Influence of ventriculoatrial timing on hemodynamics and symptoms during supraventricular tachycardia.
OBJECTIVE
Patients with reentrant supraventricular tachycardia (SVT) are often highly symptomatic and the mechanism of symptoms is not well understood. We hypothesized that variation in ventriculoatrial interval (QRS to P) modulates the left atrial pressure and symptoms during tachycardia.


RESULTS
Three hundred twenty-six patients awaiting electrophysiological study completed a questionnaire regarding "neck pounding" or "shirt flapping" during tachycardia. Mean left atrial pressure was measured during simulated atrioventricular reentry tachycardia (AVRT) and atrioventricular nodal reentry tachycardia (AVNRT) in 18 patients. Pulmonary venous flow reversal was assessed using transesophageal echocardiography in 12 dogs when pacing at 220 bpm with different VA delays (0 to 250 ms). "Shirt flapping" is present more often during AVNRT than during AVRT (58.6% vs 43.8%, respectively, P < 0.05). Simulated AVNRT is associated with higher left atrial pressure compared with AVRT (19.4 +/- 4.8 mmHg vs 13.7 +/- 3.9 mmHg, respectively, P < 0.05). In dogs, pulmonary venous flow reversal during atrial systole was observed with significantly decreasing amplitude as VA delays increased: 668 +/- 167% at 0 ms; 492 +/- 138% at 100 ms; 278 +/- 148% at 180/ms; and 134 +/- 91% at 220 ms.


CONCLUSIONS
"Shirt flapping" and "neck pounding" frequently occur during AVNRT. LA contractions during AV valve closure increase left atrial pressure and may explain differences in certain symptoms between AVNRT and AVRT.
Laurent
Gabriel
G
Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Ontario, Canada.
Leong-Poi
Howard
H
Mangat
Iqwal
I
Korley
Victoria
V
Pinter
Arnold
A
Hu
Xudong
X
So
Petsy Pui-Sze
PP
Ramadeen
Andrew
A
Dorian
Paul
P
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D017115:Catheter Ablation; D004285:Dogs; D017548:Echocardiography, Transesophageal; D004558:Electric Stimulation; D006321:Heart / Q000503:physiopathology*; D006325:Heart Atria; D006352:Heart Ventricles; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D011652:Pulmonary Circulation / Q000502:physiology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology*