Understanding Clinical Cardiac Electrophysiology: A Conceptually Guided Approach

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, proven approach to understanding how electrical current flows through the heart, how normal heart rhythms are altered in various disease states, and how pacing and other treatments restore the heart to its normal rhythms. The second half of the book is told from the clinician s eye–view and comprises conceptual renderings of electrical activity, ECGs and other diagnostic materials; mirroring how the clinician gathers data which is often incomplete, and how a deeper understanding of the mathematics behind electrophysiology assists in interpretation and the practice of better electrophysiology. 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 effect 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 animations showing the flow of electrical current through the heart, which help explain and visualise the concepts discussed in the text; Includes helpful chapter summaries and full color illustrations aid comprehension.

Understanding Clinical Cardiac Electrophysiology is essential reading for EP fellows; Cardiology residents; EP lab nursing staff and technicians; EP device industry professionals; and general clinical cardiologists who want to enhance their understanding of EP.

Preface vii

Acknowledgment 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 000

Peter Spector, MD
Director, Cardiac Electrophysiology and Cardiac Electrophysiology Laboratory,
Fletcher Allen Medical Center,
Fletcher Allen Professor, University of Vermont College of Medicine
Burlington, VT, USA