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(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

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