Table Of ContentM. R. Franz C. Schmitt B. Zrenner (Eds.)
Monophasic Action Potentials
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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
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ISBN-I3: 978-3-642-64585-3 e-ISBN-13: 978-3-642-60851-3
001: 10.1007/978-3-642-60851-3
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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
