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By Pappano A.J., Wier W.G.

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The excitability characteristics of cardiac cells differ considerably, depending on whether the action potentials are fast or slow responses. Fast Response Once the fast response has been initiated, the depolarized cell is no longer excitable until about the middle of the period of final repolarization (see Figures 2-1A, 2-10). The interval from the beginning of the action potential until the fiber is able to conduct another action potential is called the effective refractory period. In the fast response, this period extends from the beginning of phase 0 to a point in phase 3 when repolarization has reached about −50 mV (time c to time d in Figure 2-1A).

Modified from Singer DH, Baumgarten CM, Ten Eick RE: Cellular electrophysiology of ventricular and other dysrhythmias: studies on diseased and ischemic heart. ) CL = 2000 ms APD = 200 ms CL = 630 ms APD = 180 ms CL = 400 ms APD = 170 ms Effects of Cycle Length Changes in cycle length alter the action potential duration of cardiac cells and thus change their refractory periods. Consequently, the changes in cycle length are important factors in the initiation or termination of certain dysrhythmias.

Redrawn from James TN: The sinus node. ) and conduct the impulses within the node and to the nodal margins.  Compared with the transmembrane potential recorded from a ventricular myocardial cell (Figure 2-16A), the maximum diastolic potential of the SA node cell is usually less, the upstroke of the action potential (phase 0) is less steep, a plateau is not sustained, and repolarization (phase 3) is more gradual. These are all characteristic of the slow response described in Chapter 2. The transmembrane potential (Vm) during phase 4 is much less negative in SA (and AV) nodal automatic cells than in atrial or ventricular myocytes because nodal cells lack the iKI (inward-rectifying) type of K+ channel.

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