© 1998 American Heart Association, Inc.
Original Contributions |
Role of Pectinate Muscle Bundles in the Generation and Maintenance of Intra-atrial Reentry
Potential Implications for the Mechanism of Conversion Between Atrial Fibrillation and Atrial Flutter
From the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center (T.-J.W., M.Y., C.A.A., Y.-H.K., H.S.K., P.-S.C.) and the Division of Cardiology, Departments of Medicine (F.X., Z.Q., A.G., J.N.W.) and Pathology (M.C.F.), University of California at Los Angeles School of Medicine, Los Angeles, Calif. Dr Wu's current address is Veterans General Hospital, Taichung, Taiwan.
Correspondence to Peng-Sheng Chen, MD, Division of Cardiology, Room 5342, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail chenp{at}csmc.edu
Abstract—To determine the role of pectinate muscle (PM) bundles in the formation of intra-atrial reentry, 10 isolated canine right atrial tissues were perfused with Tyrode's solution containing 1 to 2.5 µmol/L acetylcholine (ACh). The endocardium was mapped using 477 bipolar electrodes with 1.6-mm resolution. Reentry was induced by a premature stimulus (S2). Computer simulation studies were used to investigate the importance of regional myocardial thickness in reentry formation. A total of 40 episodes of reentry were induced; 28 episodes were stationary, and the remaining 12 were nonstationary. The stationary reentry was induced either immediately after the S2 stimuli (n=9) or after an initial period of irregular activations that lasted 1460±1077 ms (n=19). Of 28 episodes, 20 were initiated by conduction block along large PM ridges, leading to wave break and the initiation of reentry. The reentrant wave fronts remained stationary and rotated around these ridges as anchoring sites. During the transition from the initial irregular activations to stationary reentry, the electrogram morphology converted from "fibrillation-like" to "flutter-like" activity. In 8 episodes, initially stationary reentry converted to irregular activations because of interference with outside wave fronts (n=5) or spontaneous separation of waves from the ridges (n=3). Compared with stationary reentry, nonstationary reentry always occurred over an area without large PMs, and the mean life span was much shorter (102±151 versus 3.8±1.1 rotations, P<0.001). Computer simulation studies showed that a critical ridge thickness is needed for reentry to anchor, thereby converting fibrillation to flutter. We conclude that PM ridge forms an area where wave break occurs, allowing the initiation of reentry. It also provides a natural anchor to the reentrant wave front, lengthening the life span of reentry. The attachment and detachment of the reentrant wave front to and from the ridge determine "flutter-like" or "fibrillation-like" activity.
Key Words: pectinate muscle bundle • reentry • anchoring • atrial arrhythmia • source-sink relationship
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