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Basic electrophysiology. Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University. Objectives. General objectives of EP-study: - Induce tachycardia & study its mechanism - Assess the integrity or function of conductive system. Sinus node function. AVN function.

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Basic electrophysiology


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basic electrophysiology

Basic electrophysiology

Dr MohamadAbdelshafy

Assistant lecturer Suez Canal University

objectives
Objectives
  • General objectives of EP-study:

- Induce tachycardia & study its mechanism

- Assess the integrity or function of conductive system

Sinus node function

AVN function

eps procedure
EPS procedure
  • Vascular access (Venous – arterial)
  • Electrode catheter (contact mapping – pacing)
  • Catheter position
  • Multichannel recording system + programmable stimulator
electrode catheter
Electrode catheter

Connecting port

1

4 3 2 1

Dist.

Prox.

Bipolar intracardiac recording (localized leectrical activity- depolarization of tissue)

ablation catheter
Ablation catheter

RF-current applic.

catheter position
Catheter position
  • SVT VT

HRA SAN HRA

His AV cond His

RVA RVA +/- LVA

CS SCV puncture

Recording from all major 4 chambers & His position

catheter position1
Catheter position

RAO

LAO

His

CS

RV

intracardiac electrogram
Intracardiac electrogram
  • Bipolar recording of cardiac elecrical activity (localized area)
  • High frequency, high amplitude signal (tissue depolar.) in contact with recording electrode
  • Nomenclature …….
  • Sequence of activation
nomenclature measurement of baseline cond intervals
Nomenclature & Measurement of baseline cond. intervals

His electrogram (3 components) low RA- His-upper RV-no AVN

P

SCL

A

V

V

Cycle length = 60.000/ HR length of time bet. Heart beats

baseline cond intervals
baseline cond. intervals
  • SCL= interval bet. 2 successive A waves
  • AH interval ( 50—120 msec) AVN
  • HV interval (35 – 55 msec) His- purk
  • His deflection (cond. Via His bundle)
  • IACT (not basic) = interval bet SAN & His
san function
SAN function
  • Pacing (site- type- differentiation)
  • Tests of SAN function:

-SNRT (assess SAN automaticity) (up to 1500 msec) - variable with HR

-cSNRT (SNRT-BSL) up to 525 msec

- SACT (50-125 msec) assess cond. of impulse from SAN to adjacent atrial tiss

san function1
SAN function

Recovery interval

Time = 30 sec

A

550

400

HRA

S1

SCL= 450 msec SNRT= 550 msec CSNRT= 150 msec

san function2
SAN function

Idea: reset the SAN – Narula method

8 paced beats

580

S1

A

Recovery interval= time of paced beat penetrates & resets SAN+SCL+time for spont. Beat to exit SAN = SCL+ 2 SACT

assessment of avn function
Assessment of AVN function
  • Pacing:

site

type (burst –ramp)

Extrastimulation (site – number- coupling intervals)

Differentiation (atrial- ventricular)

atrial pacing
Atrial pacing

Pacing interval

S1

A V

A V

v pacing
V pacing

A V

V A

tests of avn function
Tests of AVN function
  • Antegrade 1:1 AV conduction
  • Antegrade WCL
  • Retrograde 1:1 VA conduction
  • Retrograde WCL
  • AVN/ERP
avn erp
AVN/ERP

S1

S2

400/350

1 1 va cond
1:1 VA cond.

Retrograde sequence of activation

V A

PCL= 300 msec

va dissociation
VA dissociation

A

A

V

V

V

PCL=260 msec