Action Potential Duration Gradient Protects the Right Atrium from Fibrillating

Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is characterized by rapid and disorganized electrical activity in the atria. Atrial arrhythmias can be triggered from an ectopic focus, i.e., an abnormal impulse originating in an area other than the sinus node, generating reentrant waves. The regional ionic heterogeneities found in the atria cause a gradual shortening of the action potential duration (APD) with increased distance from the sinoatrial node. It is generally thought that the only electrophysiological consequence of the spatial dispersion of cardiac action potentials (AP) is the enhancement of reentry. This paper investigates the effect of a gradient in APD on arrhythmogenesis via computer simulations. A gradient of ionic properties was introduced into a computationally efficient computer model of the canine atria to produce a smooth distribution of APDs. The window of vulnerability for ectopic beat-induction of reentry was determined for both left atrium (LA) and the right atrium (RA) stimulation, with and without an APD gradient. The shortened windows of vulnerability in the RA, due to the addition of the APD gradient, suggests a protective mechanism against AF. The left atrial window of vulnerability was slightly longer from ionic dispersion.