Atrial arrhythmias are believed to be influenced by autonomic nervous system tone. We evaluated the effects of sympathetic and parasympathetic activation on atrial flutter (AFl) by determining the effects of norepinephrine (NE) and acetylcholine (ACh) on the composition of the excitable gap. A model of reentry around the tricuspid valve was produced in 17 chloralose anesthetized dogs using a Y-shaped lesion in the intercaval area that extended to the right atrial appendage. Excitable gap characteristics were determined during AFl by scanning diastole with a single premature extrastimulus at progressively shorter coupling intervals to define the reset-response curve. Measurements were made during a constant infusion of NE (15 µg/min) into the right coronary artery and repeated during ACh infusion (2 µg/min) following a 15 min recovery period. The excitable gap (27 ± 1 ms) was significantly (P < 0.001) increased by NE (34 ± 1 ms) and ACh (50 ± 2 ms). The fully excitable portion (7 ± 1 ms) was also significantly (P < 0.001) increased by NE (17 ± 1 ms) and ACh (43 ± 2 ms). We conclude that both neurotransmitters increase the safety margin of full excitability ahead of the wavefront, demonstrating that parasympathetic and sympathetic activation can facilitate the persistence of this refractory atrial arrhythmia.Key words: atrial flutter, acetylcholine, norepinephrine, excitable gap.
Atrial reentry around an anatomic barrier with a partially refractory excitable gap. A canine model of atrial flutter.