Advertisement

Experimental Animal Models of Atrial Arrhythmias and Their Relevance to Post-Operative Atrial Arrhythmias that Occur in Humans Unergoing Cardiac Surgery

  • Gregory K. Feld
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 222)

Abstract

Atrial arrhythmias, such as atrial fibrillation (AFIB), atrial flutter (AFL) and atrial tachycardia (AT) are relatively common following cardiac surgery [1-2]. Patients undergoing cardiac surgery may be particularly prone to develop atrial arrhythmias for a variety of reasons, including the type of surgery performed, the presence of underlying heart disease and other associated medical conditions such as hypertension, hemodynamic instability or congestive heart failure, pulmonary insufficiency, associated pericardial inflammation, and the increased sympathetic and vagal nervous system activity that accompanies such surgery [1-2]. Post-operative atrial arrhythmias may cause significant symptoms including palpitations, shortness of breath, chest pain and even syncope due to the hemodynamic instability that often exists in this setting. If associated with a rapid ventricular response, post-operative atrial arrhythmias may cause ischemia or congestive heart failure, and in the case of atrial fibrillation thromboembolic stroke may even occur. The treatment, and perhaps more importantly the prevention of atrial arrhythmias following cardiac surgery is therefore critical. Fortunately, through extensive experimental and clinical studies significant progress has been made towards delineating the mechanisms and possible treatments for most atrial arrhythmias, including those that occur in the post-operative period following cardiac surgery.

Keywords

Atrial Fibrillation Antiarrhythmic Drug Atrial Flutter Atrial Tachycardia Atrial Arrhythmia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Michelson EL, Morganroth J, MacVaugh H. Postoperative arrhythmias after coronary artery and cardiac valvular surgery detected by long-term electrocardiographic monitoring Am Heart T 1982;104:442–448.CrossRefGoogle Scholar
  2. 2.
    Yousif H, Davies G, Oakley CM. Peri-operative supraventricular arrhythmias in coronary artery bypass graft surgery, Int J Cardiol 1990;26:313–318.CrossRefPubMedGoogle Scholar
  3. 3.
    Cox JL, Canavan TE, Scheussler RB, et.al. The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 1991; 101:406–426.PubMedGoogle Scholar
  4. 4.
    Jalife J, Berenfeld O, Skanes A, Mandapati R. Mechanism of atrial fibrillation: Mother rotors or multiple daughter wavelets or both. J Cardiovasc Electrophysiol 1998;9:S2–S12.CrossRefPubMedGoogle Scholar
  5. 5.
    Disertori M, Inama G, Vergara G, Guanerio M, Del Favero A, Furlanello F. Evidence of a reentry circuit in the common type of atrial flutter in man. Circulation 1963;67:434–440.Google Scholar
  6. 6.
    Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT, James TN. Entrainment and interruption of atrial flutter with atrial pacing: Studies in man following open-heart surgery. Circulation 1997;56:737–745.Google Scholar
  7. 7.
    Lesh MD, Kalman JM, Saxon LA, Dorostkar PE. Electrophysiology of “incisional” reentrant atrial tachycardia complicating surgery for congenital heart disease. Pacing Clin Electrophysiol 1997;20:2107–2111.CrossRefPubMedGoogle Scholar
  8. 8.
    Kaiman JM, VenHare GF, Olgin JE, Saxon LA, Stark SI, Lesh MD. Ablation of “incisional” reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation 1996;93:502–512.Google Scholar
  9. 9.
    Kuck KH, Ernst S, Cappato R, Braun E, et.al. Nonfluoroscopic mapping of atrial fibrillation. J Cardiovasc Electrophysiol 1998;9:S57–S62.PubMedGoogle Scholar
  10. 10.
    Pitschner HF, BeTkovic A, Grumbrecht S, Neuzner J. Multielectrode basket catheter mapping for human atrial fibrillation. J Cardiovasc Electrophysiol 1998;9:S48–S56.PubMedGoogle Scholar
  11. 11.
    Cosio FG, Arribas F, Lopez-Gil M, Palacios J. Atrial flutter mapping or ablation I. Studying atrial flutter mechanisms by mapping and entrainment. Pacing Clin Electrophysiol 1996;19:841–853.CrossRefPubMedGoogle Scholar
  12. 12.
