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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION

Chapter Summary

This chapter examines our present understanding of anatomical, cellular, ionic, and molecular mechanisms responsible for cardiac arrhythmias (see Fuster and Hurst’s Central Illustration). The anatomical basis of cardiac arrhythmia is first discussed, with focus on the spatial relationships of cardiac and neighborhood structures when maneuvering catheters in and around the heart. The generation and maintenance of cardiac arrhythmias and conduction disturbances depend on the interactions of various genetic, molecular, fixed, and dynamic factors. Recent years have witnessed important advances in our understanding of the structural, molecular, and electrophysiologic mechanisms, fueled by innovative research into the genetic basis and predisposition for electrical dysfunction of the heart. These advances notwithstanding, our appreciation of the basis for many rhythm disturbances is still incomplete. While it is not possible to comprehensively review all important literature in this book chapter, we tried to examine new insights obtained from recent studies and put them into historical perspective whenever possible.

eFig 34-01 Chapter 34: Electrophysiologic Anatomy, Mechanisms of Arrhythmias and Conduction Disturbances, and Genetics

INTRODUCTION

Recent years have witnessed important advances in our understanding of the structural, molecular, and electrophysiologic mechanisms underlying the development of a variety of cardiac arrhythmias (Table 34–1) and conduction disturbances. Progress in our understanding of these phenomena has been fueled by innovative advances in our understanding of the genetic basis and predisposition for electrical dysfunction of the heart. These advances notwithstanding, our appreciation of the basis for many rhythm disturbances is incomplete. This chapter examines our present understanding of anatomical, cellular, ionic, and molecular mechanisms responsible for cardiac arrhythmias. The first section of the chapter describes the anatomical basis of cardiac arrhythmia and focuses on the spatial relationships of cardiac and neighborhood structures when maneuvering catheters in and around the heart. The second section describes the general mechanisms of cardiac arrhythmogenesis. The third section describes the genetic basis of cardiac arrhythmia. The generation and maintenance of cardiac arrhythmias depend on the interactions of genetic, molecular, fixed, and dynamic factors. While it is not possible to comprehensively review all important literature in this book chapter, we tried to examine new insights obtained from recent studies and put them into historical perspective whenever possible.

TABLE 34–1.Characteristics and Presumed Mechanisms of Cardiac Arrhythmia

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