Circulation, Vol 88, 736-749, Copyright © 1993 by American Heart Association
C Kirchhof, F Chorro, GJ Scheffer, J Brugada, K Konings, Z Zetelaki and M Allessie
BACKGROUND. It recently has been demonstrated that during atrial
fibrillation, a short and variable excitable gap exists, allowing regional
control of atrial fibrillation by local stimulation. In the present study,
we visualized the process of excitation during regional entrainment of
atrial fibrillation by rapid pacing. METHODS AND RESULTS. In six open-chest
dogs, the excitation of the left atrial free wall was mapped using a
spoon-shaped mapping electrode (248 points). Episodes of atrial
fibrillation were induced by burst pacing (50 Hz, 2 seconds). During atrial
fibrillation, the electrograms showed rapid irregular activity with a
median cycle length of 98 +/- 16 ms (mean +/- SD, n = 6). Rapid pacing in
the center of the mapping electrode at intervals slightly shorter or longer
than the median atrial fibrillation interval resulted in regional capture
of atrial fibrillation. The window of entrainment was 16 +/- 5 ms. Mapping
of atrial fibrillation showed that the left atrium was activated by
fibrillatory wavelets coming from different directions. During entrainment,
a relatively large area with a diameter of about 4 cm was activated by
uniform wave fronts propagating away from the site of stimulation. The area
of entrainment was limited by intra-atrial conduction block and by
collision with fibrillation waves. Regional control of atrial fibrillation
was lost by pacing either too slowly or too rapidly. In the first case,
retrograde invasion of the area of entrainment by fibrillatory waves
resulted in depolarization of the pacing site prior to the stimulus. Pacing
too rapidly caused acceleration of atrial fibrillation by induction of
local intra-atrial reentry circuits with a revolution time shorter than the
pacing interval. CONCLUSIONS. During atrial fibrillation, an area with a
diameter of about 4 cm can be entrained by local pacing. The resulting
reduction in fibrillating tissue mass was not sufficient to terminate
atrial fibrillation. Extension of the area of entrainment was limited by
intra-atrial conduction block, whereas entrainment at a too high rate
resulted in acceleration of atrial fibrillation by induction of local
microreentry.
ARTICLES
Regional entrainment of atrial fibrillation studied by high-resolution mapping in open-chest dogs
Department of Physiology, University of Limburg, Maastricht, The Netherlands.
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