    Cosio FG, Goicolea A, Lopez-Gil M, Arribal S, Barroso JL. Atrial endocardial mapping in the rare form of atrial flutter. Am J Cardiol 1990;66:715–720.CrossRefPubMedGoogle Scholar
  13. 13.
    Kottkamp H, Hindricks G, Breithardt G, Borgreffe M. Three-dimensional electromagnetic catheter technology: Electroanatomical mapping of the right atrium and ablation of ectopic atrial tachycardia. J Cardiovasc Electrophysiol 1997;8:1332–1337.CrossRefPubMedGoogle Scholar
  14. 14.
    Feld GK: Catheter Ablation for the Treatment of Atrial Tachycardias. Prog Cardiovas Dis 38:205–224,1995.CrossRefGoogle Scholar
  15. 15.
    Konigs KT, Kirchhof CJ, Smeets JR, Wellens HJ, Penn OC, Allessie MA. High density mapping of electrically induced atrial fibrillation in humans. Circulation 1994;89:1665–1680.Google Scholar
  16. 16.
    Klein GJ, Guiraudon GM, Sharma AD, Milstein S. Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter. Am J Cardiol 1986;57:587–591.CrossRefPubMedGoogle Scholar
  17. 17.
    Rosenbleuth A, Garcia-Ramos J. Studies of artificial obstacles on experimental auricular flutter. Am Heart J 1947;33:677–684.CrossRefGoogle Scholar
  18. 18.
    Frame LH, Page RL, Hoffman BG. Atrial re-entry around an anatomic barrier with a partially excitable gap. A canine model of atrial flutter. Circ Res 1986;58:495–511.PubMedGoogle Scholar
  19. 19.
    Frame LH. The tricuspid ring model of atrial flutter. In: Waldo AL, Touboul P, (eds). “Atrial Flutter: Advances in Mechanisms and Management.” Armonk, NY, Futura Publishing Co., 1996, pp 159–172.Google Scholar
  20. 20.
    Feld GK, Shahandeh-Rad F. Activation patterns in experimental canine atrial flutter produced by right atrial crush-injury. J Am Coll Cardiol 1992;20:441–451.CrossRefPubMedGoogle Scholar
  21. 21.
    Feld GK, Shehandeh-Rad F. Mechanism of double potentials recorded during sustained atrial flutter in the canine right atrial crush-injury model. Circulation 1992;86:628–641.PubMedGoogle Scholar
  22. 22.
    Page PL, Plumb VJ, Okumura K, Waldo L. A new animal model of atrial flutter. J Am Coll Cardiol 1986;8:872–879.CrossRefPubMedGoogle Scholar
  23. 23.
    Okumura K, Plumb VJ, Page PL, Waldo AL. Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram. J Am Coll Cardiol 1991;17:509–518.CrossRefPubMedGoogle Scholar
  24. 24.
    Hoyden PA. Activation sequence during atrial flutter in dogs with surgically-induced right atrial enlargement. I: Observations during sustained rhythms. Circ Res 1988;62:596–607.Google Scholar
  25. 25.
    Boyden PA. Studies in animal models of atrial flutter. Tricuspid regurgitation model. In: Waldo AL, Touboul P, (eds). “Atrial Flutter: Advances in Mechanisms and Management.” Armonk, NY, Futura Publishing Co., 1996, pp 137–157.Google Scholar
  26. 26.
    Wang Z, Page P, Nattel S. Mechanism of flecainide’s antiarrhythmic action in experimental atrial fibrillation. Circ Res 1992;71:271–287.PubMedGoogle Scholar
  27. 27.
    Wang J, Bourne GW, Wang Z, Villemaire C, Talajic M, Nattel S. Comparative mechanisms of drug action in experimental atrial fibrillation. Importance of use-dependent effects on refractoriness. Circulation 1993;88:1030–1044.PubMedGoogle Scholar
  28. 28.
    Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995;92:1954–1968.PubMedGoogle Scholar
  29. 29.
    Wijffels MC, Kirchhof CJ, Dorland R, Power J, Allessie MA. Electrical remodeling due to atrial fibrillation in chronically instrumented conscious goats: Roles of neurohumoral changes, ischemia, atrial stretch, and high rate of electrical activation. Circulation 1997;96:3710–3720.PubMedGoogle Scholar
  30. 30.
