AVNRT was associated with a higher frequency of 'shirt flapping' symptoms compared to AVRT (58.6% vs 43.8%, P<0.05) and higher mean left atrial pressure (19.4 vs 13.7 mmHg, P<0.05).
Observational (n=326)
Does variation in ventriculoatrial timing (AVNRT vs AVRT) modulate left atrial pressure and symptoms during supraventricular tachycardia?
Left atrial contractions against a closed AV valve during AVNRT increase left atrial pressure, explaining the higher frequency of 'shirt flapping' and 'neck pounding' symptoms compared to AVRT.
Absolute Event Rate: 58.6% vs 43.8%
p-value: p=<0.05
AIMS: 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. METHODS AND 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. CONCLUSION: "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 et al. (Thu,) conducted a observational in Reentrant supraventricular tachycardia (SVT) (n=326). Atrioventricular nodal reentry tachycardia (AVNRT) vs. Atrioventricular reentry tachycardia (AVRT) was evaluated on "Shirt flapping" symptom during tachycardia (p=<0.05). AVNRT was associated with a higher frequency of 'shirt flapping' symptoms compared to AVRT (58.6% vs 43.8%, P<0.05) and higher mean left atrial pressure (19.4 vs 13.7 mmHg, P<0.05).