Bachelor's degree in Cardiocirculatory Physiopathology and Cardiovascular Perfusion Techniques (national qualification)

Electrocardiography, arrhythmology and electrostimulation - ELETTROCARDIOGRAFIA, ARITMOLOGIA ED ELETTROSTIMOLAZIONE 1

Course code
Name of lecturer
Alessandro Costa
Number of ECTS credits allocated
Academic sector
Language of instruction
Lezioni PERF 1 SEMESTRE dal Oct 1, 2019 al Dec 20, 2019.

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Lesson timetable

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Learning outcomes

Cardiac conduction system: anatomy, cell physiology, relations between action potential and cardiac cycle; relations between action potential and EKG.
Basic EKG: priciples, leads, vectors, cardiac axis, normal EKG pattern.
Cardiac arrhythmology: sinus rhythm, basic mechanism of arrhythmogenesis, classification of arrhythmias.
Cardiac pacing: principles and essential functional parameters of cardiac pacemakers.


Membrane Potential & Action Potential of cardiac cells (working myocardium vs conductive cells).
Main cardiac ion-channels (sodium, calcium, potassium, "funny" channels).
The heart as a "functional syncytium".
Main connections among cardiac cells (gap junctions etc.).
Anatomy of cardiac conduction system (Sinus Node etc.).
Cardiac electric activation sequence.
Endo/epicardial differences between depolarization and repolarization.
Arrhytmias main mechanisms (re-entry, automatism, triggered activity).
Details about re-entry (anatomic and functional).
Anatomy of Koch Triangle.
Accessory Pathways: anatomy, electrophysiology, ECG patterns ("delta wave").
Supraventricular Tachiarrhythmias (basic mechanisms and consequent EKG patterns):
• AV node tachycardia (slow-fast, fast-slow)
• Atrio-ventricular reentry (through accessory pathway, manifest or concealed); WPW sdr. and clinical risks.
• Typical Atrial Flutter ("sawtooth wave"), or Atypical Flutter
• Atrial Fibrillation (with clinical aspects: classification, symptoms, clinical risks...)
• "Wide QRS-complex tachycardias" (the main ones)
• seno-atrial blocks;
• AV-blocks;
Main indications for pacemaker implant;
basic components of a pacing system;
basic functions of a pacing system:
Ohm's Law: physical dimensions of sensing, pacing and impedance; concept of sensing and pacing threshold.
Single/dual/ three-chamber pacing: main specificities.

Reference books
Author Title Publisher Year ISBN Note
AIAC associazione italiana di aritmologia e cardiostimolazione - Oreto Giuseppe AIAC trattato italiano di elettrofisiologia ed elettrostimolazione (Edizione 1) Centro Scientifico Editore 2009 9788876408410 3 Volumi
Delise Pietro Aritmie - Fisiopatologia e diagnosi: dall' ecg al mappaggio tridimensionale (Edizione 4) Cesi 2008 9788889590126
Zipes Douglas P. - Jalife José Cardiac Electrophysiology: From Cell to Bedside (Edizione 7) Elsevier - Saunders 2017 9780323447331
Ho Reginald T. Electrophysiology of Arrhythmias Practical Images for Diagnosis and Ablation (Edizione 1) Wolters Kluwer / Lippincott Williams & Wilkins 2009 9781605475905
Delise Pietro Elettrocardiografia 2.0 - Il valore aggiunto nell' epoca delle alte tecnologie (Edizione 1) Cesi 2019 9788889590669
Oreto Giuseppe I disordini del ritmo cardiaco - Diagnosi delle aritmie cardiache all' elettrocardiogramma di superficie (Edizione 2) Centro Scientifico Editore 2001 9788876403491
Oreto Giuseppe L' Elettrocardiogramma : un mosaico a 12 tessere (Edizione 1) Centro Scientifico Editore 2008 9788876407246
Kenny Tom The Nuts and Bolts of ICD Therapy (Edizione 1) Wiley 2005 9781405135115

Assessment methods and criteria

Oral Examination

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