TY - JOUR
T1 - Ventricular Tachycardia and Ventricular Fibrillation in Patients with Short P‐R Intervals and Narrow QRS Complexes
AU - MYERBURG, ROBERT J.
AU - SUNG, RUEY J.
AU - CASTELLANOS, AGUSTIN
PY - 1979/11
Y1 - 1979/11
N2 - Eleven patients with short P-R intervals and narrow QRS complexes had ventricular tachycardia due to organic heart disease: mitral valve prolapse with mitral insufficiency (2 patients); alcoholic (?) cardiomyopathy (2 patients); and coronary artery disease (7 patients). Intracardiac studies showed short A-H intervals during sinus rhythm in all cases. The onset of ventricular fibrillation (which, to our knowledge, has not been observed in patients having short P-R and A-H intervals co-existing with narrow QRS complexes) was documented in 4 cases. Only 1 patient (with quinidine syncope) had been premedicated. In the 3 other patients the episodes of ventricular fibrillation appeared during bouts of atrial fibrillation with rapid ventricular rates which could have been an expression of the 'enhanced A-V conduction' that had been manifested in sinus beats by short P-R and A-H intervals. In clinical settings and physiological conditions proven to be hemodynamically unstable (such as transient ischemia or acute myocardial infarction) these rapid ventricular rates could have led to ventricular fibrillation; directly because of the R-on-T phenomenon, and/or indirectly due to decreased coronary perfusion. Ventricular tachycardia and ventricular fibrillation due to organic heart disease probably occur more often than suggested by the few reported cases in the literature. Its significance, however, has to be clarified by further prospective studies.
AB - Eleven patients with short P-R intervals and narrow QRS complexes had ventricular tachycardia due to organic heart disease: mitral valve prolapse with mitral insufficiency (2 patients); alcoholic (?) cardiomyopathy (2 patients); and coronary artery disease (7 patients). Intracardiac studies showed short A-H intervals during sinus rhythm in all cases. The onset of ventricular fibrillation (which, to our knowledge, has not been observed in patients having short P-R and A-H intervals co-existing with narrow QRS complexes) was documented in 4 cases. Only 1 patient (with quinidine syncope) had been premedicated. In the 3 other patients the episodes of ventricular fibrillation appeared during bouts of atrial fibrillation with rapid ventricular rates which could have been an expression of the 'enhanced A-V conduction' that had been manifested in sinus beats by short P-R and A-H intervals. In clinical settings and physiological conditions proven to be hemodynamically unstable (such as transient ischemia or acute myocardial infarction) these rapid ventricular rates could have led to ventricular fibrillation; directly because of the R-on-T phenomenon, and/or indirectly due to decreased coronary perfusion. Ventricular tachycardia and ventricular fibrillation due to organic heart disease probably occur more often than suggested by the few reported cases in the literature. Its significance, however, has to be clarified by further prospective studies.
KW - His bundle recording
KW - Lown‐Ganong‐Levine syndrome
KW - short P‐R interval
KW - sudden death
KW - ventricular fibrillation
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=0018631693&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0018631693&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.1979.tb04275.x
DO - 10.1111/j.1540-8159.1979.tb04275.x
M3 - Article
C2 - 95218
AN - SCOPUS:0018631693
VL - 2
SP - 568
EP - 578
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 6
ER -