Shimizu A, Nozaki A, Rudy Y, Waldo A L
Department of Medicine, Case Western Reserve University/University Hospitals of Cleveland 44106.
J Am Coll Cardiol. 1993 Dec;22(7):2022-32. doi: 10.1016/0735-1097(93)90793-z.
We tested the hypothesis that double potentials recorded during atrial flutter in a functionally determined reentrant circuit reflect activation of the reentrant wave front around an area of functional conduction block.
The center of the atrial flutter reentrant circuit in the sterile pericarditis canine model is characterized by double potentials.
We studied 11 episodes of atrial flutter in eight dogs during interruption of atrial flutter while pacing the atria. A multielectrode mapping system was used to record simultaneously from 190 electrodes on the right atrium (location of reentry).
Interruption of atrial flutter occurred when the orthodromic wave front from the pacing impulse blocked in an area of slow conduction in the reentrant circuit. The response of the double potential with interruption of atrial flutter depended on the location of the recording site relative to this area of block. Two types of response were seen. When the double potential was recorded orthodromically distal to this area of block, interruption of atrial flutter was associated with disappearance of the second deflection, and continued pacing after interruption of atrial flutter was not associated with reappearance of the second potential. When the double potential was recorded at a site orthodromically proximal to the area of block, interruption of atrial flutter was not associated with disappearance of the second potential, and when rapid atrial pacing was continued, the double potential remained despite disappearance of the atrial flutter reentrant circuit.
Double potentials represent functional conduction block in the center of the reentrant circuit, with each deflection of the double potential reflecting activation on either side of the area of functional block. The data also demonstrate that double potentials are not limited to a reentrant circuit, as they were recorded on either side of an area of block in the absence of such a circuit.
我们检验了这样一个假设，即在功能确定的折返环路中，心房扑动期间记录到的双电位反映了围绕功能性传导阻滞区域的折返波前的激活。
无菌性心包炎犬模型中心房扑动折返环路的中心以双电位为特征。
我们在八只犬的11次心房扑动发作期间，在心房起搏时中断心房扑动进行研究。使用多电极标测系统同时记录右心房（折返部位）的190个电极的电活动。
当起搏冲动的顺向波前在折返环路的缓慢传导区域受阻时，心房扑动中断。心房扑动中断时双电位的反应取决于记录部位相对于该阻滞区域的位置。观察到两种类型的反应。当在该阻滞区域远端顺向记录到双电位时心房扑动中断与第二个波峰消失相关，心房扑动中断后继续起搏与第二个电位再现无关。当在该阻滞区域近端顺向部位记录到双电位时，心房扑动中断与第二个电位消失无关，并且当继续快速心房起搏时，尽管心房扑动折返环路消失，双电位仍存在。
双电位代表折返环路中心的功能性传导阻滞，双电位的每个波峰反映功能性阻滞区域两侧的激活。数据还表明双电位并不局限于折返环路，因为在没有这种环路的阻滞区域两侧都记录到了双电位。
