Basic Mechanisms of Cardiac Impulse Propagation and Associated Arrhythmias

Department of Physiology, University of Bern, Switzerland; and the Cardiac Bioelectricity Research and Training Center, Departments of Biomedical Engineering, Physiology and Biophysics, and Medicine, Case Western Reserve University, Cleveland, Ohio Kléber, André G., and Yoram Rudy. Basic Mechanisms of Cardiac Impulse Propagation and Associated Arrhythmias. Physiol Rev 84: 431–488, 2004; 10.1152/physrev.00025.2003.—Propagation of excitation in the heart involves action potential (AP) generation by cardiac cells and its propagation in the multicellular tissue. AP conduction is the outcome of complex interactions between cellular electrical activity, electrical cell-to-cell communication, and the cardiac tissue structure. As shown in this review, strong interactions occur among these determinants of electrical impulse propagation. A special form of conduction that underlies many cardiac arrhythmias involves circulating excitation. In this situation, the curvature of the propagating excitation wavefront and the interaction of the wavefront with the repolarization tail of the preceding wave are additional important determinants of impulse propagation. This review attempts to synthesize results from computer simulations and experimental preparations to define mechanisms and biophysical principles that govern normal and abnormal conduction in the heart. Address for reprint requests and other correspondence: A. G. Kléber, Dept. of Physiology, Univ. of Bern, Bühlplatz 5, CH-3012 Bern, Switzerland (E-mail: kleber{at}pyl.unibe.ch ).