By: Nik-Othman Abdullah

Electrophysiology is the study of the electrical nature

of tissues and cells.
It involves the movement and measurement of voltage
and current coursing through the tissues through the
ion channel proteins;
It also includes the movement and adverse effects of
currents in whole organs such as the heart
In medicine, an Electrophysiology study (EP Test) is
used to study abnormal heart rhythms (arrhythmia)
and other related cardiophysiological functions that
involves movement (tachycardia, bradycardia etc.)
Cardiac dysrhythmia or arrhythmia is the abnormal rate or
rhythm of the hearts beat
An irregular heartbeat must not be confused with an irregular
heart rate. Arrhythmias, irregular heart beating, may occur
during regular and irregular heart rates
It can either cause the heart to beat faster, slower or irregularly
Though most arrhythmias are harmless, some could be
serious and life-threatening; the heart may not be able to
pump enough blood throughout the body, which can be fatal
for vital organs that requires sufficient blood flow eg. brain,
lungs, liver etc.
During a heartbeat, the electrical impulses travel in a specific and organized pathway. When the
impulses are interrupted this causes the heart to produce an irregular heartbeat
Coronary artery diseases such as atherosclerosis (artery hardening), ischemia (blood-supply
restriction to tissues) and angina (chest pain due to restriction of blood-supply to muscles)
Blood electrolyte imbalance (lack of sodium and potassium in the diet, hyponatrimia etc.)
Smoking, drinking and use of CNS-acting drugs such as cocaine, methamphetamine, cannabis etc.
Strong emotional stress such as anger, depression or even surprise
Genetic or congenital heart defects
The phrase heart skipped a beat refers to arrhythmia, which occurs when seeing or experiencing
something staggering. This is caused by the elevated hormone levels produced by the body, which in
turn causes the heart to work profusely in an unexpected manner; this sudden surge of hormones
may trigger an arrhythmia

DRUGS
SMOKING
SMOKING
STRONG EMOTIONAL STRESS
STRONG EMOTIONAL STRESS
STRONG EMOTIONAL STRESS
STRONG
EMOTIONAL
STRESS
DRINKING
ARRYTHMIA
An Intracardiac electrophysiological study (EPS)
is a test to measure if the hearts electrical signals
are properly functioning
In the course of an average human lifespan, the
possibility of having one or more abnormal heart
functions is relatively high
An EPS is a minimally invasive procedure that helps
physicians and specialists, such as cardiologist,
determine heart rhythm problems and abnormal heart
function
Wire electrodes will be placed in the heart.
These electrodes measure the electrical
activity in the heart
The groin or neck area will be cleansed and
a topical anesthetic will be applied
IV sheaths will then be inserted through the
groin or the neck area
The physician then uses a fluoroscope
(moving x-ray images) to guide the catheter
to the heart, placing the electrodes in the
right places
The electrodes pick up the hearts electrical
impulses for measurement
The electrodes may produce controlled
impulses to induce arrhythmia. This will
help the physician understand the causes
and location of the abnormalities lie.

Living things are composed of electrical
properties running through our cells and
tissues. They are transferred and run across
different parts of our bodies through the ion
channels of the cells
The study of electrophysiology involves
measuring these electrical charges to
determine whether a part of the tissue, or
even a whole organ is working and functioning
properly
Electrophysiology measures the bioelectricity of living things
In neuroscience, it includes the electrical properties of neurons

Involves the measurement of voltage and current across
the protective membrane of a cell
The tip of a fine microelectrode will be inserted into the
cell so that the membrane potential can be measured
The tips have a diameter of less than 1 micrometer and
a resistance of 7 megaohms
A typical membrane potential of a healthy cell is -60 to -
80 mV and the action potential +40 mV
This technique allows the physiologist to
clamp, or hold onto a desired cell
potential value
This allows easier measurement of how
much ionic current crosses a cells
membrane at a specific voltage
Many of the ion channels in the membrane
of a neuron are voltage-gated ion
channels, which only opens at a specific
voltage range
This is made possible by the near-
simultaneous currents that passes as the
recording electrode are charged to alter
the cell potential
This technique records the membrane potential by injecting a specifically measured
current through the electrode
The electrode then records and transmits the current. Unlike voltage clamp, the
current clamp has the freedom in varying, and the amplifier records the voltage
This is used to study how a cell responds when current enters a cell, which is
important in understanding how neurons respond to neurotransmitters
As we know, the body requires electricity or bioelectricity in order to contract
and expand muscles, which in turn results to movements
The hearts electrical system controls the rate and rhythm of the heart
In each and every heartbeat, an electrical signal spreads from the top part of the
heart and surges through the bottom. This causes the heart to contract and
expand, hence, the pumping mechanism of our heart, also, the heartbeat
These electrical signal begins in the sinoatrial node and travels to and fro via
the ion-channels, which is located in the right atrium
As the current travel from the right atrium to the left atrium, the atria contracts
causing blood to be pumped into the ventricles
The current then moves downward the atrioventricular node, sited in between
atria and ventricles. The signals here slows down a tad allowing the ventricles to
be filled with blood
As the electrical signal leaves the AV node or the bundle of His, the signal
causes a contraction action which allows the heart to pump blood into the lungs
and the rest of the body
Cardiac electrophysiology is the science in diagnosing and treatment of the electrical
activities of the heart
It is usually done by using invasive catheters with electrodes to either record and
induce programmed electrical stimulation (PES)

When the signals arise in the SA node and stimulates
the atria to contract, which then travels to the AV
node, stimulus is conducted through the bundle of
His to the Purkinje fibers.
It travels towards the endocardium at the hearts apex
and finally rests at the ventricular epicardium
On a microscopic point of view, the wave
depolarization propagates and travels through
adjacent cells via the gap junctions
The heart, being a functional syncytium, freely
allows propagation of electrical impulse in all
direction, which results in a single contractile function
The cardiac muscles are similar to neurons and skeletal
muscles
A myocardial cell has a negative membrane potential at rest,
the same as a neuron
During a stimulation above the treshold value, the voltage-
gated ion channels open up and allows flooding of cations
into the cell
The positively charged ions entering the cell causes
depolarization of an action potential
Similar to skeletal muscles, depolarization causes the opening
of calcium channels and release of Ca
2+

This causes calcium-calcium induction release from the
sarcoplasmic reticulum, hence, causes muscle contraction
Potassium channels then reopen, allowing potassium to flood
out of the cells causing repolarization
Electrical activity is spontaneously
generated by the SA node
The SA node is the physiological
pacemaker, responsible for the hearts
mechanism
Electrical impulses are propagated
throughout the right atrium all the way
to the left atrium, stimulating the
myocardium of the atria to contract
The activity of the electrical impulse
throughout the atria is visualize as the
P wave in an ECG
Electrical charges spreads throughout
the atria via intermodal tracts, from the
SA node to the AV node
An electrocardiogram is used to examine the electrical
conduction of the heart
A pacemaker is used to stabilize the hearts rhythm. It is
surgivally placed and inserted into the hearts conduction
system