The vulnerability of the right atrium. III. Electrophysiologic correlates of atrial vulnerability

70 patients were investigated by means of the atrial extrastimulus method at three different driving rates: 80, 100 and 120/min. At each rate the effective, the relative, the total and the functional refractory periods were measured. 30 patients who showed signs of atrial vulnerability at least one of the tested rates were included in the so called vulnerability group. The remaining 40 patients, who did not fulfill the criteria for atrial vulnerability, were included in the nonvulnerability group. When the two groups were compared to each other there were significant larger P waves (p less than 0.005), shorter effective refractory periods (p less than 0.001) and longer relative refractory periods (p less than 0.001) in the vulnerability group. With increasing driving rate there was an increased tendency to repletitive firing in the vulnerability group. The phenomenon of vulnerability correlated well with the rate-induced shortening of the effective and the lengthening of the relative refractory period. The above described phenomena are compatible with the concept of re-entry as the electrophysiologic mechanism of atrial vulnerability in man.