Study on the genesis of the double potential recorded in the high right atrium in atrial flutter and its role in the reentry circuit of atrial flutter

Tanoiri, Takashi; Komatsu, Chikayoshi; Ishinaga, Takanari; Tokuhisa, Yasutaka; Makino, Hiroshi; Nomoto, Jun; Mogi, Junichi; Okamura, Tetsuo

doi:10.1016/0002-8703(91)90955-h

Cited by 10 publications

(2 citation statements)

References 18 publications

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“…7,8 We evaluated the transverse conduction capability of the CT by RA extrastimulation from both a septal site and an anterior free wall site that were posterior anterior, respectively, to the CT. As demonstrated in the present study, extrastimulation with shorter coupling intervals resulted in split potentials and a marked alteration of the activation sequence, suggestive of a functional conduction block. 7,9,11,12,[25][26][27] The mechanism of the conduction block is very likely to be anisotropy rather than specific differences in local refractoriness. Anisotropy at the CT with a high conduction velocity in the longitudinal direction and a low conduction velocity in the transverse direction because of a high gap junction density at the end-to-end connections and a low density at the side-to-side connections is well known.…”

Section: Transverse Conduction Block Of the Ctmentioning

confidence: 99%

“…It may be partly associated with anisotropic conduction of the CT caused by a characteristic distribution of the gap junctions; 6,[26][27][28][29][30][31] however, there are other mechanisms. Unidirectional conduction block in the heart can occur at the site where the impulse is transmitted from a small to a large tissue volume; that is, the occurrence of a conduction block at an abrupt geometrical transition can be explained by both the impedance mismatch at the transition site and the critical curvature beyond the transition.…”

Section: Relationship Between Diameter and The Transverse Conduction mentioning

confidence: 99%

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Relation Between Transverse Conduction Capability and the Anatomy of the Crista Terminalis in Patients With Atrial Flutter and Atrial Fibrillation. Analysis by Intracardiac Echocardiography.

Mizumaki

Fujiki

Nagasawa

et al. 2002

Circ J

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ypical atrial flutter (AFL) is a macroreentrant rhythm localized to the right atrium (RA) 1-4 and the crista terminalis (CT) is a barrier to transverse conduction during the arrhythmia. [5][6][7][8][9][10][11][12] Although it is considered to be anatomically fixed, [5][6][7][8][9][10][11][12] mapping studies in animal models have shown that the CT barrier is functional, 10 and recent studies have suggested there is a rate-dependent transverse conduction block at the CT in patients with typical AFL. 7,8 However, the relation between transverse conduction capability and the anatomy of the CT has not been elucidated thoroughly.Intracardiac echocardiography (ICE) is a technique to visualize various intra-atrial structures that are not visible on fluoroscopy and allow precise localization of intracardiac catheters relative to anatomic structures (eg, CT, the fossa ovalis, eustachian ridge, coronary sinus, and vena cava). 9,13-16 Using ICE, some investigators found that the posterolateral boundary of the AFL circuit was located at the CT. 7,9,17 The present study was therefore designed to determineCirculation Journal Vol.66, December 2002 the relationship between transverse conduction capability and the anatomy of the CT in patients with atrial flutter or fibrillation and to clarify the role of CT in the development of these arrhythmias using ICE. Methods Study PopulationThe study group included 25 patients (7 women, 18 men; mean age, 60±12 years; range, 28-81 years) who were referred for electrophysiologic study (EPS) or radiofrequency catheter ablation. None had organic heart disease evaluated by physical examination, 12-lead ECG, chest X-ray, echocardiography and exercise test. None of the patients had evidence of intracardiac thrombus formation as assessed with transesophageal echocardiography. These patients were divided into the 3 groups: 10 patients with typical AFL (group AFL), 7 patients with paroxysmal atrial fibrillation (group AF) and 8 patients who had neither PAF nor AFL (group N: 3 patients with atrioventricular reentrant tachycardia, 2 with idiopathic ventricular tachycardia and 3 with atrioventricular nodal reentrant tachycardia). The study protocol was approved by the institutional review board and written informed consent was obtained for all patients before participation. ICE Imaging and Data AcquisitionAt the start of the study, 22 patients were in sinus rhythm Although crista terminalis (CT) has been identified as the barrier to transverse conduction during typical atrial flutter (AFL), the relation between transverse conduction capabilities and anatomy of the CT remains unclear. The aim of the study was to evaluate that relation using intracardiac echocardiography (ICE). Ten patients with typical AFL (group AFL), 7 patients with paroxysmal atrial fibrillation (PAF) (group AF) and 8 patients without PAF or AFL (group N) underwent electrophysiologic testing. Using ICE images, the maximum diameter of the short axis of the CT (dCT) was measured and mapping and pacing catheters were positioned pre...

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Section: Transverse Conduction Block Of the Ctmentioning

confidence: 99%

Section: Relationship Between Diameter and The Transverse Conduction mentioning

confidence: 99%

Relation Between Transverse Conduction Capability and the Anatomy of the Crista Terminalis in Patients With Atrial Flutter and Atrial Fibrillation. Analysis by Intracardiac Echocardiography.

Mizumaki

Fujiki

Nagasawa

et al. 2002

Circ J

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Atrial double potentials associated with a left‐sided accessory pathway having a single ventricular and two remote atrial insertions

Hluchý¹,

Lautermann²,

Sabin³

1997

Clinical Cardiology

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Summary: This paper reports the case of a 63-year-old female patient with Wolff-Parkinson-White syndrome who underwent an electrophysiologic study (EPS) and ablation using temperature-guided radiofrequency current for atrial fibrillation with a shortest preexcited RR interval of 160 ms. Detailed EPS and mapping demonstrated an unusual, complex left-sided accessory pathway, with the two distinct branches having two remote atrial insertions and a narrow common ventricular isthmus associated with the manifestation of atrial double potentials recorded from the coronary sinus. Simple ablation at the left lateral side from the ventricular aspect completely eliminated complex accessory pathway conduction, resulting in the disappearance of atrial double potentials.

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Role of anatomic architecture in sustained atrial reentry and double potentials

Yamashita

Inoue

Nozaki

et al. 1992

American Heart Journal

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Study on the genesis of the double potential recorded in the high right atrium in atrial flutter and its role in the reentry circuit of atrial flutter

Cited by 10 publications

References 18 publications

Relation Between Transverse Conduction Capability and the Anatomy of the Crista Terminalis in Patients With Atrial Flutter and Atrial Fibrillation. Analysis by Intracardiac Echocardiography.

Relation Between Transverse Conduction Capability and the Anatomy of the Crista Terminalis in Patients With Atrial Flutter and Atrial Fibrillation. Analysis by Intracardiac Echocardiography.

Atrial double potentials associated with a left‐sided accessory pathway having a single ventricular and two remote atrial insertions

Role of anatomic architecture in sustained atrial reentry and double potentials

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