On the Genesis of the Absolute Ventricular Arrhythmia Associated with Atrial Fibrillation

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Abstract
Genetic factors in the formation of the long R-R interval in ventricular arrhythmia associated with atrial fibrillation were investigated in the isolated rabbit heart which was perfused using Langendorff's technique. The trans-membrane action potentials recorded from a single cell within the A-V node or within its vicinity were analyzed, and contiguous bipolar-lead electrograms simultaneously recorded from the right atrium and ventricle. Atrial fibrillation was induced by the combined application of acetylcholine solution and electrical stimulation. Atrial excitation was mainly blocked in the right atrium and in the anterior half of the A-V node. To clarify further the time-correlation between the right atrial electrogram and the A-V nodal responses, the pattern of atrio-ventricular conduction was studied by applying only the electrical stimulation at high frequency without acetylcholine. The conduction was mainly blocked in the same sites as in the above experiment and the pattern of the conduction block in Wenckebach rhythm was observed. The conduction block within the anterior half of the A-V node may be the most important factor in producing the long R-R interval in atrial fibrillation. It was shown that the pattern of the conduction block can be explained by the Wenckebach rhythm.