ELECTROPHYSIOLOGY of heart muscle may be considered the science of the nature and propagation of electrical energy produced by heart muscle fibers submerged in a conducting medium. It deals with the generator and the medium but, at least for the purpose of this review, not with the problems of lead fields, lead placement, lead systems, or with the representation of projected cardiac electromotive forces on the body surface . It forms a basis, as yet incomplete, for a rational interpretation of an electrocardiographic curve or vectocardiographic figure . This survey is intended merely to highlight general principles and certain interrelationships . It will be concerned with (1) the basic electrical properties of heart muscle fibers, (2) the quantity and distribution of electrical forces over cardiac musculature, and (3) the distribution of electrical forces in volume conductors . Recent monographs should be consulted for more detailed discussions [1-10] . ELECTRICAL PROPERTIES OF CARDIAC FIBERS . Some physiological aspects of subcellufar structure : The cardiac cell is excitable tissue, i .e ., upon appropriate stimulus a transient change in the physicochemical properties of the cell occurs permitting alterations in ionic transfer across its boundary . The effect is usually all or none, and the disturbance is generally propagated from cell to cell . Heart muscle shares this property with nerve tissue, skeletal and smooth muscle . There are certain fundamental similarities between the electrical behavior of all excitable cells so that information gained from one can be applied to the others . There are also important dissimilarities, apparently related to the specific function of individual tissues . Since most information concerning the cellular events of excitable systems so far has been derived from nerve cells, the laws which define electrical behavior in nervous tissue are used as the prototype . Such cells resemble cables or telephone wires with one long (infinite) axis and one of relatively short diameter . For many years the cable theory of electrical conduction developed by Thomson (Lord Kelvin) in 1856 has been applied to biologic systems of this general kind [14,27] . The short, thick, grossly syncytial heart muscle fiber is a structure of greater complexity than nerve . This modifies some of the assumptions made from the study of nerve cells . Whether or not heart muscle can be considered truly syncytial in nature depends on one's point of view. Heart muscle fibers are interrupted by light-refractile bands which traverse the fiber from fibril to fibril . The function and properties of these intercalated discs are considered by some to be consistent with the existence of an absolute cell boundary [89] . They are the starting and terminal points of insertion of the myofibrils, and in a mechanical sense these structures can be considered boundaries . Electrical resistance across the discs, however, is not high [8], which may be accepted as evidence in favor of at least a functional syncytium. There are differences in electrical responses of heart muscle fibers from different species, perhaps simply related to the modifying effects of temperature and heart rate, and there are qualitative and quantitative differences in the electrical behavior of various areas within a single heart . These differences should have their morphologic counterpart . As yet little is known of submicroscopic details of cardiac tissue on which
Read full abstract