Circulation, Vol 86, 628-641, Copyright © 1992 by American Heart Association
GK Feld and F Shahandeh-Rad
BACKGROUND. During atrial flutter, double potentials may be recorded at
specific sites in the atria. It has been suggested that double potentials
represent sequential activations at the center of the reentrant circuit. An
alternative hypothesis is that double potentials represent electrical
activity in an area of slow conduction. Understanding their mechanism is
important because double potentials have been considered a possible
indicator of target sites for catheter ablation. METHODS AND RESULTS. We
systematically studied double potentials in our canine model of atrial
flutter produced by right atrial crush injury using a 64-channel
computerized mapping system with 56 electrodes on the right atrium in seven
mongrel dogs under general anesthesia. Activation maps were recorded during
sinus rhythm before and after crush injury, during rapid pacing above and
below the crush injury, and during sustained atrial flutter, entrainment of
atrial flutter, and termination of atrial flutter induced with D-sotalol (2
mg/kg). During sinus rhythm before crush injury, activation was uniform,
and double potentials were not recorded in any dog. After crush injury,
activation proceeded up to and around the crush injury, and narrowly split
double potentials were recorded in two of seven dogs. During rapid pacing
above and below the crush injury, double potentials were recorded in five
dogs. During 14 episodes of atrial flutter (mean cycle length, 140 +/- 16
msec), double potentials were recorded at electrodes along the crush
injury. The activation time of the early x component of the double
potentials (25 +/- 13 msec) was similar to that of adjacent electrodes
above the crush injury (24 +/- 11 msec), and the activation time of the
late y component (89 +/- 13 msec) was similar to that of adjacent
electrodes below the crush injury (91 +/- 14 msec). The timing of the x and
y components was dependent on the location of the recording electrode, with
x and y widely spaced at the end of the crush injury near the area of
earliest atrial activation during atrial flutter, more equally timed at the
center of the crush injury, and more closely timed at the end of the crush
injury opposite the area of earliest activation. During transient
entrainment, double potentials were accelerated to the pacing rate, but
their activation time relative to adjacent electrodes was maintained.
During abrupt termination of atrial flutter, the early x component of the
double potential was always recorded, but the late y component was not,
because of conduction block below the posterior end of the crush injury.
CONCLUSIONS. This study has shown in our canine model of atrial flutter
that double potentials are recorded from the center of the reentrant
circuit and that they represent sequential activations as the reentrant
wave front passes on either side of the crush injury.
ARTICLES
Mechanism of double potentials recorded during sustained atrial flutter in the canine right atrial crush-injury model
Division of Cardiology, University of California San Diego.
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