Circus Movement within the AV Node as a Basis for Supraventricular Tachycardia as Shown by Multiple Microelectrode Recording in the Isolated Rabbit Heart

Abstract

Supraventricular tachycardia in an isolated rabbit heart preparation was repeatedly initiated and terminated by carefully timed atrial premature beats. Transmembrane action potentials of AV nodal cells were recorded simultaneously by a "brush electrode" consisting of 10 microelectrodes. Surface electrograms of atrium and His bundle were also recorded. The moments of activation of 54 different AV nodal cells, both during regular driving of the atrium and during tachycardia were ascertained. Premature atrial beats introduced during tachycardia would either "reset" the tachycardia or terminate it. The sequence of activation of the AV nodal cells when initiating tachycardia, during tachycardia itself, and when premature beats were interpolated during tachycardia warrant the conclusion that a circus movement in the AV node, based on functional longitudinal dissociation of the upper AV node, was the underlying mechanism of the arrhythmia.