P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism
BackgroundThe mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. Methods and ResultsWe prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis at...
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| Format: | Article |
| Language: | English |
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Wiley
2018-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008528 |
| _version_ | 1818328015844671488 |
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| author | Michael E. Field Paolo Donateo Nicola Bottoni Matteo Iori Michele Brignole Ryan T. Kipp Douglas E. Kopp Miguel A. Leal Lee L. Eckhardt Jennifer M. Wright Kathleen E. Walsh Richard L. Page Mohamed H. Hamdan |
| author_facet | Michael E. Field Paolo Donateo Nicola Bottoni Matteo Iori Michele Brignole Ryan T. Kipp Douglas E. Kopp Miguel A. Leal Lee L. Eckhardt Jennifer M. Wright Kathleen E. Walsh Richard L. Page Mohamed H. Hamdan |
| author_sort | Michael E. Field |
| collection | DOAJ |
| description | BackgroundThe mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. Methods and ResultsWe prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis atrial tachycardia (AT Group). P‐wave amplitude in lead II and PR interval were measured at a lower and higher heart rate (HR1 and HR2, respectively). P‐wave amplitude increased significantly with the increase in HR in the IST Group (0.16±0.07 mV at HR1=97±12 beats per minute versus 0.21±0.08 mV at HR2=135±21 beats per minute, P=0.001). The average increase in P‐wave amplitude in the IST Group was similar to the Isuprel Group (P=0.26). PR interval significantly shortened with the increases in HR in the IST Group (146±15 ms at HR1 versus 128±16 ms at HR2, P<0.001). A similar decrease in the PR interval was noted in the Isuprel Group (P=0.6). In contrast, patients in the atrial tachycardia Group experienced PR lengthening during atrial tachycardia when compared with baseline normal sinus rhythm (153±25 ms at HR1=78±17 beats per minute versus 179±29 ms at HR2=140±28 beats per minute, P<0.01). ConclusionsWe have shown that HR increases in patients with IST were associated with an increase in P‐wave amplitude in lead II and PR shortening similar to what is seen in healthy controls following isoproterenol infusion. The increase in P‐wave amplitude and absence of PR lengthening in IST support an extrinsic mechanism consistent with a state of sympatho‐excitation with cephalic shift in sinus node activation and enhanced atrioventricular nodal conduction. |
| first_indexed | 2024-12-13T12:25:27Z |
| format | Article |
| id | doaj.art-e797c1a077be491aba3673c13fa00fd7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:25:27Z |
| publishDate | 2018-05-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e797c1a077be491aba3673c13fa00fd72022-12-21T23:46:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-05-017910.1161/JAHA.118.008528P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central MechanismMichael E. Field0Paolo Donateo1Nicola Bottoni2Matteo Iori3Michele Brignole4Ryan T. Kipp5Douglas E. Kopp6Miguel A. Leal7Lee L. Eckhardt8Jennifer M. Wright9Kathleen E. Walsh10Richard L. Page11Mohamed H. Hamdan12Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDepartment of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, ItalyDepartment of Cardiology, Arrhythmology Centre, Arcispedale S. Maria Nuova, Reggio Emilia, ItalyDepartment of Cardiology, Arrhythmology Centre, Arcispedale S. Maria Nuova, Reggio Emilia, ItalyDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WIBackgroundThe mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. Methods and ResultsWe prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis atrial tachycardia (AT Group). P‐wave amplitude in lead II and PR interval were measured at a lower and higher heart rate (HR1 and HR2, respectively). P‐wave amplitude increased significantly with the increase in HR in the IST Group (0.16±0.07 mV at HR1=97±12 beats per minute versus 0.21±0.08 mV at HR2=135±21 beats per minute, P=0.001). The average increase in P‐wave amplitude in the IST Group was similar to the Isuprel Group (P=0.26). PR interval significantly shortened with the increases in HR in the IST Group (146±15 ms at HR1 versus 128±16 ms at HR2, P<0.001). A similar decrease in the PR interval was noted in the Isuprel Group (P=0.6). In contrast, patients in the atrial tachycardia Group experienced PR lengthening during atrial tachycardia when compared with baseline normal sinus rhythm (153±25 ms at HR1=78±17 beats per minute versus 179±29 ms at HR2=140±28 beats per minute, P<0.01). ConclusionsWe have shown that HR increases in patients with IST were associated with an increase in P‐wave amplitude in lead II and PR shortening similar to what is seen in healthy controls following isoproterenol infusion. The increase in P‐wave amplitude and absence of PR lengthening in IST support an extrinsic mechanism consistent with a state of sympatho‐excitation with cephalic shift in sinus node activation and enhanced atrioventricular nodal conduction.https://www.ahajournals.org/doi/10.1161/JAHA.118.008528atrial tachycardiaatrio‐ventricular conductioninappropriate sinus tachycardia |
| spellingShingle | Michael E. Field Paolo Donateo Nicola Bottoni Matteo Iori Michele Brignole Ryan T. Kipp Douglas E. Kopp Miguel A. Leal Lee L. Eckhardt Jennifer M. Wright Kathleen E. Walsh Richard L. Page Mohamed H. Hamdan P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial tachycardia atrio‐ventricular conduction inappropriate sinus tachycardia |
| title | P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism |
| title_full | P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism |
| title_fullStr | P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism |
| title_full_unstemmed | P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism |
| title_short | P‐Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism |
| title_sort | p wave amplitude and pr changes in patients with inappropriate sinus tachycardia findings supportive of a central mechanism |
| topic | atrial tachycardia atrio‐ventricular conduction inappropriate sinus tachycardia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008528 |
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