Jeffrey P. Moak, MD, Marco A. Mercader, MD, Dingchao He, MD, TK

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Newly created animal model of human postoperative junctional ectopic tachycardia Jeffrey P. Moak, MD, Marco A. Mercader, MD, Dingchao He, MD, TK. Susheel Kumar, MD, Gregory Trachiotis, MD, Robert McCarter, ScD, Richard A. Jonas, MD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 1, Pages 212-221 (July 2013) DOI: 10.1016/j.jtcvs.2012.08.068 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow diagram of experiment design and frequency of junctional ectopic tachycardia (JET) occurrence. AVN, Atrioventricular node; RA, right atrium; RBB, right bundle branch; RF, radiofrequency; SN, sinus node; TV, tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 212-221DOI: (10.1016/j.jtcvs.2012.08.068) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Sinus node (SN) dysfunction after removal of SN region and right atrial (RA) appendage during cardiopulmonary bypass. After removal of SN region and RA appendage, 1 of 4 cardiac rhythms ensued: A, sinus bradycardia to a cycle length of 950 ms; B, low RA rhythm at a cycle length of 625 ms; C, junctional rhythm with 1:1 ventriculoatrial (VA) conduction at a cycle length of 880 ms. His bundle electrogram [arrow] precedes local ventricular electrogram by 30 ms; and D, fascicular rhythm at a cycle length of 920 ms with 1:1 VA conduction. Note change in QRS morphology compared with that in panel C. The format of the tracings is blood pressure (BP), electrocardiogram 1 (ECG 1, lead 2), electrocardiogram 2 (ECG 2, lead 3), left atrial electrogram (Atrial ELG), and right ventricular electrogram (Vent ELG) or His bundle recording. Time axis is denoted at bottom of tracing. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 212-221DOI: (10.1016/j.jtcvs.2012.08.068) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Sinus node (SN) dysfunction after removal of SN region and right atrial (RA) appendage during cardiopulmonary bypass. After removal of SN region and RA appendage, 1 of 4 cardiac rhythms ensued: A, sinus bradycardia to a cycle length of 950 ms; B, low RA rhythm at a cycle length of 625 ms; C, junctional rhythm with 1:1 ventriculoatrial (VA) conduction at a cycle length of 880 ms. His bundle electrogram [arrow] precedes local ventricular electrogram by 30 ms; and D, fascicular rhythm at a cycle length of 920 ms with 1:1 VA conduction. Note change in QRS morphology compared with that in panel C. The format of the tracings is blood pressure (BP), electrocardiogram 1 (ECG 1, lead 2), electrocardiogram 2 (ECG 2, lead 3), left atrial electrogram (Atrial ELG), and right ventricular electrogram (Vent ELG) or His bundle recording. Time axis is denoted at bottom of tracing. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 212-221DOI: (10.1016/j.jtcvs.2012.08.068) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Junctional ectopic tachycardia (JET). A, JET (rate, 175 bpm) with ventriculoatrial (VA) dissociation at a cycle length of 345 ms. Arrows denote His bundle electrogram (ELG). Local His to ventricular electrogram measured 30 ms. B, Rapid atrial pacing (rate, 180 bpm) at a cycle length of 333 ms, re-established atrial paced rhythm with QRS morphology during atrial pacing identical to JET. His-ventricular electrogram interval during atrial pacing was identical to that of JET, proving its origin from atrioventricular (AV) junction. ECG, Electrocardiogram. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 212-221DOI: (10.1016/j.jtcvs.2012.08.068) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Fascicular tachycardia (FT) at a cycle length of 350 ms with ventriculoatrial (VA) dissociation (ventricular rate, 170 bpm). Note QRS morphology is similar to that in Figure 2, D. His to local ventricular electrogram measured 20 ms. His bundle electrogram identified by arrows. BP, Blood pressure; ECG, electrocardiogram; Atrial ELG, left atrial electrogram; Vent ELG, right ventricular electrogram. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 212-221DOI: (10.1016/j.jtcvs.2012.08.068) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions