Cited by 104Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasAtrial Fibrillation Management and Outcomes

Transverse conduction capabilities of the crista terminalis in patients with atrial flutter and atrial fibrillation

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Schumacher, Burghard, Jung, Werner, Schmidt, Harald, Fischenbeck, Christoph, Lewalter, Thorsten, Hagendorff, Andreas, Omran, Heyder, Wolpert, Christian +1 more·1999·Journal of the American College of Cardiology

Abstract

Objectives In this study, the transverse conduction capabilities of the crista terminalis (CT) were determined during pacing in sinus rhythm in patients with atrial flutter and atrial fibrillation.Background It has been demonstrated that the CT is a barrier to transverse conduction during typical atrial flutter. Mapping studies in animal models provide evidence that this is functional. The influence of transverse conduction capabilities of the CT on the development of atrial flutter remains unclear.Methods The CT was identified by intracardiac echocardiography. The atrial activation at the CT was determined during programmed stimulation with one extrastimulus at five pacing sites anteriorly to the CT in 10 patients with atrial flutter and 10 patients with atrial fibrillation before and after intravenous administration of 2 mg/kg disopyramide. Subsequently, atrial arrhythmias were reinduced.Results At baseline, pacing with longer coupling intervals resulted in a transverse pulse propagation across the CT. During shorter coupling intervals, split electrograms and a marked alteration of the activation sequence of its second component were found, indicating a functional conduction block. In patients with atrial flutter, the longest coupling interval that resulted in a complete transverse conduction block at the CT was significantly longer than that in patients with atrial fibrillation (285 +/- 49 ms vs. 221 +/- 28 ms; p < 0.05). After disopyramide administration, a transverse conduction block occurred at longer coupling intervals as compared with baseline (287 +/- 68 ms vs. 250 +/- 52 ms; p < 0.05). Subsequently, a sustained atrial arrhythmia was inducible in 15 of 20 patients. This was atrial flutter in three patients with previously documented atrial fibrillation and in eight patients with history of atrial flutter. Mapping revealed a conduction block at the CT in all of these patients.Conclusions It was found that the CT provides transverse conduction capabilities and that the conduction block during atrial flutter is functional. Limited transverse conduction capabilities of the CT seem to contribute to the development of atrial flutter.

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  1. Moe G. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 1962;140:183-8.
  2. Waldo AL, Kastor JA. Atrial flutter. In: Kastor JA, ed. Arrhythmias. Philadelphia: WB Saunders, 1994:105-15.
  3. Feld GK, Shahandeh-Rad F. Activation patterns in experimental canine atrial flutter produced by right atrial crush injury. J Am Coll Cardiol 1992;20:441-51.
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  5. Feld GH, Chen PS, Nicod P, et al. Atrial proarrhythmic effects of class I antiarrhythmic drugs. Am J Cardiol 1990;66:378 -82.

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Authors
Schumacher, B., Jung, W., Schmidt, H., Fischenbeck, C., Lewalter, T., Hagendorff, A., Omran, H., Wolpert, C., & Lüderitz, B.
Affiliations
University of Bonn (DE)
Corresponding author
Schumacher, Burghard
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1999-08
Volume
34
Issue
2
Pages
363-373
ISSN
0735-1097 (ISSN-L)
OpenAlex
W1989794078
Cited by
104
References
56
Citations by year
2026: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 4 · 2014: 2 · 2013: 1 · 2012: 4
FWCI
5.74
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Universität Heidelberg
  • Rheinische Friedrich-Wilhelms-Universität Bonn
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords
crista terminalis, atrial flutter, atrial fibrillation, atrial activation sequence, disopyramide, atrial conduction, intracardiac echocardiography
MeSH terms
Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Cardiac Pacing, Artificial, Disopyramide, Echocardiography, Electrocardiography, Electrophysiology, Female, Heart Conduction System, Humans, Male, Middle Aged

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