Understanding Clinical Cardiac Electrophysiology

In the fast paced world of clinical training, students are often inundated with the what of electrophysiology without the why. This new text is designed to tell the story of electrophysiology so that the seemingly disparate myriad observations of clinical practice come into focus as a cohesive and predictable whole.

• Presents a unique, conceptually-guided approach to understanding the movement of electrical current through the heart, the impact of various disease states and the positive effect of treatment
• Reviews electrophysiologic principles and the analytic tools which, when combined with a firm grasp of EP mechanisms, allow the reader to think through any situation
• Presents the mathematics necessary for the practice of cardiac electrophysiology in an accessible and understandable manner
• Contains accompanying video clips, including computer simulations showing the flow of electrical current through the heart, which help explain and visualise concepts discussed in the text
• Includes helpful chapter summaries and full color illustrations aid comprehension

Preface vii

Acknowledgments ix

About the Companion Website xi

Part I: Third‐person omniscient (how we would see EP if we could see EP)

1 Ion channels 3

2 Action potentials 9

3 Propagation 19

4 Arrhythmia mechanisms 25

5 Anatomy for electrophysiologists 37

Part II: Doctor’s‐eye view (dealing with incomplete knowledge)

6 Deducing anatomy 49

7 Electrical activity electrodes and electrograms 59

8 Electrogram analysis: understanding electrogram morphology 69

9 Differential diagnostic pacing maneuvers 79

10 Electro‐anatomic mapping 99

Appendix: What we measure when we record an electrogram 109

Afterword: Your heart is a computer: from army ants to atrial fibrillation 115

Suggested reading 117

Index 119

PETER SPECTOR, MD PROFESSOR OF MEDICINE, Director, Cardiac Electrophysiology and Cardiac Electrophysiology Laboratory, University of Vermont Medical Center, University of Vermont College of Medicine, Burlington, VT, USA

In the fast paced world of clinical training, students are often inundated with the “what” of electrophysiology without the “why”. This new text is designed to tell the story of electrophysiology so that the seemingly disparate myriad observations of clinical practice come into focus as a cohesive and predictable whole.

The first section of the book presents Dr Spector’s unique approach to understanding the fundamental concepts in electrophysiology, from ion channels and propagation to arrhythmia mechanisms and the generation of electrograms. The second half of the book describes electrophysiology as it is seen by the clinician: through electrograms, imaging, response to pacing maneuvers and electro-anatomic mapping. The book is designed to teach the mechanisms that underlie electrophysiology so that the reader can “figure out” how to solve clinical problems rather than apply memorized algorithms.

This book:

• Presents a unique, conceptually guided approach to understanding the movement of electrical current through
• the heart, the impact of various disease states, and the positive effects of treatment
• Reviews the principles that underlie electrophysiology and the analytic tools which, when combined with a firm
• grasp of EP mechanisms, allow the reader to think through any situation in which they find themselves
• Presents the mathematics necessary for the practice of cardiac electrophysiology in an accessible and understandable manner
• Contains accompanying video clips, including simulations showing the flow of electrical current through the heart, which help explain and visualize the concepts discussed in the text
• Includes helpful chapter summaries and full-color illustrations to aid comprehension

Understanding Clinical Cardiac Electrophysiology is essential reading for cardiac electrophysiology fellows, cardiology residents on rotation, cardiac electrophysiology laboratory technicians, device industry professionals, and general clinical cardiologists who want to enhance their understanding of cardiac electrophysiology.