    Waldo AL. Transient entrainment of atrial flutter. In: Waldo AL, Touboul P, (eds). “Atrial Flutter: Advances in Mechanisms and Management.” Armonk, NY, Futura Publishing Co., 1996, pp 241–257.Google Scholar
  31. 31.
    Inoue H, Matsuo H, Takayangi K, Murao S: Clinical and experimental studies of the effects of atrial extrastimulation and rapid pacing on atrial flutter cycle. Am J Cardiol 1981;48;623–631.CrossRefPubMedGoogle Scholar
  32. 32.
    Feld GK, Fleck RP, Chen PS, Boyce K, Bahnson TD, Stein JB, Calisi CM, Ibarra M. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992;86:1233–1240.PubMedGoogle Scholar
  33. 33.
    Cosio RG, Lopez-Gil M, Goicolea A, Arribas F, Barroso JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993;71:705–709.CrossRefPubMedGoogle Scholar
  34. 34.
    Olshansky B, Okumura K, Hess PG, Waldo AL. Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 1990;16:1639–1648.CrossRefPubMedGoogle Scholar
  35. 35.
    Feld GK, Mollerus M, Birgersdotter-Green U, Fujimura O, Bahnson T, Boyce K, Rahme M. Conduction velocity in the tricuspid valve-inferior vena cava isthmus is slower in patients with a history of atrial flutter compared to those without atrial flutter. J Cardiovasc Electrophysiol 8:1338–1348, 1997.CrossRefPubMedGoogle Scholar
  36. 36.
    Olgin JE, Kaiman JM, Saxon LA, Lee RJ, Lesh MD. Mechanisms of initiation of atrial flutter in humans: Site of unidirectional block and direction of rotation. J Am Coll Cardiol 1997;29:376–384.CrossRefPubMedGoogle Scholar
  37. 37.
    Ching TT, Chen SA, Chiang CE, et.al. Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. Circulation 1997;96:2601–2611.Google Scholar
  38. 38.
    Tai CT, Chan SA, Feng AN, Yu WC, Chen YJ, Chng MS. Electropharmacological effects of class 1 and 3 antiarrhythmic drugs on typical atrial flutter: Insights into mechanism of termination. Circulation 1998;97:1335–1345.Google Scholar
  39. 39.
    Cosio FG, Arribas F, Palacios J, Tascon J, Lopez-Gil M. Fragmented electrograms and continuous electrical activity in atrial flutter. Am J Cardiol 1996;57:1309–1314.CrossRefGoogle Scholar
  40. 40.
    Cosio FG, Ambus F, Barbero JM, Kallmeyer C, Goicolea A. Validation of double spike electrograms as markers of conduction delay orblock in atrial flutter. Am J Cardiol 1988;61:775–780.CrossRefPubMedGoogle Scholar
  41. 41.
    Olshansky B, Okumura K, Henthom RW, Waldo AL. Characterization of double potentials in human atrial flutter: Studies during transient entrainment. J Am Coll Cardiol 1990; 15:833–841.CrossRefPubMedGoogle Scholar
  42. 42.
    Olgin JE, Kaiman JM, Fizpatrick AP, Lesh MD. Role of right atrial endocardial structures as barriers to conduction during human type 1 atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. Circulation 1995;92:1839–1848.PubMedGoogle Scholar
  43. 43.
    Olgin JE, Kaiman JM, Lesh MD. Conduction barriers in human atrial flutter: Correlation of electrophysiology and anatomy. J Cardiovasc Electrophysiol 1996;7:1112–1126.CrossRefPubMedGoogle Scholar
  44. 44.
    Kalman, JM, Olgin JE, Saxon LA, Fischer WG, Lee RJ, Lesh MD. Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation 1996;94:398–406.PubMedGoogle Scholar
  45. 45.
    Wells JL Jr, MacLean WAH, James TN, Waldo AL. Characterization of atrial flutter: Studies in man after open-heart surgery using fixed atrial electrodes. Circulation 1979;60:665–673.PubMedGoogle Scholar
  46. 46.
    Waldo AL, Plumb VJ, Arciniegas JG, et.al. Observations on the mechanism of atrial flutter. In Surawicz B (ed): Tachycardias. The Hague, Martinus-Nijhoff, 1984, p 213.Google Scholar
  47. 47.
