title: Spontaneous atrial flutter in a chronic canine model of the modified Fontan operation.
abstract: OBJECTIVE
  This study sought to 1) establish whether the atrial flutter (AFL) inducible acutely occurs spontaneously in a chronic canine model, and 2) characterize any reentrant circuits present chronically.
  
  
  BACKGROUND
  We previously demonstrated, in an acute canine model of the modified Fontan operation, that the lateral tunnel suture line creates a sufficient electrophysiologic substrate for AFL.
  
  
  METHODS
  Using cardiopulmonary bypass, a suture line was placed through a right atriotomy in adult dogs (n = 7) to simulate the lateral tunnel of the Fontan operation. Holter recordings were made preoperatively, on the first postoperative day and 2, 4 and 6 weeks postoperatively. At 6 to 8 weeks, through bilateral ventriculotomies, 253-point unipolar atrial electrodes were inserted. AFL was induced using atrial burst pacing, and endocardial activation sequence maps were created.
  
  
  RESULTS
  Preoperatively, all dogs were in sinus rhythm. Spontaneous AFL occurred in all dogs postoperatively, with a mean (+/-SD) cycle length of 192 +/- 22 ms. At 6 weeks postoperatively, of six dogs that survived, four had intermittent AFL, and two had incessant AFL. At reoperation, sustained AFL was inducible in six of six dogs, with a mean cycle length of 194 +/- 17 ms. Activation sequence maps demonstrated conduction block at the lateral tunnel suture line, which facilitated unidirectional conduction critical for propagation of the reentrant circuit. The AFL circuit was similar to that observed acutely.
  
  
  CONCLUSIONS
  In a chronic canine model of the modified Fontan operation, the lateral tunnel suture line alone, in the absence of atrial stretch or hypertension, provides an electrophysiologic substrate that promotes spontaneous AFL. This model may be useful for evaluating various forms of treatment and prevention of AFL after the Fontan operation.
authors.affiliation: Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Gandhi
authors.forename: B I
authors.initials: BI
authors.lastname: Bromberg
authors.forename: M D
authors.initials: MD
authors.lastname: Rodefeld
authors.forename: R B
authors.initials: RB
authors.lastname: Schuessler
authors.forename: J P
authors.initials: JP
authors.lastname: Boineau
authors.forename: J L
authors.initials: JL
authors.lastname: Cox
authors.forename: C B
authors.initials: CB
authors.lastname: Huddleston
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000209:etiology; D001282:Atrial Flutter / Q000209:etiology* / Q000503:physiopathology; D002908:Chronic Disease; D004195:Disease Models, Animal; D004285:Dogs; D015716:Electrocardiography, Ambulatory; D004594:Electrophysiology; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D012086:Reoperation; D013537:Sutures / Q000009:adverse effects; D013613:Tachycardia, Ectopic Junctional / Q000209:etiology; D013997:Time Factors