Characterization of double potentials in human atrial flutter: Studies during transient entrainment

Abstract

AbstractDouble potentials, defined as atrial electrograms with two discrete deflections per beat separated by an isoelectric interval or a low amplitude baseline, have been observed during right atrial endocardial mapping of human atrial flutter. In this study, bipolar atrial electrograms were recorded during atrial flutter (mean cycle length 235 ± 27 ms [± SEM]) from the high Right atrium, the His bundle region, the coronary sinus and at least 30 right atrial endocardial napping sites in 10 patients. Double potentials were recorded from the right atrium in all patients during atrial flutter.Double potentials were evaluated during transient entrainment of atrial flutter by rapid high right atrial pacing in 5 of the 10 patients. In four of these five patients during such transient entrainment 1) one deflection of the double potential was captured with a relatively short activation time (mean interval 89 ± 45 ms) and the other deflection was captured with a relatively long activation time (mean interval 233 ± 24 ms), producing a paradoxical decrease in the short interdeflection interval from a mean of 75 ± 20 ms to a mean of 59 ± 24 ms; and 2) the configuration of the double potential remained similar to that observed during spontaneous atrial flutter. On pacing termination 1) the two double potential deflections were found to be associated with two different atrial flutter complexes in the electrocardiogram (ECG); 2) the previous double potential deflection relation resumed; and 3) when sinus rhythm was present, the double potentials were replaced by a broad, low amplitude electrogram recording at the same site. These functional double potentials probably represent collision of activation wave fronts in a functional center of the artial flutter reentrant circuit and therefore may serve as a marker for an area of functional block. In one of the five patients, double potentials were recorded from the site during transient entrainment of atrial flutter, during spontaneous atrial flutter and during sinus rhythm. These were called persistent double potentials and were associated with the same atrial flutter complex in the ECG, indicating that not all double potentials recorded during atrial flutter represent the same phenomenon