    Chen SA, Tai CT, Chiang CE, Ding YA, Chang MS. Focal atrial tachycardia: Reanalysis of the clinical and electrophysiological characteristics and prediction of successful radiofrequency ablation. J Cardiovasc Electrophysiol 1998;9:355–365.CrossRefPubMedGoogle Scholar
  48. 48.
    Kay GN, Chong F, Epstein AE, Dailey SM, Plumb VJ. Radiofrequency ablation for treatment of primary atrial tachycardia. J Am Coll Cardiol 1993;21:901–909.CrossRefPubMedGoogle Scholar
  49. 49.
    Haissaguerre M, Gensel L, Fischer B, LeMetayer P, Poquet F, Marcus FL, Clementy J. Successful catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1994;5:1045–1052CrossRefPubMedGoogle Scholar
  50. 50.
    Jais P, Haissaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, Clementy J. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997;95:572–576.PubMedGoogle Scholar
  51. 51.
    Rensma PL, Allessie MA, Lammers WJFP, Bonke FIM, Schalij MJ. Length of excitation wave and susceptibility to reentrant atrial arrhythmias in normal conscious dogs. Circ Res 1988;62:395–410.PubMedGoogle Scholar
  52. 52.
    Wang Z, Feng J, Nattel S. Idiopathic atrial fibrillation in dogs: Electrophysiological determinants and mechanisms of antiarrhythmic action of flecainide. J Am Coll Cardiol 1995;26:277–286.CrossRefPubMedGoogle Scholar
  53. 53.
    Rahme MM, Leistad E, Cotter B, Simu S, Bahnson TD, Feld GK. Maintenance of atrial fibrillation: Dependence on the duration and dispersion of atrial refractoriness (abstract). Pacing Clin Electrophysiol 1988;21:863.Google Scholar
  54. 54.
    Ramdat Misier AR, Opthof T, van Hemel NM, et.al. Increased dispersion of refractoriness in patients with idiopathic paroxysmal atrial fibrillation. J Am Coll Cardiol 1992; 19:1531–1535.CrossRefGoogle Scholar
  55. 55.
    Kumagai K, Akimitsu S, Kawahira K, et.al. Electrophysiological properties in chronic lone atrial fibrillation. Circulation 1991;84:1662–1668.PubMedGoogle Scholar
  56. 56.
    Cox JL, Boineau JP, Schuessler RB, et al: Five-year experience with Maze procedure for atrial fibrillation. Ann Thorac Surg 1993;56:814–824.CrossRefPubMedGoogle Scholar
  57. 57.
    Haissaguerre M, Jais P, Shah DC, Gencel L, Pradeau V, Garrigues S, Chouairi S, Hocini M, Le Metayer P, Roudaut R, Clementy J. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 1996;7:1132–1144.CrossRefPubMedGoogle Scholar
  58. 58.
    Biouneau JP, Schuessler RB, Mooney CR, et.al. Natural and evoked atrial flutter due to circus movement in dogs: Role of abnormal atrial pathways, slow conduction, non-uniform refractory period distribution and premature beats. Am J Cardiol 1980;45:1167–1181.CrossRefGoogle Scholar
  59. 59.
    Frame LH, Page RL, Boyden PA, et.al. Circus movement in the canine atrium around the tricuspid ring during experimental atria flutter and during reentry in vivo. Circulation 1987;76:1155–1175.PubMedGoogle Scholar
  60. 60.
    Frame LH, Simson MB. Oscillations of conduction, action potential duration and refractoriness: A mechanism for spontaneous termination or reentrant tachycardias. Circulation 1988;78:1277–1287.PubMedGoogle Scholar
  61. 61.
    Boyden P, Graziano H. Activation mapping of reentry around an anatomical barrier in the canine atrium: Observations during the action of the class III agent, d-sotalol. J Cardiovasc Electrophysiol 1993;4:266–279.CrossRefPubMedGoogle Scholar
  62. 62.
    Pinto J, Graziano J, Boyden P. Endocardial mapping of reentry around an anatomical barrier in the canine right atrium: Observations during the action of the class IC agent, flecainide. J Cardiovasc Electrophysiol 1993;4:672–685.CrossRefPubMedGoogle Scholar
  63. 63.
