943-14 Termination and Suppression of Experimental Atrial Flutter by Quinidine: Effects on Dispersion of Repolarization and Conduction

Abstract

Recent studies in our canine crush-injury (CI) model of atrial flutter (AFL) suggest that elimination of dispersion of repolarization is an important antiarrhythmic effect of newer class 3 antiarrhythmic drugs. However, the effects of class 1a antiarrhythmic drugs on dispersion of repolarization and its relation to termination and suppression of AFL have not been studied. Therefore, the effects of quinidine 10) were studied in 8 dogs, using a 56-electrode plaque placed over the CI to map activation patterns during AFL and its induction and termination, and to measure effective refractory periods (ERP) at all 56 electrodes and conduction velocity (CV) parallel to the CI, before and after 0 (10 mg/kg over 10 min, then 3 mg/kg/hr). Induction of AFL at baseline was due to unidirectional block below the CI. a terminated AFL in only 3 dogs, due to conduction block below the CI, occurring either abruptly or following premature eccentric activation of the reentry circuit. Sustained AFL was reinducible after a in 5 dogs, and nonsustained AFL in 3. Mean overall ERP increased 14% from 112 ± 11 msec at baseline to 128 ± 15 msec after a (p < 0.001). ERP was longer below CI than above (115 ± 10 ms vs 109 ± 10 ms, p < 0.001). and this difference was not eliminated by a (133 ± 14 ms vs 123 ± 14 ms, p < 0.001). Overall dispersion of ERP (9.9 ± 2.3 msec) was unchanged by a (1 0.0 ± 1.3 msec, p = NS). The number of adjacent electrodes with ERP difference ≥20 msec (14.4 ± 10.4) was also not changed by a (12.5 ± 7.9, P = NS). CV was slower below the CI than above at baseline (0.7 ± 0.1 vs 0.9 ± 0.1 mis, p < 0.001), and this difference was unchanged by a (0.6 ± 0.1 vs 0.8 ± 0.1 mis, p < 0.001). although CV was slowed overall(p < 0.01). a prolonged AFL cycle length 57% from 123 ± 12 to 198 ± 37 msec (p < 0.01). 1) Baseline dispersion of ERP and CV is important for initiating and sustaining AFL in this model. 2) The class 1a drug quinidine is relatively ineffective in terminating and suppressing AFL in this model, because it prolongs ERP less than AFL cycle length and it does not eliminate dispersion of ERP or CV