CARDIAC

ELECTROPHYSIOLOGY
William Makdinata
 CONCEPT OF CARDIAC ELECTROPHYSIOLOGY

Conduction System
Cells to Cells

Non-Pacemaker
Cells
• Autorhytmicity • Excitation and
• Changes of Electrolyte Contraction Coupling
in Myocyte
• Resting Membrane
Potensial to Action
Pacemaker Potensial Myocardial
Contraction
cells

Conduction System
Cells to Cells
 RESTING MEMBRANE POTENTIALS

• Resting membrane potensials/ RMP

• The voltage difference across a cell plasma membrane in the resting or
quiescent state

•  There are two specialized types of cardiac muscle cells:

• Pacemaker Cells
• Pacemaker cells have no true resting potential but instead generate regular,
spontaneous action potentials (Pacemaker Potensials)
• Non-Pacemaker Cells
• Non-Pacemaker cells have true resting potential
 RESTING MEMBRANE POTENTIALS

• Many different ions present inside and outside of cells, the concentrations
of Na , K , Cl , and Ca  are most important in determining the membrane
potential across the cell membrane
•  Of the four ions, K+  is the most important in determining the resting
membrane potential
ION INSIDE (mM) OUTSIDE (mM)

Na+ 20 145
K+ 150 4
Ca2+ 0.0001 2.5
Cl- 25 140
 RESTING MEMBRANE POTENTIALS

chemical gradient
(concentration difference)
Net Electrochemical force for K = -90mV – (-96mV)=
+ 6mV
a small net outward driving force is acting on K, K slowly
leaks outward from the cell.
equilibrium potential
for K

the Em in a resting, nonpacemaker cell is very near

EK . This agreement occurs because the membrane is
much more permeable to K  in the resting state than
to other ions
 ACTION POTENTIALS

•  The two general types of cardiac action

potentials include
• Nonpacemaker action potentials
• Fast AP
• Pacemaker action potentials
• Slow AP ( Nodal Cells)
 SLOW ACTION POTENTIALS
• Phase 4: Pacemaker Potensials
• Increased inward Na+ current
• funny, or If, channels :
• The hyperpolarization-induced inward current
• Decreased outward K+ current
• The K+ channels that opened during the falling phase of the
preceding action potential slowly close at negative potentials
• Increased inward Ca2+ current
• In the second half of the pacemaker potential, If channels close
and transient Ca2+ channels (T-type Ca2+ channels) which open at
membrane potensial (–50 mV), bringing it to threshold
• Phase 0: Slow Depolarization
• Once threshold is reached (± -40mV), the rising phase of the action
potential occurs in response to activation of a long-lasting voltage-
gated Ca2+ channel (L-type Ca2+ channel; “L” standing for long-
lasting) subsequently large influx of Ca2+
• The rate of depolarization (the slope of phase 0) is much slower than
that found in other cardiac cells (e.g., in Purkinje cells)
• Phase 3: Repolarization
• K+ efflux that occurs when K+ permeability increases on activation of
voltage-gated K+ channels coupled with closure of the L-type Ca2+
channels.
• Phase 3 ends when the membrane potential reaches about –65 mV.
 AUTORHYTMIC CELLS
•  The number of action potentials per minute each type of autorhythmic cell can generate
under resting conditions is as follows:
• ■  The rate for the SA node is 70–80
• ■  The rate for the AV node is 40–60
• ■  The rate for the Bundle of His and Purkinje fibers is 20–40

Other pacemaker cells exist within the atrioventricular node and ventricular conduction system,
but their firing rates are driven by the higher rate of the SA node because the intrinsic
pacemaker activity of the secondary pacemakers is suppressed by a mechanism termed
overdrive suppression.
This mechanism causes the secondary pacemaker to become hyperpolarized when driven at a
rate above its intrinsic rate.
 FAST ACTION POTENTIALS

 A fast AP has five distinct phases

•  Phase 0: upstroke of the action potential
Fast Na+ Channels opening
•  Phase 1: rapid repolarization to the
plateau
Fast Na+ Channels closed
Transient outward K+ channels opening
• Phase 2: (Plateau Phase)
The AP plateau is maintained by Ca2 influx
through
L-type Ca2 channels opening
• Phase 3: repolarization
L-type Ca2 channels closed
Delayed rectifier K Channels (Ikr) opening
•  Phase 4:
Delayed rectifier K Channels (Ikr) closed
Inward rectifier untuk mempertahankan RMP
CONDUCTION SYSTEM
THANK YOU