The Mechanism of Canine Atrial Flutter

In anesthetized dogs, electrograms were recorded simultaneously from six atrial epicardial sites and a limb or esophageal lead in order to study the mechanism of atrial flutter induced electrically after an intercaval crush in comparison with atrial tachysystole induced by aconitine. In the former, with limb lead records resembling classical human flutter in form and regularity, activation occupied most of the atrial cycle and progressed in sequence caudally in the right atrium and cranially in the left (counterclockwise flutter); flutter was usually terminated by another crush extending from the initial one to the right atrioventricular junction. The most prominent wave in limb and esophageal leads coincided with left atrial activity. Sometimes activation proceeded clockwise. The two atrial appendages may be activated simultaneously during counterclockwise flutter. These findings support the circus movement hypothesis as the mechanism of pure atrial flutter. In contrast, with aconitine tachysystole, activation proceeded over both atria at once and was so brief that it left most of the slightly irregular atrial cycle electrically silent. Although limb leads after aconitine sometimes resembled those of flutter, the contrast in direction and duration of excitation demonstrates profound physiological differences between the two arrhythmias.