Mechanisms of atrioventricular junctional tachycardia

Barold, S. Serge; Coumel, Philippe

doi:10.1016/s0002-9149(77)80018-0

Cited by 82 publications

(1 citation statement)

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“…(1) The atrial activation sequence during the tachycardia proceeded from the atrium on the side of the bypass tract to the atrial septum and to the contralateral atrium.8 (2) During established tachycardia, spontaneous disappearance of bundle branch block ipsilateral to the bypass tract coincided with acceleration of the tachycardia rate, due to shortening of the RP interval. [8][9][10] The criteria for reciprocation confined to the AV junction included: (1) atrial activation sequence proceeding from the low atrial septum to both atria symmetrically;8 (2) no acceleration in the tachycardia rate with spontaneous disappearance of bundle branch block;9' 10 (3) consistent prolongation of the PR interval before the initiation of the tachycardia by premature atrial complexes;7' 11 and (4) ventriculoatrial conduction time less than or equal to 0 msec during PSVT.12 Table 1 is a summary of the case material, the tachycardia circuit, the rate range at 00 position, and the response of the tachycardia in each patient to phenylephrine, deep inspiration and the dependent body position. The tachycardia terminated in response to i.v.…”

Section: Criteria For Psvtmentioning

confidence: 99%

Effects of respiration and posture on paroxysmal supraventricular tachycardia.

Waxman¹,

Bonet²,

Finley³

et al. 1980

Circulation

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SUMMARY The capacity of deep inspiration and the dependent body position to terminate episodes of tachycardia was studied in 11 patients with recurrent paroxysmal supraventricular tachycardia (PSVT). In eight patients, a deep inspiration and a dependent position repeatedly terminated episodes of PSVT. Reasons for failure were found in the other three patients. A deep inspiration or assumption of a dependent position dramatically raised arterial blood pressure and terminated episodes of PSVT by reflexly increasing vagal drive. The magnitude of the rise in blood pressure was directly proportional to the depth of the inspired volume and to the extent of body dependency. The upright position attenuated the respiratory-induced increase in blood pressure and blocked PSVT termination. Likewise, vagal blockade with atropine did not affect the effects of respiration or dependent position on blood pressure but prevented termination of PSVT.PATIENTS with paroxysmal supraventricular tachycardia (PSVT) are encouraged to explore techniques to effect self-termination of the tachycardia." 2 Among the most common maneuvers are carotid sinus massage and the Valsalva maneuver.'-4 These methods are not always successful or especially easy to perform properly. Because some patients who suffer from PSVT report tachycardia termination from simpler maneuvers such as deep inspiration or a dependent body position we decided to investigate how these maneuvers might terminate PSVT. Our purpose was to define the mechanisms of action of these maneuvers and to delineate conditions in which they would be successful and those in which they might fail. Materials and MethodsEleven consecutive patients who suffered from PSVT for many years were selected for tlhis study (table 1). All had undergone extensive unsuccessful drug trials over a period of years. Characteristically, these patients had episodes of tachycardia that lasted for many hours without spontaneous termination and required multiple hospital visits for electroversion or treatment with potent vagal maneuvers. Although PSVT in all cases could be terminated by vagal techniques, none of these patients had ever tried to terminate PSVT by deep inspiration or by assuming a dependent body position. All patients were referred because they had requested a permanent atrial radio frequency pacemaker for self-termination of the arrhythmias.5' 6 In this context, we extensively explored the actions of respiration and body position on the tachycardia process.From the Department of Medicine, University of Toronto, and the Cardiovascular Unit, Toronto General Hospital, Toronto, Ontario, Canada. Supported in part by grants from the Ontario Heart Foundation and the Canadian Heart Foundation. The techniques used to explore the electrophysiologic character of PSVT and the suitability of a permanent radio frequency pacemaker to effect selfconversion have been extensively described."' 6Stimulating electrodes were placed in the right atrium and/or the right ventricle to initiate tachycardia. Aortic blood p...

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Section: Criteria For Psvtmentioning

confidence: 99%