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Electrophysiology of Normal Cardiac Rhythm01:19

Electrophysiology of Normal Cardiac Rhythm

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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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Mechanism of Cardiac Arrhythmias01:28

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Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
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Disturbances in Heart Rhythm01:28

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Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Typical heart performance is influenced by heart rate, rhythm, myocardial contraction, and metabolism or blood flow. The cardiac muscle exhibits distinct electrophysiological features, including pacemaker activity and calcium channel control, which play a vital role in the heart's response to various drugs. The autonomic nervous system, comprising the sympathetic and parasympathetic branches, regulates heart rate. Sympathetic activation increases heart rate, while parasympathetic activation...
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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
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Related Experiment Video

Updated: Jun 4, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Spatial ventricular gradient is associated with pacing-induced cardiomyopathy.

Mohamad Raad1, Daniel B Kramer2, Hans F Stabenau3

  • 1Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Heart Rhythm
|December 30, 2024
PubMed
Summary

Spatial ventricular gradient (SVG) predicts pacing-induced cardiomyopathy (PICM). This vectorcardiographic marker can identify patients at high risk, informing early pacing strategies to prevent heart dysfunction.

Keywords:
PacemakerPacing-induced cardiomyopathyRight ventricular pacingRisk predictionSpatial ventricular gradient

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Pacing-induced cardiomyopathy (PICM) is a common complication of right ventricular pacing.
  • Predictive methods for PICM are needed to guide initial pacing strategies and monitoring.
  • Reoperation for biventricular or conduction system pacing is often required for PICM.

Purpose of the Study:

  • To investigate the association between the spatial ventricular gradient (SVG) and the development of PICM.
  • To determine if SVG, a marker of electrical and mechanical heterogeneity, can predict PICM.
  • To evaluate SVG as a potential biomarker for identifying patients at risk of PICM.

Main Methods:

  • Retrospective study of 203 patients who received pacemakers between 2003 and 2012.
  • Analysis of baseline demographic, echocardiographic, and electrocardiographic parameters, including SVG.
  • Utilized adjusted Cox proportional hazards modeling to assess SVG's association with PICM risk.

Main Results:

  • 22% of patients developed PICM during follow-up.
  • Unadjusted analysis showed male sex, QRS duration, and SVG azimuth predicted PICM.
  • Adjusted analysis revealed higher tertiles of mean adjusted SVG azimuth before and after implantation significantly predicted PICM.

Conclusions:

  • Spatial ventricular gradient assessment before and after pacemaker implantation identifies patients at elevated PICM risk.
  • SVG may help select patients who would benefit from initial biventricular or conduction system pacing.
  • This finding supports using SVG to personalize pacing strategies and mitigate PICM development.