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Mechanism and Clinical Significance of Atrial Repetitive Responses in Man
Author(s) -
COSÍO FRANCISCO G.,
LLOVET ALFREDO,
VIDAL JOSÉ M.
Publication year - 1983
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1983.tb06582.x
Subject(s) - medicine , atrial fibrillation , refractory period , cardiology , atrial flutter , effective refractory period , p wave , supraventricular arrhythmia , electrophysiology , anesthesia
We have studied the electrophysiological correlates of atrial repetitive responses, induced by single extrastimuli, in a group of 25 patients undergoing electrophysiologic studies for a variety of supraventricular and ventricular arrhythmias. The incidence of repetitive responses was not related to a previous history of atrial tachyarrhythmias. Repetitive responses were observed only when the extrastimulus elicited a significant intra‐atrial conduction delay, as measured from the extrastimulus artifact, to two or three points in the atria. This condition was fulfilled only when the basic atrial rhythm was paced, and it was also facilitated by increasing atrial rate, which shortened the atrial effective refractory period. Atrial pacing thus seemed to facilitate the production of atrial repetitive responses by both promoting intra‐atrial conduction delays during extrastimulation, and by shortening the atrial refractory period. Alrial repetitive responses are probably a nonspecific phenomenon, unrelated to a tendency towards atrial tachyarrhythmias; their mechanism is probably local re‐entry, related to slow conduction of impulses during incomplete repoiarization, and under favorable conditions they may precipitate atrial flutter or fibrillation in predisposed patients.