Circulation, Vol 89, 2107-2116, Copyright © 1994 by American Heart Association
F Ravelli, M Disertori, F Cozzi, R Antolini and MA Allessie
BACKGROUND: Slight variation in cycle lengths of common and rapid atrial
flutter in humans is an established phenomenon, but its mechanisms have not
been completely clarified. In a previous study, we demonstrated that in
common atrial flutter the variations in atrial cycle length were due to
atrial stretch affecting the revolution time of a reentrant circuit. In the
present study, we investigate the nature of atrial cycle length variations
in the rapid type of human atrial flutter. METHODS AND RESULTS: Atrial
interval variations of 17 episodes of rapid atrial flutter in 14 patients
were investigated by measuring the sequence of atrial intervals from
intraesophageal or intra-atrial leads and the onset of QRS complexes from a
surface lead (V1). To study whether interval variation in flutter cycle was
related to ventricular activity, a phase plot was constructed in which the
flutter cycle length was plotted against the time after the previous QRS
complex. This showed that the interval fluctuations were strictly coupled
to the moment of ventricular activation. After the onset of the QRS
complex, the rapid atrial flutter interval gradually decreased by an
average of 4.1% (P < .001) and reached a minimum value after 300 to 600
milliseconds. Thereafter, the intervals increased again until the next
ventricular beat occurred. In 10 patients developing both common and rapid
atrial flutter, two different phase relations were found. Whereas during
common atrial flutter the atrial interval increased after the QRS complex,
it decreased during rapid atrial flutter. In three patients, intra-atrial
pressure was recorded together with the electrical activity during both
common and rapid atrial flutter episodes. This showed that variations in
atrial flutter cycle length were associated with the rise of atrial
pressure during ventricular contraction. CONCLUSIONS: These findings
indicate a role of contraction- excitation feedback caused by atrial
stretch after a ventricular activation. The shortening of the atrial
interval after the onset of the QRS complex as found in patients during
rapid atrial flutter can be explained by stretch-induced shortening of
atrial refractoriness and consequent shortening of the revolution time of a
functionally determined intra-atrial circuit.
ARTICLES
Ventricular beats induce variations in cycle length of rapid (type II) atrial flutter in humans. Evidence of leading circle reentry
Department of Physics, University of Trento, Italy.
This article has been cited by other articles:
 |
|
 |
|
  N. H. L. Kuijpers, H. M. M. ten Eikelder, P. H. M. Bovendeerd, S. Verheule, T. Arts, and P. A. J. Hilbers Mechanoelectric feedback leads to conduction slowing and block in acutely dilated atria: a modeling study of cardiac electromechanics Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2832 - H2853. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. C. Tan, W. Liu, and D. A. Saint Differential expression of the mechanosensitive potassium channel TREK-1 in epicardial and endocardial myocytes in rat ventricle Exp Physiol, May 1, 2004; 89(3): 237 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Korte, M. Niehaus, G. Borchert, and J. Tebbenjohanns Significant prolongation of atrial monophasic action potential duration: short-term reverse electrophysiological changes after internal cardioversion of atrial fibrillation Cardiovasc Res, March 1, 2002; 53(4): 944 - 951. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bode, A. Katchman, R. L. Woosley, and M. R. Franz Gadolinium Decreases Stretch-Induced Vulnerability to Atrial Fibrillation Circulation, May 9, 2000; 101(18): 2200 - 2205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Biffi, G Boriani, G Bronzetti, A Capucci, A Branzi, and B Magnani Electrophysiological effects of flecainide and propafenone on atrial fibrillation cycle and relation with arrhythmia termination Heart, August 1, 1999; 82(2): 176 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pandozi, L. Bianconi, M. Villani, G. Gentilucci, A. Castro, G. Altamura, A. P. Jesi, F. Lamberti, F. Ammirati, and M. Santini Electrophysiological Characteristics of the Human Atria After Cardioversion of Persistent Atrial Fibrillation Circulation, December 22, 1998; 98(25): 2860 - 2865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Ravelli, B. S. Stambler, and K. A. Ellenbogen Atrial Flutter Cycle Length Oscillations and Role of the Autonomic Nervous System • Response Circulation, August 11, 1998; 98(6): 607 - 608. [Full Text] [PDF]
|
|
|
|
|
|
F. Ravelli and M. Allessie Effects of Atrial Dilatation on Refractory Period and Vulnerability to Atrial Fibrillation in the Isolated Langendorff-Perfused Rabbit Heart Circulation, September 2, 1997; 96(5): 1686 - 1695. [Abstract] [Full Text]
|
|
|
|
|
|
C. Pandozi, L. Bianconi, M. Villani, A. Castro, G. Altamura, S. Toscano, A. P. Jesi, G. Gentilucci, F. Ammirati, F. L. Bianco, et al. Local Capture by Atrial Pacing in Spontaneous Chronic Atrial Fibrillation Circulation, May 20, 1997; 95(10): 2416 - 2422. [Abstract] [Full Text]
|
|
|
|
|
|
B. S. Stambler and K. A. Ellenbogen Elucidating the Mechanisms of Atrial Flutter Cycle Length Variability Using Power Spectral Analysis Techniques Circulation, November 15, 1996; 94(10): 2515 - 2525. [Abstract] [Full Text]
|
|
|
|
|
|
A. Capucci, M. Biffi, G. Boriani, F. Ravelli, G. Nollo, P. Sabbatani, C. Orsi, and B. Magnani Dynamic Electrophysiological Behavior of Human Atria During Paroxysmal Atrial Fibrillation Circulation, September 1, 1995; 92(5): 1193 - 1202. [Abstract] [Full Text]
|
|