Circulation, Vol 78, 1277-1287, Copyright © 1988 by American Heart Association
LH Frame and MB Simson
The mechanism of cycle length oscillation and its role in spontaneous
termination of reentry was studied in an in vitro preparation of canine
atrial tissue surrounding the tricuspid orifice. Reentry occurred around a
fixed path with incomplete recovery of excitability. Among 18 experiments,
there was complete concordance between the occurrence of spontaneous cycle
length oscillation and spontaneous terminations; both were observed in 10
experiments and neither in the other eight (p less than 0.001). Local
changes in conduction during oscillations resulted from the dependence of
both conduction velocity and action potential duration on the preceding
local diastolic interval. Interval-dependent changes in action potential
duration contributed to the oscillation by altering the next diastolic
interval. Because of changes in action potential duration, changes in cycle
length were poorly correlated with changes in diastolic interval and,
therefore, with local conduction velocity. Complex oscillations resulted
from variations in conduction time at multiple sites in the circuit.
Oscillations caused most spontaneous terminations. The critical event was
an exceptionally long diastolic interval preceding the next-to-last cycle
that accelerated local conduction (which tended to shorten the last cycle)
and prolonged action potential duration and refractoriness at the site of
block. Ninety-two of 99 recordings of spontaneous termination showed
evidence of oscillation of conduction and refractoriness causing block.
ARTICLES
Oscillations of conduction, action potential duration, and refractoriness. A mechanism for spontaneous termination of reentrant tachycardias
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
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