Circulation, Vol 56, 737-745, Copyright © 1977 by American Heart Association
AL Waldo, WA MacLean, RB Karp, NT Kouchoukos and TN James
To examine the question of why the pacing rate and duration of atrial
pacing are crucial factors in the successful interruption of atrial
flutter, studies were performed on 30 patients in the period following open
heart surgery. In each patient the diagnosis of atrial flutter was made
using a pair of wire electrodes placed on the right atrial epicardium at
the time of operation and brought out through the anterior chest wall. The
same electrodes were used for atrial pacing. Pacing faster than the
spontaneous rate of the atrial flutter which failed to interrupt the atrial
flutter was associated with transient entrainment of the atrial flutter up
to the atrial pacing rate. Atrial flutter was interrupted successfully when
the atria were paced at a rate which was too fast for the atrial flutter to
follow. This was heralded by the conversion of previously negative flutter
waves to positive atrial complexes in ECG lead II. When pacing the atria at
a constant rate, 2-22 seconds with a mean of 10 seconds were required to
interrupt the atrial flutter.
ARTICLES
Entrainment and interruption of atrial flutter with atrial pacing: studies in man following open heart surgery
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