Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter

Ching Tai Tai, Shih Ann Chen, Chern En Chiang, Shih Huang Lee, Kwo Chang Ueng, Zu Chi Wen, Jin Long Huang, Yi Jen Chen, Wen Chung Yu, An Ning Feng, Chuen Wang Chiou, Mau Song Chang

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Previous electrophysiological studies in patients with typical atrial flutter suggested that the slow conduction zone might be located in the low right atrial isthmus, which is a path formed by orifice of inferior vena cava, eustachian valve/ridge, coronary sinus ostium, and tricuspid annulus. The conduction characteristics during atrial pacing and responses to antiarrhythmic drugs of this anatomic isthmus were unknown. Methods and Results: Forty-four patients, 20 patients with paroxysmal supraventricular tachycardia (group 1) and 24 patients with clinically documented paroxysmal typical atrial flutter (group 2), were studied. A 20- pole halo catheter was situated around the tricuspid annulus. Incremental pacing from the low right atrium and coronary sinus ostium was performed to measure the conduction time and velocity along the isthmus and lateral wall in the baseline state and after intravenous infusion of procainamide or sotalol. In both groups, conduction velocity in the isthmus during incremental pacing was significantly lower than that in the lateral wall before and after infusion of antiarrhythmic drugs. Furthermore gradual conduction delay with unidirectional block in the isthmus was relevant to initiation of typical atrial flutter. Compared with group 1, group 2 had a lower conduction velocity in the isthmus and shorter right atrial refractory period. Procainamide significantly decreased the conduction velocity, but sotalol did not change it. In contrast, sotalol significantly prolonged the atrial refractory period with a higher extent than procainamide. After infusion of procainamide, the increase of conduction time in the isthmus accounted for 52±19% of the increase in flutter cycle length, and 5 of 12 patients (42%) had spontaneous termination of typical flutter. After infusion of sotalol, typical flutter was induced in only 6 of 12 patients (50%) without significant prolongation of flutter cycle length. Conclusions: The low right atrial isthmus with rate-dependent slow conduction properties is critical to initiation of typical human atrial flutter. It may be the potentially pharmacological target of antiarrhythmic drugs in the future.

Original languageEnglish
Pages (from-to)2601-2611
Number of pages11
JournalCirculation
Volume96
Issue number8
Publication statusPublished - Oct 21 1997
Externally publishedYes

Fingerprint

Atrial Flutter
Sotalol
Procainamide
Pharmacology
Anti-Arrhythmia Agents
Coronary Sinus
Paroxysmal Tachycardia
Supraventricular Tachycardia
Inferior Vena Cava
Heart Atria
Intravenous Infusions
Catheters

Keywords

  • Atrial flutter
  • Conduction
  • Procainamide
  • Sotalol

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Tai, C. T., Chen, S. A., Chiang, C. E., Lee, S. H., Ueng, K. C., Wen, Z. C., ... Chang, M. S. (1997). Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. Circulation, 96(8), 2601-2611.

Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. / Tai, Ching Tai; Chen, Shih Ann; Chiang, Chern En; Lee, Shih Huang; Ueng, Kwo Chang; Wen, Zu Chi; Huang, Jin Long; Chen, Yi Jen; Yu, Wen Chung; Feng, An Ning; Chiou, Chuen Wang; Chang, Mau Song.

In: Circulation, Vol. 96, No. 8, 21.10.1997, p. 2601-2611.

Research output: Contribution to journalArticle

Tai, CT, Chen, SA, Chiang, CE, Lee, SH, Ueng, KC, Wen, ZC, Huang, JL, Chen, YJ, Yu, WC, Feng, AN, Chiou, CW & Chang, MS 1997, 'Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter', Circulation, vol. 96, no. 8, pp. 2601-2611.
Tai CT, Chen SA, Chiang CE, Lee SH, Ueng KC, Wen ZC et al. Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. Circulation. 1997 Oct 21;96(8):2601-2611.
Tai, Ching Tai ; Chen, Shih Ann ; Chiang, Chern En ; Lee, Shih Huang ; Ueng, Kwo Chang ; Wen, Zu Chi ; Huang, Jin Long ; Chen, Yi Jen ; Yu, Wen Chung ; Feng, An Ning ; Chiou, Chuen Wang ; Chang, Mau Song. / Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. In: Circulation. 1997 ; Vol. 96, No. 8. pp. 2601-2611.
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abstract = "Background: Previous electrophysiological studies in patients with typical atrial flutter suggested that the slow conduction zone might be located in the low right atrial isthmus, which is a path formed by orifice of inferior vena cava, eustachian valve/ridge, coronary sinus ostium, and tricuspid annulus. The conduction characteristics during atrial pacing and responses to antiarrhythmic drugs of this anatomic isthmus were unknown. Methods and Results: Forty-four patients, 20 patients with paroxysmal supraventricular tachycardia (group 1) and 24 patients with clinically documented paroxysmal typical atrial flutter (group 2), were studied. A 20- pole halo catheter was situated around the tricuspid annulus. Incremental pacing from the low right atrium and coronary sinus ostium was performed to measure the conduction time and velocity along the isthmus and lateral wall in the baseline state and after intravenous infusion of procainamide or sotalol. In both groups, conduction velocity in the isthmus during incremental pacing was significantly lower than that in the lateral wall before and after infusion of antiarrhythmic drugs. Furthermore gradual conduction delay with unidirectional block in the isthmus was relevant to initiation of typical atrial flutter. Compared with group 1, group 2 had a lower conduction velocity in the isthmus and shorter right atrial refractory period. Procainamide significantly decreased the conduction velocity, but sotalol did not change it. In contrast, sotalol significantly prolonged the atrial refractory period with a higher extent than procainamide. After infusion of procainamide, the increase of conduction time in the isthmus accounted for 52±19{\%} of the increase in flutter cycle length, and 5 of 12 patients (42{\%}) had spontaneous termination of typical flutter. After infusion of sotalol, typical flutter was induced in only 6 of 12 patients (50{\%}) without significant prolongation of flutter cycle length. Conclusions: The low right atrial isthmus with rate-dependent slow conduction properties is critical to initiation of typical human atrial flutter. It may be the potentially pharmacological target of antiarrhythmic drugs in the future.",
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AU - Tai, Ching Tai

