This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Uno, K. Articles by Waldo, A. L. Search for Related Content PubMed PubMed Citation Articles by Uno, K. Articles by Waldo, A. L. Related Collections Arrhythmias, clinical electrophysiology, drugs Animal models of human disease Arrythmias-basic studies

(Circulation. 1999;100:1354-1360.)
© 1999 American Heart Association, Inc.

Basic Science Reports

New Insights Regarding the Atrial Flutter Reentrant Circuit

Studies in the Canine Sterile Pericarditis Model

Kikuya Uno, MD; Koichiro Kumagai, MD; Celeen M. Khrestian, BS; Albert L. Waldo, MD

From the Department of Medicine, Case Western Reserve University and the University Hospitals of Cleveland, Cleveland, Ohio.

Correspondence to Albert L. Waldo, MD, Division of Cardiology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5038. E-mail alw2{at}po.cwru.edu

Background—We studied atrial activation during induced atrial flutter in the canine sterile pericarditis model to test the hypothesis that the atrial flutter reentrant circuit includes a septal component.

Methods and Results—We studied 10 episodes of induced, sustained (>5 minutes) atrial flutter in 9 dogs. In all episodes, the reentrant circuit included a septal component. In 6 episodes, there were 2 reentrant circuits, one in the right atrial free wall and the second involving the atrial septum, Bachmann's bundle, and the right atrial free wall; both circuits shared a pathway in the right atrial free wall (figure-of-eight). The direction (superior or inferior) of the septal wave front of the second circuit correlated with the direction (clockwise or counterclockwise, respectively) of the right atrial free-wall circuit. A line of functional block in the right atrial free wall was part of both reentrant circuits. In the other 4 atrial flutter episodes, only 1 reentrant circuit was present, with activation in an inferior-to-superior direction in the septum and a superior-to-inferior direction in the right atrial free wall in 2 episodes and in the opposite direction in the other 2 episodes. In all atrial flutter episodes, the flutter wave polarity in ECG lead II was determined by the direction of activation in the left atrium; polarity was positive when the direction was superior to inferior and negative when the direction was inferior to superior.

Conclusions—In this model of atrial flutter, the reentrant circuit (1) always included a septal component, (2) did not always require a right atrial free-wall reentrant circuit, (3) demonstrated figure-of-eight reentry when a reentrant circuit was present in the right atrial free wall, and (4) was associated with a line of functional block in the right atrial free wall.

Key Words: atrial flutter • mapping • pericarditis • reentry

This article has been cited by other articles:

				A. L. Waldo and G. K. Feld Inter-Relationships of Atrial Fibrillation and Atrial Flutter: Mechanisms and Clinical Implications J. Am. Coll. Cardiol., February 26, 2008; 51(8): 779 - 786. [Abstract] [Full Text] [PDF]

				K. Ryu, L. Li, C. M. Khrestian, N. Matsumoto, J. Sahadevan, M. L. Ruehr, D. R. Van Wagoner, I. R. Efimov, and A. L. Waldo Effects of sterile pericarditis on connexins 40 and 43 in the atria: correlation with abnormal conduction and atrial arrhythmias Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H1231 - H1241. [Abstract] [Full Text] [PDF]

				S. M. Narayan, A. Hassankhani, G. K. Feld, and V. Bhargava Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1269 - 1279. [Abstract] [Full Text] [PDF]

				C.-T. Tai, T.-Y. Liu, P.-C. Lee, Y.-J. Lin, M.-S. Chang, and S.-A. Chen Non-contact mapping to guide radiofrequency ablation of atypical right atrial flutter J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1080 - 1086. [Abstract] [Full Text] [PDF]

				A. Bochoeyer, Y. Yang, J. Cheng, R. J. Lee, E. C. Keung, N. F. Marrouche, A. Natale, and M. M. Scheinman Surface Electrocardiographic Characteristics of Right and Left Atrial Flutter Circulation, July 8, 2003; 108(1): 60 - 66. [Abstract] [Full Text] [PDF]

				L.-M. Rodriguez, C. Timmermans, A. Nabar, L. Hofstra, and H. J.J. Wellens Biatrial Activation in Isthmus-Dependent Atrial Flutter Circulation, November 20, 2001; 104(21): 2545 - 2550. [Abstract] [Full Text] [PDF]

				K. Matsuo, K. Uno, C. M. Khrestian, and A. L. Waldo Conduction left-to-right and right-to-left across the crista terminalis Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1683 - H1691. [Abstract] [Full Text] [PDF]

				Y. Tomita, K. Matsuo, J. Sahadevan, C. M. Khrestian, and A. L. Waldo Role of Functional Block Extension in Lesion-Related Atrial Flutter Circulation, February 20, 2001; 103(7): 1025 - 1030. [Abstract] [Full Text] [PDF]

				P. Jais, D. C. Shah, M. Haissaguerre, M. Hocini, J. T. Peng, A. Takahashi, S. Garrigue, P. Le Metayer, and J. Clementy Mapping and Ablation of Left Atrial Flutters Circulation, June 27, 2000; 101(25): 2928 - 2934. [Abstract] [Full Text] [PDF]