Monophasic Action Potentials: Basics and Clinical Application PDF
Preview Monophasic Action Potentials: Basics and Clinical Application
M. R. Franz C. Schmitt B. Zrenner (Eds.) Monophasic Action Potentials Springer Berlin Heidelberg New York Barcelona Budapest Hongkong London Mailand Paris Santa Clara Singapur Tokio M. R. Franz C. Schmitt B. Zrenner (Eds.) Monophasic Action Potentials Basics and Clinical Application With 168 Figures and lO Tables Springer MICHAEL R. FRANZ, M.D., Ph.D., Prof. of Med. Division of Cardiology Veterans Affairs Medical Center and Georgetown University 50 Irving St NW Washington, DC 20422, USA Priv.-Doz. Dr. CLAUS SCHMITT Dr. BERNHARD ZRENNER Elektrophysiologisches Labor Deutsches Herzzentrum Miinchen LazarettstraBe 36, 80636 Miinchen, Germany ISBN-13: 978-3-642-64585-3 Library of Congress Cataloging-in-Publication Data Monophasic action potentials: basics and clinical application / M.R. Franz, C. Schmitt, B. Zrenner, eds. p. cm. Includes bibliographical references and index. ISBN-13: 978-3-642-64585-3 (alk. paper) 1. Arrhythmia-Congresses. 2. Heart-Electric properties- Congresses. I. Franz, M. R. (Michael R.), 1949- II. Schmitt, Claus-Gunter. III. Zrenner, B. (Bernhard), 1954- [DNLM: 1. Arrhythmia-congresses. 2. Action Potentials congresses. 3. Heart Conduction System-physiopathology congresses. WG 330 M751 19971 RC685.A65M66 1997 616.i'28-dc21 This work is subject to copyright. All rights are reserved whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrati ons, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law_ ISBN-I3: 978-3-642-64585-3 e-ISBN-13: 978-3-642-60851-3 001: 10.1007/978-3-642-60851-3 © Springer-Verlag Berlin Heidelberg 1997 Softcover reprint of the hardcover I st edition 1997 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover: design produktion GmbH Typesetting: Cicero Lasersatz GmbH, Dinkelscherben b_ Augsburg SPIN: 10575471 9/3134 - 543210 - Printed on acid-free paper Preface Basic electrophysiology is proceeding at a fast pace, and clinical elec trophysiology has made new inroads that have produced significant changes in the diagnosis and management of cardiac arrhythmias. It is, however, often difficult to extrapolate knowledge from bench science into clinical electrophysiology. Over the last two decades, monophasic action potential (MAP) recording has matured into a technique that provides a valuable and readily available link between basic and clinical electrophysiology. The primary domain of MAP recording lies in evaluating abnormalities of myocardial repolarization, currently considered a new frontier of ar rhythmogenesis. Repolarization abnormalities occur under a multitude of conditions (including antiarrhythmic drugs, myocardial ischemia, and hemodynamic overload) and manifest themselves as prolongation of the action potential, increased dispersion of ventricular repolarizati on, and early or delayed afterdepolarizations. This symposium book summarizes the results of a I-day meeting in Munich, Germany, on December 7,1996. The symposium was dedicated exclusively to MAP recordings and the role myocardial repolarization abnormalities play in arrhythmogenesis. A group of international experts presented exciting data on MAP recording techniques, the mechanism and interpretation of MAPs, and novel aspects of repolari zation-related arrhythmias. The symposium and this proceedings book have been made possible by an unconditional grant from Biotronik, Berlin, Germany. For that we are very grateful. Washington and Munich, April 1997 M. R. FRANZ C. SCHMITT B. ZRENNER Contents I Historical Development and MAP Recording Technique Historical Development of the Monophasic Action Potential Recording Technique S. BERTIL OLSSON and SHIWEN YUAN ........................... 3 Monophasic Action Potential Recordings: What Are They, How Can They Be Recorded, What Is Their Use? MICHAEL R. FRANZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 22 Basic Biophysical Characteristics of Fractally Coated Electrodes A. BOLZ, V. LANG, T. WETZIG, and M. SCHALDACH .... . . . . . . . . .. 