    Feld GK: Characteristics of the canine crush-injury model of atrial flutter. In: Atrial Flutter: Advances in Mechanisms and Management. Waldo AL, Touboul P, eds; Futura Publishing Co., Armonk, NY, 1996, pp 193–217.Google Scholar
  64. 64.
    Cha YM, Wales A, Wolf P, Shahrokni S, Sawhney N, Feld GK. Electrophysiologic effects of the new class 3 antiarrhythmic drug dofetilide compared to the class 1a antiarrhythmic drug quinidine in experimental canine atrial flutter: Role of dispersion of refractoriness in antiarrhythmic efficacy. J Cardiovasc Electrophysiol 7:809–827, 1996.CrossRefPubMedGoogle Scholar
  65. 65.
    Feld GK, Venkatesh N, Singh BN. Pharmacologic conversion and suppression of experimental canine atrial flutter. Differing effects of D-sotalol, quinidine and lidocaine and the significance of changes in refractoriness and conduction. Circulation 74(1): 197–204, 1986.PubMedGoogle Scholar
  66. 66.
    Feld GK, Venkatesh N, Singh BN: Effects of N-acetylprocainamide and recainam in experimental canine atrial flutter: Significance of the changes in refractoriness and conduction velocity in the conversion and suppression of atrial flutter. J Cardiovasc Phar 11:573–580, 1988.CrossRefGoogle Scholar
  67. 67.
    Stambler BS, Wood MA, Ellenbogen KA. Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and atrial fibrillation: Electrophysiological determinants of enhanced conversion efficacy. Circulation 1997;96:4298–4306.PubMedGoogle Scholar
  68. 68.
    Shimizu A, Nozaki A, Rudy Y, Waldo AL. Onset of induced atrial flutter in the canine pericarditis model. J Am Coll Cardiol 1991;17:1223–1234.CrossRefPubMedGoogle Scholar
  69. 69.
    Waldo AL. The canine sterile pericarditis model of atrial flutter. In: Atrial Flutter: Advances in Mechanisms and Management. Waldo AL, Touboul P, eds; Futura Publishing Co., Armonk, NY, 1996, pp 173–192.Google Scholar
  70. 70.
    Schoels W, Gough WB, Restive M, El-Sherif N. Circus movement atrial flutter in the canine sterile pericarditis model. Activation patterns during initiation, termination and sustained re-entry in vivo. Circ Res 1990;67:35–50.PubMedGoogle Scholar
  71. 71.
    Boyden, PA. Effects of pharmacologic agents on induced atrial flutter in dogs with right atrial enlargement. J Cardiovasc Pharm 1986;8:170–177.CrossRefGoogle Scholar
  72. 72.
    Brown BB, Acheson GH. Aconitine induced auricular arrhythmias and their relation to circus movement and flutter. Circulation 1952;6:529.PubMedGoogle Scholar
  73. 73.
    Tieleman, RG, Van Gelder, IC, Crijns, HJG, De Kam, PJ, Van Den Berg, MP, Haaksma, J, Van Der Woude, HJ, Allessie, MA. Early recurrences of atrial fibrillation after electrical cardioversion: A result of fibrillation induced electrical remodeling of the atria? J Am Coll Cardiol 1998;31:167–73.CrossRefPubMedGoogle Scholar
  74. 74.
    Arzbaecher R, Gemperline J, Haklin M, Bucemi P. Rapid drug infusion for termination of atrial fibrillation in an experimental model. Pacing Clin Electrophysiol 1998;21:288–291.CrossRefPubMedGoogle Scholar
  75. 75.
    Fieguth HG, Wahlers T, Borst HG. Inhibition of atrial fibrillation by pulmonary vein isolation and auricular resection-Experimental study in a sheep model. Europ J Cardio Thorac Surg 1997;11:714–721.CrossRefGoogle Scholar
  76. 76.
    Wang Z, Feng J, Nattel S. Idiopathic atrial fibrillation in dogs: Electrophysiologic determinants and mechanisms of antiarrhythmic action of flecainide. J Am Coll Cardiol 1995;26:277–286.CrossRefPubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Gregory K. Feld
    • 1
  1. 1.University of CaliforniaSan Diego

Personalised recommendations