. 72.
    Jordan JL, Yamaguchi I, Mandel WJ: Studies on the mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation 1978; 57:217.PubMedGoogle Scholar
  73. 73.
    Narula OS, Narula JT: Various techniques for electrophysiological evaluation of sinus node function, in Puel P (ed): Troubles du Rhythme et Electrostimulation Toulouse, Société de la Nouvelle Imprimerie Fournie, 1978, p 15.Google Scholar
  74. 74.
    Robertson JF, Cain ME, Horowitz LN, et al: Anatomic and electrophysiologic correlates of ventricular tachycardia requiring left ventricular stimulation. Am J Cardiol 1981; 48:263.PubMedCrossRefGoogle Scholar
  75. 75.
    Freedman RA, Swerdlow DC, Echt DS, et al: Facilitation of ventricular tachyarrhythmia induction by isoproterenol. Am J Cardiol 1984; 54:765.PubMedCrossRefGoogle Scholar
  76. 76.
    Weber H, Schmitz L: Catheter technique for closed-chest ablation of an accessory atrioventricular pathway. N Engl J Med 1983; 308:653.PubMedGoogle Scholar
  77. 77.
    Morady F, Scheinman MM: Transvenous catheter ablation of a posteroseptal accessory pathway in a patient with Wolff-Parkinson-White syndrome. N Engl J Med 1984; 310:705.PubMedCrossRefGoogle Scholar
  78. 78.
    Morady F, Scheinman MM, Winston SA, et al: Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways. Circulation 1985; 72:170.PubMedCrossRefGoogle Scholar
  79. 79.
    Ward DE, Camm AJ: Treatment of tachycardias associated with the Wolff-Parkinson-White syndrome by transvenous electrical ablation of accessory pathways. Br Heart J 1985; 53:64.PubMedCrossRefGoogle Scholar
  80. 80.
    Gallagher J, Svenson RH, Kassell JH, et al: Catheter technique for closed-chest ablation of the atrioventricular conduction system. N Engl J Med 1982; 4:194.CrossRefGoogle Scholar
  81. 81.
    Sharma AD, Klein GJ, Guiraudon GM, et al: Atrial fibrillation in the Wolff-Parkinson-White syndrome: Incidence after surgical ablation of the accessory pathway. Circulation 1985; 72:161.PubMedCrossRefGoogle Scholar
  82. 82.
    Reiffei JA, Bigger JT Jr, Cramer M, et al: Ability of Holter electrocardiographic recording and atrial stimulation to detect sinus nodal dysfunction in symptomatic and asymptomatic patients with sinus bradycardia. Am J Cardiol 1977; 40:189.CrossRefGoogle Scholar
  83. 83.
    Strauss HC, Bigger JT Jr, Saroff AL, et al: Electrophysiologic evaluation of sinus node dysfunction. Circulation 1976; 53:763.PubMedGoogle Scholar
  84. 84.
    Narula OS, Scherlag BJ, Samet P, et al: Atrioventricular block: Localization and classification by His bundle recordings. Am J Med 1971; 50:146.PubMedCrossRefGoogle Scholar
  85. 85.
    Narula OS, Scherlag BJ, Javier RR: Analysis of the AV conduction defect in complete heart block utilizing His bundle electrograms. Circulation 1970 1970; 41:367.Google Scholar
  86. 86.
    Peuch P, Grolleau R, Guimond C: Incidence of different types of AV block and their localization by His Bundle recording, in Wellens HJJ, Lie K, Janse M, (eds): The Conduction System of the Heart. Leiden, Stenfert Kroese, 1976, p 467.Google Scholar
  87. 87.
    Dhingra RC, Wyndham C, Amat-y-Leon F, et al: Incidence and site of atrioventricular block in patients with chronic bifasicular block. Circulation 1979; 59:238.PubMedGoogle Scholar
  88. 88.
    Ezri M, Lerman BB, Marchlinski FE, et al: Electrophysiologic evaluation of syncope in patients with bifasicular block. Am Heart J 1983; 106:693.PubMedCrossRefGoogle Scholar
  89. 89.
    Kulbertus HE: Reevaluation of the prognosis of patients with LAD-RBB. Am Heart J 1976; 92:665.PubMedCrossRefGoogle Scholar
  90. 90.
    Dhingra RC, Denes P, Wu D, et al: Prospective observations in patients with chronic bundle branch block and marked H-V prolongation. Circulation 1976; 53:600.PubMedGoogle Scholar
  91. 91.
    McAnnuity JH, Rahimtoola SH, Murphy ES, et al: A prospective study of sudden death in “high-risk” bundle branch block. N Engl J Med 1978; 299:209.CrossRefGoogle Scholar

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© Springer-Verlag New York Inc. 1989

Authors and Affiliations

  • Donald G. Rubenstein
  • Carol Zaher

There are no affiliations available

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