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To the Editor: The clinical investigation published in the Japanese Circulation Journal1 was an excellent study of the correlation between the effective refractory period (ERP) and activation – recovery interval (ARI) using the intracardiac unipolar electrogram recorded at multiple sites in the human right ventricle. This electrophysiologic study (EPS) clarified the close correlation between ARI and ERP and hence addressed the utility of ARI as a parameter of local ERP, the distribution of which is difficult to evaluate simultaneously in the clinical EPS. The ARI is also obtained during the basic EPS, using a microelectrode that is usually applied to record intracellular action potential. Action potential duration (APD) has also been reported to reflect the ARI derived from an extracellular unipolar electrogram under microelectrode recording in an in vivo animal study.2,3 The authors investigated the relationship between the ARI and ERP in control and dl-sotalol groups and found an identical linear regression in both groups, which contained various heart diseases. These findings indicate ARI is a reasonable parameter of local ERP under the pharmacologic intervention for a variety of organic heart diseases. However, as the authors noted in their study limitations, the unipolar electrogram is distorted and obtained by pacing with a relatively higher end diastolic threshold intensity in the arrhythmogenic substrate, such as the ischemic or degenerated area. Dispersion of the ERP is of paramount importance in clarifying the arrhythmogenic mechanisms in such an area. Therefore, in order to extrapolate the correlation between ARI and ERP to the arrhythmogenic substrate, measurement of the ARI should be conducted under exact exclusion criteria. 3

circulation journal

Correlation Between the Effective Refractory Period and Activation-Recovery Interval Calculated From the Intracardiac Unipolar Electrogram of Humans With and Without dl-Sotalol treatment.