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A Model for Mechano-Electrical Feedback Effects on Atrial Flutter Interval Variability

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Abstract

Atrial flutter is a supraventricular arrhythmia, based on a reentrant mechanism mainly confined to the right atrium. Although atrial flutter is considered a regular rhythm, the atrial flutter interval (i.e., the time interval between consecutive atrial activation times) presents a spontaneous beat-to-beat variability, which has been suggested to be related to ventricular contraction and respiration by mechano-electrical feedback. This paper introduces a model to predict atrial activity during atrial flutter, based on the assumption that atrial flutter variability is related to the phase of the reentrant activity in the ventricular and respiratory cycles. Thus, atrial intervals are given as a superimposition of phase-dependent ventricular and respiratory modulations. The model includes a simplified atrioventricular (AV) branch with constant refractoriness and conduction times, which allows the prediction of ventricular activations in a closed-loop with atrial activations. Model predictions are quantitatively compared with real activation series recorded in 12 patients with atrial flutter. The model predicts the time course of both atrial and ventricular time series with a high beat-to-beat agreement, reproducing 96±8% and 86±21% of atrial and ventricular variability, respectively. The model also predicts the existence of phase-locking of atrial flutter intervals during periodic ventricular pacing and such results are observed in patients. These results constitute evidence in favor of mechano-electrical feedback as a major source of cycle length variability during atrial flutter.

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Authors and Affiliations

  1. Department of Physics, University of Trento, via Sommarive, 14, 38050, Povo, Trento, Italy

    Michela Masé

  2. Centre for Nonlinear Dynamics, Department of Physiology, McGill University, 3655 Prom. Sir William Osler, Montreal, Québec, Canada, H3G1Y6

    Leon Glass

  3. Department of Physics, University of Trento, and Fondazione Bruno Kessler, via Sommarive, 14, 38050, Povo, Trento, Italy

    Flavia Ravelli

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  1. Michela Masé
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  2. Leon Glass
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Correspondence to Michela Masé.

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Masé, M., Glass, L. & Ravelli, F. A Model for Mechano-Electrical Feedback Effects on Atrial Flutter Interval Variability. Bull. Math. Biol. 70, 1326–1347 (2008). https://doi.org/10.1007/s11538-008-9301-x

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