Circulation, Vol 76, 1155-1175, Copyright © 1987 by American Heart Association
LH Frame, RL Page, PA Boyden, JJ Fenoglio Jr and BF Hoffman
A Y-shaped lesion in the right atrium allows induction of atrial flutter in
dogs. We recorded the activation sequence during this tachycardia from 96
endocardial bipolar electrodes using intracavitary electrode arrays during
12 separate episodes in three isolated perfused hearts. In each case a
reentrant impulse circulated around the tricuspid valve orifice in either a
clockwise or counter-clockwise direction. Cutting the pathway terminated
the rhythm and prevented its reinduction. There was no discrete segment of
markedly slow conduction in the reentrant circuit. The tachycardia cycle
length was decreased by methacholine and increased by lidocaine. Reentry
was also induced in atrial tissue around the tricuspid orifice when this
structure was isolated and superfused in vitro. Tachycardia cycle lengths
varied from 205 to 399 msec, depending on the circumference of the ring and
temperature. Induction of tachycardia by premature stimulation depended on
differences in the duration of the effective refractory period among parts
of the ring. Conduction velocity was relatively uniform and was slower
during tachycardias than during pacing at long cycle lengths. Analysis of
the response to premature stimuli that reset the tachycardia provided
evidence for incomplete recovery of excitability between depolarizations
during the tachycardia. Fast-response action potentials were recorded
throughout the pathway and up to six to eight cell layers deep. Histologic
studies showed the supravalvular lamina, a circumferential band of fibers
several cell layers below the endocardial surface, to be continuous around
the tricuspid orifice. Propagation through this layer best explains the
conduction velocities observed in the intact heart during flutter in this
preparation.
ARTICLES
Circus movement in the canine atrium around the tricuspid ring during experimental atrial flutter and during reentry in vitro
Department of Pharmacology, Columbia College of Physicians and Surgeons, New York, NY 10032.
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