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 Tomita, Y. Articles by Waldo, A. L. Search for Related Content PubMed PubMed Citation Articles by Tomita, Y. Articles by Waldo, A. L. Related Collections Animal models of human disease Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2001;103:1025.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Role of Functional Block Extension in Lesion-Related Atrial Flutter

Yasushi Tomita, MD; Kunihiro Matsuo, MD; Jayakumar Sahadevan, MD; Celeen M. Khrestian, BS; Albert L. Waldo, MD

From the Department of Medicine, Division of Cardiology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio.

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

Background—A line of block in the right atrium (RA) between the venae cavae is necessary to obtain classic atrial flutter (AFL). We tested the hypothesis that the location of that line of block would determine whether the AFL reentrant circuit would be due to single-loop reentry or figure-of-8 reentry.

Methods and Results—Simultaneous mapping from 392 sites (both atria and the atrial septum) was performed in 13 normal dogs before and after creating a linear lesion on the RA free wall. The lesion was 1 to 1.5 cm anterior and parallel to the crista terminalis (7 dogs) or posterior and close to the crista terminalis region (6 dogs). Sustained AFL (>2 minutes) was then induced. In 4 dogs with an anterior lesion, the AFL reentrant circuit traveled around the lesion (lesion reentry). In 9 dogs (3 with anterior lesions and 6 with posterior lesions), the AFL reentrant circuit included the anterior RA free wall, the atrial septum, and Bachmann’s bundle (single-loop reentry). In these 9 dogs, the fixed line of block was extended to the superior and/or inferior vena cava by a functional line of block, thereby preventing lesion reentry. No figure-of-8 reentry was induced.

Conclusions—In this model, the location of a fixed line of block and its functional extension determine the type of AFL reentry. These data provide an explanation for the chronic AFL that occurs in some patients after surgical repair of congenital heart lesions.

Key Words: atrial flutter • electrophysiology • lesion • mapping • reentry

This article has been cited by other articles:

				K. C. Roberts-Thomson, I. H. Stevenson, P. M. Kistler, H. M. Haqqani, J. C. Goldblatt, P. Sanders, and J. M. Kalman Anatomically Determined Functional Conduction Delay in the Posterior Left Atrium: Relationship to Structural Heart Disease J. Am. Coll. Cardiol., February 26, 2008; 51(8): 856 - 862. [Abstract] [Full Text] [PDF]

				J. B. Morton, P. Sanders, J. K. Vohra, P. B. Sparks, J. G. Morgan, S. J. Spence, L. E. Grigg, and J. M. Kalman Effect of Chronic Right Atrial Stretch on Atrial Electrical Remodeling in Patients With an Atrial Septal Defect Circulation, April 8, 2003; 107(13): 1775 - 1782. [Abstract] [Full Text] [PDF]

				S. M. Markowitz, R. F. Brodman, K. M. Stein, S. Mittal, D. J. Slotwiner, S. Iwai, M. K. Das, and B. B. Lerman Lesional tachycardias related to mitral valve surgery J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1973 - 1983. [Abstract] [Full Text] [PDF]

				A. L. Waldo Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? Cardiovasc Res, May 1, 2002; 54(2): 217 - 229. [Full Text] [PDF]

				J. B. Morton, M. J. Byrne, J. M. Power, J. Raman, and J. M. Kalman Electrical Remodeling of the Atrium in an Anatomic Model of Atrial Flutter: Relationship Between Substrate and Triggers for Conversion to Atrial Fibrillation Circulation, January 15, 2002; 105(2): 258 - 264. [Abstract] [Full Text] [PDF]