40 Recording of Monophasic Action Potentials with Fractally Coated Electrodes - Experimental and Initial Clinical Results BERNHARD ZRENNER, RICHARD DE LA CHAUX, JURGEN SCHREIECK, MICHAEL SCHNEIDER, and CLAUS SCHMITT 58 II Evaluation of Anti-and Proarrhythmic Effects Rate Dependence of Antiarrhythmic and Pro arrhythmic Properties of Class I and Class III Antiarrhythmic Drugs JORG WEIRICH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 71 Frequency-Dependent Effects of Class III Antiarrhythmic Agents as Assessed by MAP Recordings - Possible Advantages of I Blockade Ks CLAUS SCHMITT, JURGEN SCHREIECK, MARTIN KARCH, and BERNHARD ZRENNER ................................. 85 Endothelin -Induced Ventricular Arrhythmias BELA MERKELY, LASZLO GELLER, and RUDIGER BECKER 97 VIII Contents III Mechanisms: Atrial and Ventricular Arrhythmias The Effects of Atrial Fibrillation on the Monophasic Action Potential of the Caprine Atrium MAURITS A. ALLESSIE, MAURITS WIJFFELS, RICK DORLAND, LUCIE VAN DER ZEE, and MARC VOS ...... . . . . . . . . . . . . . . . . . .. 117 Excitable Gap, Antiarrhythmic Actions, Electrical Remodeling: The Role Of MAP Recording in Atrial Fibrillation And Other Atrial Tachyarrhythmias MICHAEL R. FRANZ ....................................... 126 Propagated Graded Responses and Dispersion of Repolarization as Two Different Mechanisms of Ventricular Vulnerability to Reentry HRAYR S. KARAGUEUZIAN and PENG-SHENG CHEN ............ 139 Mechanisms of Induction and Termination of Ventricular Fibrillation STEFFEN BEHRENS and MICHAEL R. FRANZ ................... 189 IV Ischemia - Dispersion Some Effects of Ischaemia and Changes in Ventricular Loading On Repolarisation PETER TAGGART ......................................... 201 Electrophysiological Characteristics of the M Cell CHARLES ANTZELEVITCH, VLADISLAV V. NESTERENKO, WATARU SHIMIZU, and JOSE M. DI DIEGO .................... 212 Dispersion of Ventricular Repolarization - Myocardial and Electrocardiographic Markers MARKUS ZABEL, STEFAN H. HOHNLOSER, and MICHAEL R. FRANZ ................................... 227 Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239 List of Contributors Prof. Dr. M. A. ALLESSIE Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands Dr. CHARLES ANTZELEVITCH Director Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, New York 13504, USA Dr. STEFFEN BEHRENS Depart. of Cardiology, Klinikum Benjamin Franklin, Free University Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany PD Dr. A. BOLz Department of Biomedical Engineering University of Erlangen-Nuremberg Turnstra6e 5, D-91054 Erlangen, Germany MICHAEL R. FRANZ, M. D., Ph. D. Professor of Medicine and Pharmacology Cardiology Division, VAMC 50 Irving St, NW Washington, DC 20422, USA HRAYR S KARAGUEUZIAN, Ph.D. Cedars-Sinai Research Institute Davis Research Bldg. Rm. 6066 8700 Beverly Boulevard Los Angeles, California 90048, USA x List of Contributors Dr. BELA MERKELY Semmelweis Medizinische Universitat GefaB- und Herzchirurgische Klinik Kardiologische Abteilung H-122 Budapest, Varosmajor u. 68, Hungary BERTIL OLSSON, M. D. Ph. D. Department of Cardiology University Hospital S-221 85 Lund, Sweden PD Dr. CLAUS SCHMITT Deutsches Herzzentrum Miinchen Lazarettstr. 36, D-80636 Miinchen, Germany PETER TAGGART MD, FRCP Department of Cardiology The Middlesex Hospital London WIN 8AA, u.K. PD Dr. med. J. WEIRICH Physiologisches Institut; Universitat Freiburg Hermann-Herder-Str. 7, D-79104 Freiburg, Germany Dr. MARKUS ZABEL Div. of Cardiology, Dept. of Medicine J.w. Goethe University Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany DR. BERNHARD ZRENNER Deutsches Herzzentrum Miinchen Lazarettstr. 36, D-80636 Miinchen, Germany I Historical Development and MAP Recording Technique
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