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

EPS procedure

 Vascular access (Venous – arterial)

 Electrode catheter (contact mapping –
pacing)
 Catheter position
 Multichannel recording system +
programmable stimulator
Electrode catheter Connecting port

4 312 1

Dist.
Prox.

Bipolar intracardiac recording

(localized leectrical activity-
depolarization of tissue)
Ablation catheter RF-current
applic.
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 position
RAO LAO

His

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

P
SCL A

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

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
Sequence of activation-catheter
setup
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
 Recovery interval
SAN function Time = 30 sec

550 A
HRA 400
S1

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

 SAN function Idea: reset the SAN – Narula method
8 paced beats

S1 580
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

 Pacing:
site
type (burst –ramp)
Extrastimulation (site – number-
coupling intervals)
Differentiation (atrial- ventricular)
Atrial pacing Pacing interval

S1

AV AV
V pacing

AV VA
Tests of AVN function

 Antegrade 1:1 AV conduction

 Antegrade WCL
 Retrograde 1:1 VA conduction
 Retrograde WCL
 AVN/ERP
1:1 AV cond.

AV
AVN/ERP

S1 S2

400/350
1:1 VA cond.
Retrograde sequence of activation

VA

PCL= 300 msec

VA dissociation

A A

V V V

PCL=260 msec
V. extrastim

S1 S2
S