Electrophysiological Foundations of Cardiac Arrhythmias

A Bridge Between Basic Mechanisms and Clinical Electrophysiology

By (author) Andrew L. Wit, Hein J. Wellens, Mark E. Josephson

Publication date:

01 May 2017

Publisher

Cardiotext Publishing

ISBN-13: 9781942909125

This book teaches the fundamental concepts of cardiac electrophysiology with an emphasis on the relationship of basic mechanisms to clinical arrhythmias. Understanding this relationship and the underlying mechanisms of arrhythmogenesis will be valuable to medical students in general and physicians entering the fields of cardiology and clinical electrophysiology, as well as those scientists and clinicians already working in this field.

The book is divided into three parts that cover the major mechanisms of arrhythmogenesis: Part I – Automaticity, Part II – Afterdepolarizations and Triggered Activity, and Part III – Abnormal Impulse Conduction and Reentry. Each part starts with a chapter that describes the basic science principles related to that particular mechanism. Topics include: impulse initiation and rate control, membrane currents, conduction, and the effects of programmed electrical stimulation and pharmacologic agents. Subsequent chapters in each part are organized around examples of clinical arrhythmias and then focus on the relevant EP mechanisms and the characteristic responses to interventions. The characteristics of the three different mechanisms are compared and contrasted throughout the text.

Throughout the book, the aspects of basic EP mechanisms and examples from EP studies and pharmacologic interventions are paired with clinical examples. The end result is enhanced understanding of how EP mechanisms and testing relate to arrhythmogenesis in a way that can be applied broadly to a variety of situations in a clinical setting.

This definitive book also includes:

More than 300 figures, including ECGs and original diagrams that illustrate essential electrophysiology concepts.
Case studies of clinical arrhythmias with explanations of how ECG characteristics and the responses to electrical stimulation denote arrhythmogenic mechanisms.

Part I – Automaticity
Chapter 1. Basic Principles of Normal Automaticity
Chapter 2. Sinus Node Normal Automaticity and Automatic Arrhythmias
Chapter 3. Atrial, A-V Junctional, and Ventricular Normal Automaticity and Automatic Arrhythmias
Chapter 4. Abnormal Automaticity: Basic Principles and Arrhythmias

Part II – Afterdepolarizations and Triggered Activity
Chapter 5. Basic Principles of Delayed Afterdepolarizations and Triggered Action Potentials
Chapter 6. Delayed Afterdepolarization: Triggered Arrhythmias
Chapter 7. Basic Principles of Early Afterdepolarization and Triggered Action Potentials
Chapter 8. Early Afterdepolarization: Triggered Arrhythmias

Part III - Altered (Abnormal) Impulse Conduction and Reentry
Chapter 9. Basic Principles of Reentry: Altered Conduction and Reentrant Excitation
Chapter 10. Atrial Reentrant Arrhythmias
Chapter 11. Atrioventricular (A-V) Junctional Reentrant Arrhythmias
Chapter 12. Ventricular Reentrant Arrhythmias

The electrophysiologist as the name implies has traditionally been a “physiologist.” Advances in our discipline, be they pharmacological, ablative, or other, have been made on a foundation of better understanding of the mechanism of arrhythmia coupled with technical advances to allow this knowledge to become clinically useful and practical. It seems obvious to conclude that continued progress will be laid on a foundation of more knowledge. Unfortunately, the traditional emphasis on understanding the basic physiology in our specialty has been challenged by clinical exigencies and pressure of time in busy clinical units.

It is thus very timely that we now have available a concise and very readable text providing the fundamentals of the physiology underlying clinical EP. Unique is the emphasis of directly linking the underlying physiology to our understanding of clinical arrhythmias. This link is provided masterfully and clearly by arguably the most influential leaders of our time in the basic arena, Dr. Wit, and in the clinical arena, the tandem of Drs. Wellens and Josephson. I highly recommend this volume to any current trainee as a cornerstone of their chosen career, especially since it is unlikely to be taught to them so clearly and systematically in their current program. Of course, it goes without saying that such a text will enhance the depth of understanding of our craft regardless of the particular path we have taken. I am sure that many of us will join me in expressing their enthusiasm and gratitude to the authors for producing this unique contribution.
- George Klein, MD; Western University, London, Ontario, Canada