© 1997 American Heart Association, Inc.
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Attachment of Meandering Reentrant Wave Fronts to Anatomic Obstacles in the Atrium
Role of the Obstacle Size
From the Division of Cardiology (T.I., M.Y., T.U., D.H., W.J.M., P.-S.C., H.S.K.), Department of Medicine, and the Department of Pathology (M.C.F.), Cedars-Sinai Medical Center, Burns and Allen Research Institute, and UCLA School of Medicine, Los Angeles, Calif.
Correspondence to Hrayr S. Karagueuzian, PhD, Division of Cardiology, Cedars-Sinai Research Institute, 8700 Beverly Blvd, Room 6066, Los Angeles, CA 90048. E-mail Karagueuzian{at}csmc.edu
Abstract Acetylcholine chloride (ACh) induces nonstationary meandering reentrant wave fronts in the atrium. We hypothesized that an anatomic obstacle of a suitable size prevents meandering by causing attachment of the reentrant wave front tip to the obstacle. Eight isolated canine right atrial tissues (area, 3.8x3.2 cm) were mounted in a tissue bath and superfused with Tyrode's solution containing 10 to 15 µmol/L ACh. Holes with 2- to 10-mm diameters were sequentially created in the center of the tissue with biopsy punches. Reentry was induced by a premature stimulus after eight regular stimuli at 400-ms cycle length. The endocardial activation maps and the motion of the induced reentry were visualized dynamically before and after each test lesion using 509 bipolar electrodes. In the absence of a lesion (n=8), the induced single reentrant wave front, in the form of a spiral wave, meandered irregularly from one site to another before terminating at the tissue border. Holes with 2- to 4-mm diameters (n=6) had no effect on meandering. However, when the hole diameters were increased to 6 mm (n=8), 8 mm (n=8), and 10 mm (n=6), the tip of the spiral wave attached to the holes, and reentry became stationary. Transition from meandering to an attached state converted the irregular and polymorphic electrogram to a periodic and monomorphic activity with longer cycle lengths (101±11 versus 131±9 ms for no hole versus 10-mm hole, respectively; P<.001). Regression analysis showed a significant positive linear correlation between the cycle length of the reentry and the hole diameter (r=.89, P<.01) and between the cycle length of the reentry and the excitable gap (r=.89, P<.05). We conclude that a critically sized anatomic obstacle converts a nonstationary meandering reentrant wave front to a stationary one. This transition converts an irregular "fibrillation-like" activity into regular monomorphic activity.
Key Words: reentry • mapping • atrium • source-sink relationship • acetylcholine
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