AU - Chen, Shih Ann

AU - Chiang, Chern En

AU - Lee, Shih Huang

AU - Ueng, Kwo Chang

AU - Wen, Zu Chi

AU - Huang, Jin Long

AU - Chen, Yi Jen

AU - Yu, Wen Chung

AU - Feng, An Ning

AU - Chiou, Chuen Wang

AU - Chang, Mau Song

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Y1 - 1997/10/21

N2 - Background: Previous electrophysiological studies in patients with typical atrial flutter suggested that the slow conduction zone might be located in the low right atrial isthmus, which is a path formed by orifice of inferior vena cava, eustachian valve/ridge, coronary sinus ostium, and tricuspid annulus. The conduction characteristics during atrial pacing and responses to antiarrhythmic drugs of this anatomic isthmus were unknown. Methods and Results: Forty-four patients, 20 patients with paroxysmal supraventricular tachycardia (group 1) and 24 patients with clinically documented paroxysmal typical atrial flutter (group 2), were studied. A 20- pole halo catheter was situated around the tricuspid annulus. Incremental pacing from the low right atrium and coronary sinus ostium was performed to measure the conduction time and velocity along the isthmus and lateral wall in the baseline state and after intravenous infusion of procainamide or sotalol. In both groups, conduction velocity in the isthmus during incremental pacing was significantly lower than that in the lateral wall before and after infusion of antiarrhythmic drugs. Furthermore gradual conduction delay with unidirectional block in the isthmus was relevant to initiation of typical atrial flutter. Compared with group 1, group 2 had a lower conduction velocity in the isthmus and shorter right atrial refractory period. Procainamide significantly decreased the conduction velocity, but sotalol did not change it. In contrast, sotalol significantly prolonged the atrial refractory period with a higher extent than procainamide. After infusion of procainamide, the increase of conduction time in the isthmus accounted for 52±19% of the increase in flutter cycle length, and 5 of 12 patients (42%) had spontaneous termination of typical flutter. After infusion of sotalol, typical flutter was induced in only 6 of 12 patients (50%) without significant prolongation of flutter cycle length. Conclusions: The low right atrial isthmus with rate-dependent slow conduction properties is critical to initiation of typical human atrial flutter. It may be the potentially pharmacological target of antiarrhythmic drugs in the future.

AB - Background: Previous electrophysiological studies in patients with typical atrial flutter suggested that the slow conduction zone might be located in the low right atrial isthmus, which is a path formed by orifice of inferior vena cava, eustachian valve/ridge, coronary sinus ostium, and tricuspid annulus. The conduction characteristics during atrial pacing and responses to antiarrhythmic drugs of this anatomic isthmus were unknown. Methods and Results: Forty-four patients, 20 patients with paroxysmal supraventricular tachycardia (group 1) and 24 patients with clinically documented paroxysmal typical atrial flutter (group 2), were studied. A 20- pole halo catheter was situated around the tricuspid annulus. Incremental pacing from the low right atrium and coronary sinus ostium was performed to measure the conduction time and velocity along the isthmus and lateral wall in the baseline state and after intravenous infusion of procainamide or sotalol. In both groups, conduction velocity in the isthmus during incremental pacing was significantly lower than that in the lateral wall before and after infusion of antiarrhythmic drugs. Furthermore gradual conduction delay with unidirectional block in the isthmus was relevant to initiation of typical atrial flutter. Compared with group 1, group 2 had a lower conduction velocity in the isthmus and shorter right atrial refractory period. Procainamide significantly decreased the conduction velocity, but sotalol did not change it. In contrast, sotalol significantly prolonged the atrial refractory period with a higher extent than procainamide. After infusion of procainamide, the increase of conduction time in the isthmus accounted for 52±19% of the increase in flutter cycle length, and 5 of 12 patients (42%) had spontaneous termination of typical flutter. After infusion of sotalol, typical flutter was induced in only 6 of 12 patients (50%) without significant prolongation of flutter cycle length. Conclusions: The low right atrial isthmus with rate-dependent slow conduction properties is critical to initiation of typical human atrial flutter. It may be the potentially pharmacological target of antiarrhythmic drugs in the future.

KW - Atrial flutter

KW - Conduction

KW - Procainamide

KW - Sotalol

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