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Basic Basic electrophysiology electrophysiology Dr Mohamad Abdelshafy Dr Mohamad Abdelshafy Assistant lecturer Suez Assistant lecturer Suez Canal University Canal University

Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

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Page 1: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Basic Basic electrophysiologyelectrophysiology

Dr Mohamad AbdelshafyDr Mohamad Abdelshafy

Assistant lecturer Suez Canal Assistant lecturer Suez Canal UniversityUniversity

Page 2: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

ObjectivesObjectives

General objectives of EP-study:General objectives of EP-study:

- Induce tachycardia & study its - Induce tachycardia & study its mechanismmechanism

- Assess the integrity or - Assess the integrity or function of conductive systemfunction of conductive system

Sinus node function AVN function

Page 3: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

EPS procedureEPS procedure

Vascular access (Venous – Vascular access (Venous – arterial)arterial)

Electrode catheter (contact Electrode catheter (contact mapping – pacing)mapping – pacing)

Catheter positionCatheter position Multichannel recording system + Multichannel recording system +

programmable stimulator programmable stimulator

Page 4: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Electrode catheterElectrode catheter

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

Connecting port

14 3 2 1

Dist.Prox.

Page 5: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Ablation catheterAblation catheter RF-current applic.

Page 6: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Catheter positionCatheter position

SVT VTSVT VT

HRA SAN HRAHRA SAN HRA

His AV cond HisHis AV cond His

RVA RVA +/- RVA RVA +/- LVALVA

CS SCV punctureCS SCV puncture

Recording from all major 4 chambers & His position

Page 7: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Catheter positionCatheter positionRAO LAO

CS

His

RV

Page 8: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Intracardiac electrogramIntracardiac electrogram

Bipolar recording of cardiac Bipolar recording of cardiac elecrical activity (localized area)elecrical activity (localized area)

High frequency, high amplitude High frequency, high amplitude signal (tissue depolar.) in contact signal (tissue depolar.) in contact with recording electrodewith recording electrode

Nomenclature …….Nomenclature ……. Sequence of activationSequence of activation

Page 9: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Nomenclature & Nomenclature & Measurement of baseline Measurement of baseline cond. intervalscond. intervals

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

V

A

V

SCLP

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

Page 10: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

baseline cond. intervalsbaseline cond. intervals

SCL= interval bet. 2 successive A SCL= interval bet. 2 successive A waveswaves

AH interval ( 50—120 msec) AVNAH interval ( 50—120 msec) AVN HV interval (35 – 55 msec) His- HV interval (35 – 55 msec) His-

purkpurk His deflection (cond. Via His bundle)His deflection (cond. Via His bundle) IACT (not basic) = interval bet SAN & IACT (not basic) = interval bet SAN &

HisHis

Page 11: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Sequence of activation-Sequence of activation-catheter setupcatheter setup

Page 12: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

SAN functionSAN function

Pacing (site- type- differentiation)Pacing (site- type- differentiation) Tests of SAN function:Tests of SAN function:

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

-cSNRT (SNRT-BSL) up to 525 msec-cSNRT (SNRT-BSL) up to 525 msec

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

Page 13: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

SAN functionSAN function

S1A550

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

400

Time = 30 sec

HRA

Recovery interval

Page 14: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

SAN functionSAN function

S1 A

Idea: reset the SAN – Narula method

580

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

8 paced beats

Page 15: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Assessment of AVN functionAssessment of AVN function

Pacing:Pacing:

sitesite

type (burst –ramp)type (burst –ramp)

Extrastimulation (site – number- Extrastimulation (site – number- coupling intervals)coupling intervals)

Differentiation (atrial- ventricular)Differentiation (atrial- ventricular)

Page 16: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Atrial pacingAtrial pacing

A V

A V

S1

Pacing interval

Page 17: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

V pacingV pacing

A V V A

Page 18: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

Tests of AVN functionTests of AVN function

Antegrade 1:1 AV conductionAntegrade 1:1 AV conduction Antegrade WCLAntegrade WCL Retrograde 1:1 VA conductionRetrograde 1:1 VA conduction Retrograde WCLRetrograde WCL AVN/ERPAVN/ERP

Page 19: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

1:1 AV cond.1:1 AV cond.

A V

Page 20: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

AVN/ERPAVN/ERP

400/350

S1 S2

Page 21: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

1:1 VA cond.1:1 VA cond.

PCL= 300 msec

V A

Retrograde sequence of activation

Page 22: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

VA dissociationVA dissociation

PCL=260 msec

A A

V V V

Page 23: Basic electrophysiology Dr Mohamad Abdelshafy Assistant lecturer Suez Canal University

V. extrastimV. extrastim

S1

SS2