Author + information
- Received February 11, 1992
- Revision received July 2, 1992
- Accepted July 14, 1992
- Published online January 1, 1993.
- Wolfgang Schoels, MD∗,a,1,
- Wolfgang Kuebler, MD, FACCa,
- Hua Yang, PhD∗,
- William B. Gough, PhD∗ and
- Nabil El-Sherif, MD, FACC∗
- ↵∗Address for correspondence: Wolfgang Schoels, MD, Abteilung Innere Medizin III, Medizinische Universitätsklinik, Bergheimerstrasse 58, 6900 Heidelberg, Germany.
Objectives. This study was designed to test the concept of a functional/anatomic interaction in a canine model of reentry based on right atrial enlargement and to elucidate the electrophysiologic basis for functional conduction block.
Background. The monotonic feature of atrial flutter suggests a uniform substrate for the arrhythmia. Atrial flutter in the sterile pericarditis model is due to single-loop circus movement around a functional or a functional/anatomic obstacle near the atrioventricular (AV) ring. Sustained circus movement requires a critical interaction of a functional arc of block, a natural obstacle, the AV ring and a zone of slow conduction. The location of the inferior vena cava predisposes the lower right atrium to single-loop reentry.
Methods. In 11 dogs with right atrial enlargement, 127 bipolar epicardial electrograms were obtained during atrial flutter. For correlation of activation and refractory maps, the effective refractory period under each electrode was determined using the extrastimulus technique.
Results. Atrial flutter was due to single-loop reentry around functional arcs of block near the AV ring (n = 2) or around functional/anatomic obstacles (n = 8) involving the inferior vena cava. A slow zone was located between the arc and the AV ring and between the inferior vena cava and AV ring, respectively. During initiation, the arc joined the AV ring, forcing activation to proceed around the free end of the arc before breaking through the arc near the AV ring. Arrhythmia termination repuired the arc of block to rejoin the AV ring. Inducibillity of sustained atrial flutter was associated with a marked spatial dispersion of refractoriness. The configuration of the functional arc of block was critically dependent on the spatial pattern of refractoriness.
Conclusions. Atrial flutter requires a similar functional or functional/anatomic substrate independent of the underlying etiology. The spatial distribution of refractoriness in enlarged canine atria provides an adequate substrate for the devlopment of functional conduction block
↵1 Dr. Schoels is a recipient of a stipend of the Deutsche Gesellschaft für Herz-und Kreistaufforschung, Bad Nauheim, Germany.
☆ This study was supported by Grants HL 36680 and HL 31341 from the National Institutes of Health, Bethesda, Maryland and the Medical Research Funds of the Department of Veterans Affairs, Washington, D.C.
- Received February 11, 1992.
- Revision received July 2, 1992.
- Accepted July 14, 1992.